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Endocrine

Endocrine. Pituitary gland 5-2. Hyperpituitarism. What two hormones are affected with hyperpituitarism? GH ADH. Hyperpituitarism. h GH Adult Acromegaly Child Gigantism h ADH Syndrome of Inappropriate Antidiuretic Hormone (SIADH).

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Endocrine

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  1. Endocrine Pituitary gland 5-2

  2. Hyperpituitarism • What two hormones are affected with hyperpituitarism? • GH • ADH

  3. Hyperpituitarism • hGH • Adult • Acromegaly • Child • Gigantism • h ADH • Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

  4. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) • Definition • Excess ADH • What does ADH do? • Causes kidneys to reabsorb water  • i urine output  • h fluid volume

  5. SIADH - Etiology • #1 • Lung CA • Other CA • COPD

  6. SIADH – S&S • Water retention • Edema • Wt gain • Urine • Concentrated • Sp. gravity • h

  7. SIADH: S&S • Hyponatremia • < 130 • Normal 135-145 meq/dl • Muscle cramps • Weakness • Serum Osmolality • Decreased • Blood leaks into brain  • Brain swelling  • Lethargy, seizures, coma • Deathmosis

  8. SIADH: Medical treatment • Tx underlying disorder • Resolve fluid volume excess • Restrict H2O • Promote H20 voiding • Sodium replacement

  9. SIADH: Rx Furosemide (Lasix) • Action • Enhance diuresis • Nrs consideration • P Fluid & electrolyte panels • I&O • VS • q day wt

  10. SIADH: Rx Demeclcycline hydrochloride (Declomycin) • Action • Enhances Na+ retention Fludrocortisone (Florinef) • Action • Enhances Na+ retention • Nrs. Consideration • Fluid restriction

  11. SIADH: Nrs. Dx • Fluid Volume Excess

  12. Hypopituitarism • Definition • i secretion of pituitary hormones • Etiology • #1 Tumor • Congenital defects • Pituitary infarction • Pituitary surgery • Pituitary CA

  13. Hypopituitarism • Clinical manifestations are slow to appear & are not really apparent until 75% of the pituitary is destroyed

  14. Hypopituitarism: • Primary • Trouble w/ the Pituitary • i Pituitary hormone • Secondary • Trouble somewhere else (not pituitary)  • i pituitary hormone • Usually hypothalmus

  15. Hypopituitarism: Growth hormone • Dx: • Dwarfism • S&S (i GH) • Apparent by 6 months • Delayed puberty • Growth rate ½ unto 4 ft. • Body proportions = normal • Accel. aging

  16. Hypopituitarism: FSH & LH • Female • Amenorrhea • Infertility • i libido • Breast atrophy • Male • Weakness • Impotence • i libido • Testicles soften & shrink

  17. Hypopituitarism: TSH • Severe growth retardation (even w/ tx) • S&S (i TSH) • Think slow • Lethargy • Bradycardia • Slow thoughts • Cold intolerance

  18. Hypopituitarism: ACTH • ACTH • Handle stress • S&S (i ACTH) • Fatigue • Wt loss • Anorexia • Depigmentation of skin • V/S when stressed • Fever • Hypotension

  19. Hypopituitarism: Prolactin • S&S (i prolactin) • Absent postpartum lactation

  20. Hypopituitarism: Simmond’s Disease • AKA • Panhypopituitarism • Definition • Total absence of all pit. hormones • Etiology • Surgery • Infection • Injury • Tumor

  21. Hypopituitarism: Simmond’s Disease • Clinical Manifestations • Wt loss • Gen. debility • Weak • i libido • Cold intolerance • Tx • Administration of all Pit. hormones

  22. Hypopituitarism: ADH • Dx: • Diabetes Insipidus • Definition • i ADH • Vasopressin

  23. Hypopituitarism: Diabetes Insipidus • Etiology • Injury to pituitary or hypothalamus • Pregnancy • Medication use • Lithium • Lasix • Kidney not respond to ADH

  24. Hypopituitarism: Diabetes Insipidus • Clinical manifestations • Polyuria • Sp. gravity of urine • i • Serum osmolality • h • Na+ levels • h • Hypernatremia • > 145

  25. Hypopituitarism: Diabetes Insipidus • Extreme thirst • Cold beverages • Wt. loss • Dizziness • Constipation • Fatigue

  26. Hypopituitarism: Diabetes Insipidus • Complications • Hypovolemia • Circulatory collapse • Unconsciousness • CNS damage • Prognosis • OK (w/ fluid)

  27. Hypopituitarism: Diabetes Insipidus • Medical treatment • Fluid replacement • Replace hormone • ADH/Vasopressin • Fix underlying cause

  28. Hypopituitarism: Diabetes InsipidusRx Desmopressin acetate (Stimate) • Action • Synthetic ADH • Route • Parenteral • Nasal • Nrs. Considerations • Clear nasal passage

  29. Hypopituitarism: Diabetes InsipidusRx Vasopressine (Pitressin) • Action • ADH hormone • Route • Parenteral • Nasal • S/E • Increased BP

  30. Hypopituitarism: Diabetes InsipidusRx • If D.I. is due to kidney • More ADH not help

  31. Hypopituitarism: Diabetes Insipidus • Nrs. Dx • Fluid Volume Deficit • Nursing interventions • I&O • P Electrolytes • h Na+ intake • VS

  32. Mrs. Waterfall • What would the name of this disorder be? • 2. What is causing the elevated ADH levels? 3. What other lab values would coincide with this disorder?

  33. Mrs. Waterfall 4. What nursing diagnosis is appropriate for this disorder? 5. What interventions would you as a nurse start with this diagnosis? 6. What medications would you expect the doctor to order?

  34. Ms. Pealot • Why is Ms. Pealot not started on insulin? • 2. What hormonal irregularity causes diabetes insipidus? 3. What can cause diabetes insipidus? 4. Besides polyuria & polydipsia, what other clinical manifestations would you expect?

  35. 5. What dx tests would confirm the dx of diabetes insipidus? 6. What nrs. dx would best apply to Ms. Pealot? 7. What nrs. interventions would you implement? 8. What doctors order would you expect to see?

  36. Pituitary Tumors • Definitions • Anterior Pit. • Clinical Manifestations • H/A • Visual problems • Personality changes • Dementation • S&S of hypopituitarism

  37. Pituitary Tumors • Medical treatment • Remove tumor • Radiation • Cryohypophysectomy • Rx • Hormone replacement

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