EXAM 3 MED SURG II FOCUS POINTS
Posterior Pituitary
●
stores and releases ADH; is a potent vasoconstrictor
ADDISONS
●
TOO LITTLE CORTISOL
●
Adrenal tissue is destroyed by antibodies
●
Symptoms
○
Not evident until 90% of the adrenal cortex is destroyed
○
Often pt is in advanced stages before DX is made
○
Biggest symptom: Bronze pigmentation of the skin
■
Hypotension, hyperkalemia (>145), muscle weakness
●
Diet
○
Increase sodium (especially in hot weather d/t diaphoresis)
○
Limit potassium
○
Increase fluid intake
●
Diagnostics
○
Hyperkalemia (>145)
●
Addison’s Crisis
○
Acute adrenal insufficiency, pt goes into this when dx isn’t managed
properly
○
Priority is to treat pt’s hypoglycemia with 5% dextrose and 0.9%
normal saline together as a bolus (gets pt’s BP and sugars UP)
●
RN MGT
○
Hypotension d/t hypovolemia (FVD) is a major concern
■
Tell pt to keep legs elevated when lying/sitting and to increase
fluid intake
●
Treatment
○
Glucocorticoids / corticosteroids
■
DON'T TAPER THESE
■
Mimic action of cortisol / aldosterone which pt is deficient in
CUSHING’S DISEASE
●
TOO MUCH CORTISOL
●
Caused by excessive corticosteroid administration
○
Too high of doses of prednisone, hydrocortisone
○
Leads to development of a tumor on adrenal gland which secretes
ACTH (aka cortisol)
●
Symptoms
○
Hirsutism - excessive growth of dark, coarse hair in a male-like pattern
(in females)
●
Diet
○
Pts at high risk for muscle wasting and osteoporosis
○
Need to be on a high protein, high calcium, high vitamin D diet to
prevent risks from occurring
■
Cheese, Milk - good dietary choices for these pts ●
Diagnostics
○
24-Hour Urine for Free Cortisol (80-120mcg per 24 hr is normal)
○
Above 120 = Cushings
○
If borderlining around 120, do a low-dose dexamethasone suppression
test
●
Medications
○
Ketoconazole
■
Take with a full glass of water or acidic juice (fruit juice) and
food
○
Antacids and contraindicated, enhances absorption
●
Surgical MGT
○
Adrenalectomy - removal of tumor or pituitary gland
■
Pre-operative care
●
Control blood sugar levels
●
Stabilize BP
●
Correct hypokalemia
●
High protein diet
●
Teach ab post-op care
●
Anticipate NG, CATH, IV placement
■
Post-operative care
●
AM Urine to check cortisol levels at the same time each
morning in order to evaluate effectiveness of surgery
●
Education
○
Can’t stop taking corticosteroids abruptly or end up with adrenal
insufficiency, MUST TAPER, this results in extreme hypotension (80/40)
and hypoglycemia
ACROMEGALY
●
Excess GH in adults
●
Pt’s can develop diabetes (GH antagonizes action of insulin) , watch for
symptoms (polyuria, polydipsia, polyphagia) which are an immediate concern
GIGANTISM
●
Excess GH in children
●
Abnormally large growth d/t excess GH in childhood before epiphyseal plates
close
●
Involves mainly long bones, children can grow up to 8 feet tall and weight
over 300 lb
ACROMEGALY / GIGANTISM
●
Medications
○
Octreotide - given IM, into intragluteal muscle, lowers GH levels
●
Surgical MGT
○
Transsphenoidal microsurgery
■
Removal of GH secreting tumor or pituitary gland
■
Go in nasally or through upper lip
■
Post-operative care
Posterior Pituitary
●
stores and releases ADH; is a potent vasoconstrictor
ADDISONS
●
TOO LITTLE CORTISOL
●
Adrenal tissue is destroyed by antibodies
●
Symptoms
○
Not evident until 90% of the adrenal cortex is destroyed
○
Often pt is in advanced stages before DX is made
○
Biggest symptom: Bronze pigmentation of the skin
■
Hypotension, hyperkalemia (>145), muscle weakness
●
Diet
○
Increase sodium (especially in hot weather d/t diaphoresis)
○
Limit potassium
○
Increase fluid intake
●
Diagnostics
○
Hyperkalemia (>145)
●
Addison’s Crisis
○
Acute adrenal insufficiency, pt goes into this when dx isn’t managed
properly
○
Priority is to treat pt’s hypoglycemia with 5% dextrose and 0.9%
normal saline together as a bolus (gets pt’s BP and sugars UP)
●
RN MGT
○
Hypotension d/t hypovolemia (FVD) is a major concern
■
Tell pt to keep legs elevated when lying/sitting and to increase
fluid intake
●
Treatment
○
Glucocorticoids / corticosteroids
■
DON'T TAPER THESE
■
Mimic action of cortisol / aldosterone which pt is deficient in
CUSHING’S DISEASE
●
TOO MUCH CORTISOL
●
Caused by excessive corticosteroid administration
○
Too high of doses of prednisone, hydrocortisone
○
Leads to development of a tumor on adrenal gland which secretes
ACTH (aka cortisol)
●
Symptoms
○
Hirsutism - excessive growth of dark, coarse hair in a male-like pattern
(in females)
●
Diet
○
Pts at high risk for muscle wasting and osteoporosis
○
Need to be on a high protein, high calcium, high vitamin D diet to
prevent risks from occurring
■
Cheese, Milk - good dietary choices for these pts ●
Diagnostics
○
24-Hour Urine for Free Cortisol (80-120mcg per 24 hr is normal)
○
Above 120 = Cushings
○
If borderlining around 120, do a low-dose dexamethasone suppression
test
●
Medications
○
Ketoconazole
■
Take with a full glass of water or acidic juice (fruit juice) and
food
○
Antacids and contraindicated, enhances absorption
●
Surgical MGT
○
Adrenalectomy - removal of tumor or pituitary gland
■
Pre-operative care
●
Control blood sugar levels
●
Stabilize BP
●
Correct hypokalemia
●
High protein diet
●
Teach ab post-op care
●
Anticipate NG, CATH, IV placement
■
Post-operative care
●
AM Urine to check cortisol levels at the same time each
morning in order to evaluate effectiveness of surgery
●
Education
○
Can’t stop taking corticosteroids abruptly or end up with adrenal
insufficiency, MUST TAPER, this results in extreme hypotension (80/40)
and hypoglycemia
ACROMEGALY
●
Excess GH in adults
●
Pt’s can develop diabetes (GH antagonizes action of insulin) , watch for
symptoms (polyuria, polydipsia, polyphagia) which are an immediate concern
GIGANTISM
●
Excess GH in children
●
Abnormally large growth d/t excess GH in childhood before epiphyseal plates
close
●
Involves mainly long bones, children can grow up to 8 feet tall and weight
over 300 lb
ACROMEGALY / GIGANTISM
●
Medications
○
Octreotide - given IM, into intragluteal muscle, lowers GH levels
●
Surgical MGT
○
Transsphenoidal microsurgery
■
Removal of GH secreting tumor or pituitary gland
■
Go in nasally or through upper lip
■
Post-operative care
