LEARNING GUIDE FOR ADRENAL GLANDS by 56lqR8b2

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									             LEARNING GUIDE-Adrenal/Pituitary Dysfunction 2010
                              Endocrine

Questions 1-3 review only
(p. 1239 text)

1. The pituitary gland (master gland) also known as the ________ is located
beneath the ___________; has 2 parts, anterior pituitary or ________ and the
posterior pituitary or ________. The anterior pituitary is glandular tissue: the
posterior pituitary is composed of _______ tissue and is an extension of the
______________.

The anterior pituitary has several types of endocrine cells and secretes at least six
major hormones; posterior pituitary secretes two major hormones produced in the
_______.

Several hormones secreted by anterior pituitary control secretion of hormones in
other organs are known as ______ hormones. Examples include thyroid stimulating
hormone (TSH); ___________ hormone (abbreviated as _______); follicle
stimulating hormone (FSH) and luteinizing hormone (LH). Two other hormones
released by anterior pituitary are prolactin and _______ hormone.

The posterior pituitary secretes two hormones: _______ hormone and oxytocin.
Vasopressin, a potent vasoconstrictor, is a form of ________ _______
(abbreviated- ADH).

(p. 1241) The two adrenal glands are located on the upper portion of each ______;
two distinct parts of the adrenals: ___________ and __________ . The inner portion
secretes catecholamines:__________ (also known as adrenaline), norepinephrine
(noradrenaline) and a smaller amount of _______. Catecholamines, generally
considered _________, are hormones when secreted by the adrenal medulla and
then released into circulation for widespread effect.

The outer part of adrenal gland secretes more than ____ steroid hormones which
are classified as _________, ________ and __________. *AKA “salt, sugar and
sex”.


2. Describe negative feedback system of hormonal control; give one example. p
1237)




3. Explain positive feedback mechanism of hormonal control; give one example. p.
1237-8)




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   4. Complete the table to review Key Endocrine Functions: (p. 1236 Tab. 48-1)
Endocrine/                       Target Tissue     Function of
Hormones                                           Hormone
Anterior Pituitary
(adenohypophysis)
1.Growth hormone (GH)/
somatotropin

2. Adrenocoticotropic
hormone (ACTH)

3. Gonadotropic hormones:
   FSH
   LH
   MSH
4. Prolactin
Posterior Pituitary
(neuro-hypophysis)
1. Antidiuretic hormone
(ADH) or vasopressin)

2. Oxytocin
Adrenal Cortex
1. Corticosteroids (ex.
cortisol, hydrocortisone)

2. Androgens (as
testosterone. androsterone,
estrogens)

3.Mineralocorticosteroid (ex
aldosterone)
Adrenal Medulla
1. Epinephrine (Adrenaline)
2. Norepinephrine

                               Ptuitary/adrenal disorders
      5. Complete the following table related to manifestations of pituitary conditions:
 ANTERIOR PITUITARY           SIGNS AND          KEY DIAGNOSTIC           PRIORITY NSG DX
                              SYMPTOMS           TESTS
1. Hypersecretion:
acromegaly
(What hormone?)
(p. 1291-1293)
      POSTERIOR               SIGNS AND          KEY DIAGNOSTIC           PRIORITY NSG DX
      PITUITARY               SYMPTOMS           TESTS
1. Hypersecretion:
SIADH (p. 1294)
2. Hyposecretion:
diabetes insipidus (DI)
(p. 1296)




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6.     What medication would be effective in treating acromegaly? Give generic and
       trade name and explain how it achieves its effectiveness. (p. 1292)

       What medication is available as long-term replacement therapy for an adult
       with growth hormone deficiency?


       What medications are likely to be used in treating prolactinomas; how do they
       achieve their effectiveness? (p. 1293)

7.     SIADH causes a/an _____________ (increase or decrease) in urine OUTPUT.
       Describe characteristics of the urine output and explain the reasons:


8.     DI causes a/an ______________ (increase or decrease) in urine OUTPUT.
       Describe characteristics of the urine output and explain the reasons:


9.     There are 3 types of DI. List the types and briefly describe etiology: (p. 1296)
       a.

       b.

       c.

10.    *For SIADH, the nurse would ____________ (encourage or limit) oral fluids
       for the client; for the client with DI, the nurse would ___________________
       (encourage or limit) oral fluids.

11.    For SIADH, serum studies show _________ (hypo or hyper)- natremia; for
       the DI client, serum studies show __________ (hypo or hyper)- natremia.
       Sodium replacement, would be indicated for ________ (SIADH or ADH).

