PITUITARY Diabetes Insipidus (pituitary problem caused by stroke/trauma) Lack of ADH-> Lack of Water in the system(hypotension)-> over excretion

n of bodily fluids (polyuria) -> high urine concentration usually less than 1.010. Lack of water in the system -> Hypernatremia (because sodium level is higher than water content) Medications: Chlorpropamide (Diabenese)- oral diabetic agent that control blood sugar levels in diabetic clients And by producing insulin from the pancreas. Carbamazepine- It is an anticonvulsant that rectifies tremors and neurological problems Desmopressin- an anti-diuretic to promote water retention in the body Demopressin acetate- an anti-diuretic (injection, intra-nasally or orally) IV fluids with isotonic saline Tx: 1) 2) 3) 4) Cardio assessment then neurological assessment Provide safe environment due to hypotension Take in fluids , monitor specific gravity of urine Wear a medic-alert bracelet

SIADH (over-secretion of ADH hormone caused by trauma, stroke, lungs/pancreas, medications, stress)> too much water in the body system-> hyponatremia-> water in the body and head causes intracranial pressure in the head and on the optic nerves-> lowered LOC-> lowered mental status-> lack of urine-> water retention->wt gain->jugular vein distention-> hypertension from too much fluids-> too much fluids cause tachycardia-> crackles Medications - IV hypertonic saline solution to replace electrolytes (do not give water because it can lead to water intoxication) - Demeclocycline (Declomycin) an amnioglyside for antibiotics - Diuretics - Potassium supplements Tx: 1) 2) 3) 4) 5) Cardiac/neuro monitor Safe environment I&O + daily weight+ urine tests Fluid restriction Low sodium diet

HYPOPITUITARISM Hypo-secretion of pituitary hormones : GH- Growth Hormone- too little causes reduced cardiac output, obesity and lack of growth tissues ADH- anti-diuretic hormone- helps retain water in the body- too little causes hypovolemia and low blood pressure hypernatremia too little water causes lowered cardiac output TSH- thyroid stimulating hormone- helps with metabolism- too little causes obesity

Gonadotropic- sex cells lowered may cause sexual dysfunction ACTH: Addisons disease Symptoms of pituitary tumors: headaches and visual defects since pituitary is near the eyes HYPERPITUITARISM Hyper-secretion of pituitary hormones : GH- Growth Hormone- Acromegaly ADH- anti-diuretic hormone- SIADH TSH- thyroid stimulating hormone- helps with metabolism- hyperthyroidism Gonadotropic- sex cells too sexual ACTH- Cushings Disease Symptoms of pituitary tumors: headaches and visual defects since pituitary is near the eyes Interventions1) Emotional support 2) Frequent skin care 3) Joint pain relief 4) Radiation of the pituitary gland if prescribed 5) SURGERY: HYPOPHYSECTOMY: pituitary adenctomy, transphenoidal pituitary surgery): Removal of pituitary tumor via craniotomy or transsphenoidal approach (usually trans because it has less complications) a. Complications for craniotomy- increased ICP, bleeding, meningitis and hypopituitarism b. Complications for trans- cerebrospinal fluid leak, infection and hypopituitarism Post op- 1) monitor airway first!!! Then for NASAL drainage. Leakage of nasal drainage may indicate cerebrospinal fluid leakage. Check for glucose in drainage ) 2) elevate head of the bed 3) avoid sneezing, coughing and blowing nose 4) monitor for diabetes insipidus/siadh 5) intake/output 6) glucocorticoids to replace pituitary hormones 7) meds Addison Disease- lack of cortisol Low cortisol means low immune system. MONITOR WHITE BLOOD CELLS. USUALLY LOW-> watch out for people with infections!! Monitor blood glucose too due to low cortisol usually it is low in sugar hence hypoglycemia. Low sodium too due to low cortisol= hyponatremia. Always observe for ADDISONIAN CRISIS which is precipitated by stress, infection, trauma and surgery. Symptoms: Hypoglycemia, hyponatremia, low cortisol= weight loss, menstrual changes, bowel disturbances, weakness due to hypoglycemia , BRONZE SKIN , postural hypotension. Warnings: AVOID- OTC MEDICATIONS! , STRESSFUL SITUATIONS! Wear a medic-alert bracelet Medications- hydrocortisone sodium succinate (glucocorticoid) hormonal therapy

