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pituitary

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pituitary

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    1. Pituitary Hypophysis = Pituitary

    3. Pituitary

    4. Anterior Pituitary Disorders

    5. Hypopituitarism Etiology and risk factors Invasion- pituitary tumors, CNS tumors, carotid aneurysm?most common Infarction-postpartum necrosis (Sheehans syndrome), pituitary apoplexy Infiltration-sarcoidosis, hemochromatosis Injury-head trauma, child abuse Immunologic-lymphocytic hypophysitis Iatrogenic-surgery, radiation therapy Infectious-mycoses, tuberculosis, syphilis Idiopathic-familial Isolated-deficiency of an anterior pituitary hormone (eg. GH, LH, FSH, TSH, ACTH-LPH, prolactin

    6. Hypopituitarism Pathophysiology- deficiency of one or more of the hormones produced by the anterior lobe of the pituitary Clinical manifestations Short stature Sexual and reproductive disorders Hypothyroidism Secondary adrenocortical insufficiency Prolactin insufficiency Medical management- Treatment of choice= removal of causative factor and permanent replacement of the target hormones Nursing management- focus on care of target organ

    7. Hyperpituitary Syndromes associated Cushings Syndrome Acromegaly Amenorrhea Galactorrhea Hyperthyroidism Hypergonadism (males)

    8. Cushings Syndrome

    9. Acromegaly

    10. Gigantism

    11. Hyperpituitary/hyperprolactinemia Etiology and risk factors Pathophysiology Overproduction of porlactin and growth hormone by the adenomas Clinical manifestations Abnormal growth patterns, galactorrhea Medical management-surgery Nursing management- emotional support, comfort throughout preoperative period, physical and neurological assessment

    12. Hyperpituitarism Treatment of choice

    14. TranssphenoidalHypophysectomy Frequent oral hygeine is needed- no toothbrushing for 2 wks- use lubricant on lips Avoid coughing, sneezing, or activities that cause a rise in intracranial pressure-monitor ICP

    15. TranssphenoidalHypophysectomy Monitor UOP for signs of Diabetes Insipidus: UOP greater than 200 ml/hr with SG less than 1.005-monitor for hormonal insufficiencies Monitor nasal drainage for CSF leakage-may discern by testing with dipstick for presence of glucose (should be negative if nasal drainage)

    16. Transsphenoidal Hypophysectomy Monitor for meningitis Temperature elevation Severe headache Irritability Nuchal rigidity

    17. Transsphenoidal Hypophysectomy Monitor for adrenal insufficiency/ acute adrenal insufficiency/Addisonian Crisis

    18. Other Disorders Posterior lobe (neurophyseal disorders) ADH deficiency aka diabetes insipidus Excess ADH = SIADH or syndrome of inappropriate ADH SIADH seen with lung cancer, head injuries, cranial surgery, pituitary tumors, encephalitis, poliomyelitis, myxedema

    19. Posterior lobe (neurophyseal disorders) Sexual disturbances excess secretion of LH/FSH from pituitary tumors can produce sexual precocity in children Amenorrhea or galactorrhea in women Bromocriptine, a dopamine agonist, inhibits prolactin secretion

    20. Gondal disorders Testicular dysfunction (secondary to a disorder of hypothalamic-pituitary function- a gonadatropin deficiency, Kallmanns syndrome, abnormal maturation with midline defects: cleft lip/palate, color blindness, anosmia, ataxia)

    21. References Ackley, B. & Ladewig, G. (2006). Nursing Diagnosis Handbook: A Guide to Planning Care, (7th ed.) St. Louis: Mosby Black, J. & Hawks, J (2005). Medical-Surgical Nursing: Clinical Management for Positive Outcomes, (7th ed.), Philadelphia: W.B. Saunders Hockenberry, M. (2003). Whaley & Wongs Nursing Care of Infants and Children, (7th ed)., St. Louis: Mosby Karch, A. (2006). Focus on Nursing Pharmacology (3rd ed.)., Philadelphia: Lippincott Williams, S. & Schlenker, E. (2003). Essentials of Nutrition and Diet Therapy, (8th ed.), St. Louis: Mosby