2.Serum sodium will be very low (< 135). Why? 3.Specific gravity of urine will be high. Why? 4. (Pt suffers from symptoms of a dilutional hyponatremia)
Anterior Pituitary Disorders/ TUMORS • TUMORS are the most common cause of primary (anterior) pituitary disorders. • The most common manifestation is headache. …visual disturbances due to the expansion of the mass on the optic nerve. • The pituitary hormones may hyper secrete or hypo secrete hormones.
Anterior Pituitary Disorders/ TUMORS TREATMENT • Transphenoidal microsurgery is an approach through the mouth, and along the floor of the nasal passage. • The dura mater is incised and the abnormal tissue is identified and removed. To prevent CSF leakage, the dura mater may be patched with a piece of fascia, or muscle taken from the leg.
Transphenoidal microsurgery • Pre-op • Teach- Can’t sneeze, blow nose, cough, bend over.
TREATMENT Transphenoidal microsurgery • Post-op ASSESS neoro staus q1h x 24h , then q4 • The nose is packed and a gauze dressing or sling is worn under the • Prophylactic antibiotics o Diabetes Insipidus o The patient may need lifelong hormone replacement therapy. o Monitor nasal drainage for HALO sign
TREATMENT Transphenoidal microsurgery o Post-op nursing care is aimed at measures that reduce ICP. o Patient’s suture line is at the junction of the gums and upper lip. Patients must avoid trauma to the suture line- (Use a foam toothette, instead of a bristled brush.)
Adrenocortical Insufficiency=Addison’s disease • Clinical Manifestations : Skin color changes occur: hyperpigmentation due to uninhibited ACTH release from the anterior pituitary. Muscle weakness& fatigue Hypotension Nausea, vomiting, weight loss, diarrhea Loss of hair Hypoglycemia •
Adrenal crisis (Addisonian crisis, acute adrenal insufficiency) • A sudden decrease or absence of adrenocortical hormones. • Often occurs when a person is exposed to major stresses, such as trauma, infection, surgery, or major illness. (May be due to hemorrhage, infection, or infarction within the adrenal gland itself)
Adrenal crisis (Addisonian crisis, acute adrenal insufficiency) • Clinical Manifestations: Severe dehydration Weakness Confusion Decreased sodium reabsorption, and increased potassium retention Circulatory deterioration Hypovolemic shock: sodium, water, and chloride are excreted in great amounts Cardiac dysrhythmias •
Adrenal crisis (Addisonian crisis, acute adrenal insufficiency) • Management: Fluid replacement: Isotonic dextrose and saline Parenteral Dextrose IV Hydrocortisone Monitor serum glucose, electrolytes Hemodynamic and cardiac monitoring • Eventual hormone replacement
Adrenal Medulla - Pheochromocytoma The function of the adrenal medulla is to produce and secrete catecholamines. Epinephrine -80% (heart, BMR) Norepinephrine -20% (also secreted by the sympathetic nerve terminals; arteriole vasoconstriction)
Pheochromocytoma They are rare adrenal medullary tumors whose
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- Winter '20
- Adrenal insufficiency, Cushing, Pituitary disorders, ADH ADH ADH