ADDISONIAN CRISIS! A life threatening situation that is caused by a severe lack of adrenal cortex hormone- usually immediately triggered by trauma, stress, infection and surgery Symptoms: Severe leg abdominal, leg and back pain Severe hypotension, severe hypoglycemia, severe headache, very weak Confusion Shock InterventionsHydrocortisone sodium succinate (sulu-cortef) first action! Monitor blood pressure! Neurological status for confusion Intake and output Lab values- SODIUM, POTASSIUM, BLOOD SUGAR PROTECT CLIENT FROM INFECTION- and good environment Cushing disease- overproduction of cortisol (more sodium, more water retaining, more weight in body) from increased ACTH-> hypernatremia, hyperglycemia, weakness, purple striae on abdomen and upper thigh, easily bruises, hypertension, truncal obesity(in the belly), moon face, bell bump, hirsutism (man characteristics on females) Cushing syndrome- overproduction of cortisol not caused by ACTH but an outside factor such as medications Interventions are same as hyperpituitirism !- hypophysectomy surgery can be a treatment ; chemotherapy THYROID GLAND DISORDERS Thyroid- controls oxygen consumption, metabolism, calcium absorption, contractility of the heart LOW thyroid = high tsh, t3, t 4 Too low of thyroid is called mexydema in adults and Cretinism in infants Symptoms are: Hypoactive bowel constipation Low heart rate Low blood pressure Low oxygen Low temperature Low sodium Edema, weight gain, round face Increased levels of thyroid stimulating hormones Signs of hypothyroidism in an infant 1) Decreased respiration 2) Cyanosis (from lack of oxygen supply) 3) Hoarse cry

4) Poor feeding 5) Mental retardation 6) Elevations of thyroid stimulating hormone Medications 1) SYNTHROID- thyroid replacement . must check pulse and make sure its not above 100 in adult or above 120 in infants. Interventions Warm environment because theyre usually cold High fiber diet to combat constipation Mxydema coma may happen! Sx: hypotension, hypoglycemia, hyponatremia, edema, coma If it happens: first thing to do is airway maintenance. Then institute aspiration precautions Normal/hypertonic saline is prescribed Synthoird immediately Glucose administration to combat low blood glucose monitor low glucose assess temperature! Make sure it rises up Monitor BP make sure it goes up keep the client warm! Due to low temp mental status Hyperthyroidism Graves Disease -low tsh, elevated t 3 and t 4 hormones Increased: Metabolism, blood pressure, thyroid tissues (goiter), tremors, pulse, a-fib, insomnia, EXOPTHALMOS (BULGING EYES), weight loss , high temp, heat intolerance , diaphoresis, increased bowel movements, smooth soft skin and hair , irritability, agitation and mood swings Medications: Propylthiouracil- treats graves disease Tapazole- Treats hyperthyroidism Radioactive Iodine- destroys some of the overgrowth of thyroid gland Propranolol- treating tachycardia Interventions - Adequate rest - Cool environment - Weight daily - High calorie diet Thyroidectomy- removing part of the thyroid to reduce hyperthyroidism. Client is given LUGOL solution which is an iodine preparation - Assess for hyperglycemia! - Postoperative Teaching : Teach coughing/deep breathing exercises- how to support the neck when coughing and moving - Postoperative procedures: assess airway!! (check for swelling)- check for dysphagia, respiratory obstruction, high pitched voice, stridor, restlessness are all signs of complication check for bleeding,

Check for hypocalcemia which can be caused by trauma to parathyroid gland (tetany, nervousness irritability ) give calcium gluconate if thats the case - have a trach set ready , oxygen and suction because usually theres swelling. Signs to use it is: changes in voices , and signs of laryngeal stridor. - Position: semi fowlers position to support the neck and keep the head and neck as straight as possible Thyroid Storm: Life-threatening condition from infection or surgery/stress Sx: hypertension, ELEVATED Temperature, tachycardia, N/V,D, tremors, irritability, delirium, coma Treatment: anti-thyroid medications (Tapazole, propylthiouracil), beta blockers to lower pulse, glucocorticoids to reduce inflammation, iodines, acetaminophen (its a nonsalicylate and doesnt produce free thyroid) Parathyroid- controls calcium and phosphorous regulation and consists of 4 glands on the thyroid gland Hypoparathyroidism- insufficient parathormone low calcium and high phosphorous= leading to neuro hyperexcitability, depression, carpopedal spasms, scary hair, cataracts, changes in teeth, seizures, changes in EKG (prolonged QT intervals and inverted t waves)