12.    Vasopressin, a form of ADH. Replacing ADH is necessary for ____________
       (SIADH or DI). However, ____________ __________ (also known as ______)
       is treatment of choice to replace ADH, and can be administered __________,
       ___________, or _______________. (p. 1297 & Notes)

13.    A patient had a transphenoidal hypophysectomy for removal of pituitary
       tumor. List three (3) critical nursing interventions: (Notes & p. 1291-1292)
       a.

       b.

       c.

       d.
14.    Cushing’s syndrome/disease (see text p.1312; Tab. 50-12)-a spectrum of
      abnormalities caused by an excess of ___________ , particularly __________ .

      Several conditions can cause Cushing’s syndrome/disease (1) most common is
      iatrogenic (induced inadvertently by medical treatment or procedures)
      administration of exogenous ____________ such as ____________; (2)



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             Approximately 85% of cases of endogenous Cushing’s syndrome (*from
             substances that originate from within an organism, tissue, or cell) are due to an
             adrenocorticotropic hormone (ACTH) secreting pituitary tumor (* Cushing’s
             disease if originates from pituitary); (3) Other causes include ________
             tumors: and (4) ectopic ACTH producing tumors outside hypothalamic-pituitary
             adrenal axis, usually lung or pancreas


       15.    Complete Dx tests for Cushing’s syndrome (p.1314, 1250-51 tab 48-8)
Test                        Test Finding                     Significance
24 hr urine collection –free   Normal is less than ________ mcg/24)     Urine levels above _______mcg/day
cortisol *preferred test                                                indicates ________ _______. If
                                                                        “positive”, dexamethazone suppression
p. 1351                                                                 (ACTH suppression) test conducted-
                                                                        addresses ______ function.
Cortisol (total serum          Normal is 5-23 mcg/dl at 8 am; _____     Levels should be _________(higher or
cortisol level; diurnal        mcg/dl ______ at 4 pm                    lower) in morning than in evening. (*if
variation                                                               normal)
Plasma ACTH levels             Measures plasma levels of ACTH           Important in determining if under or
(adrenocoroticotropic          which controls _______ secretion of      overproduction of cortisol is due to
hormone, ACTH                  ______ ; Normal in morning < 80          dysfunction of ________ or _______
corticotropin) p. 1250         pg/ml; evening <50 pg/ml                 gland.
ACTH suppression               Decadron (dexamethasone) 2 mg            Patient must not be under stress with
(dexamethasone                 given at ____ pm to suppress secretion   this procedure; must be fasting. Timing
suppression)                   of ______ _______ hormone. Plasma        of samples is important ? (yes or no?)
                               cortisol level drawn at 8 am; Cortisol
                               level of <5 mcg/dl indicates normal
                               _____ response.
MRI & CT                       Evaluate presence of tumor               Determine underlying cause problem
Basic Metabolic
Panel- K,NA/CBC

          15. Identify key clinical manifestations of Cushing’s Syndrome: (p. 1312-1313;
          Tab 50-13 and Fig 50-11) *brief
                       SYSTEM                                        MANIFESTATIONS
Integumentary


Cardiovascular


CNS


Musculoskeletal


GI


Reproductive


Metabolic Effects




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16.    If Cushing’s Syndrome due to adrenal cortex tumor, an adrenalectomy may
        be performed. Answer these questions related to pre-and post-operative care
       priorities. (p. 1315)
        a. What type of pre-operative diet and why?

           b. Why is there a high risk for hemorrhage and other complications?

           c. Explain rationale for use of high doses of corticosteroids during and for
              several days after surgery (adrenalectomy)

           d. Why is patient at increased risk for hypertension?

           e. What life-threatening event that may occur post-operatively related to
              corticosteroids; what are signs and symptoms of this event?

                   What actions must be taken?

           f.   Discharge instructions following adrenal surgery are based upon: (p.
                1315)


           g. If patient requires long-term corticosteroid replacement therapy, state
              major teaching needs specific to use of this drug include time of day to
              take, risk of abrupt cessation etc. (p. 1314, 1317, 1319 and Tab. 50-20)


17.   Name three (3) medications that may be used to “control” symptoms of
      Cushing’s syndrome (if surgery contraindicated and/or surgical/radiation
      adjunct); describe how each medication works. (p. 1312; 1324 & Tab. 50-14
      and Notes)
      a.

      b.

      c.

18.   For each nursing diagnoses related to Cushing’s Syndrome, give several
      nursing interventions: (p. 1314)

      a. Imbalanced nutrition; more than body requirements:


      b. Impaired skin integrity:


      c. Risk for infection:


      d. Disturbed body image:




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19. Fill in the blanks: (notes and p. 1316-1317 of text)
    Addison’s disease (*primary adrenocortical insufficiency/hypofunction)
    is a disorder resulting from destruction or dysfunction of the __________
    gland; result is chronic __________ of cortisol, aldosterone, and adrenal
    androgens, accompanied by skin __________.

     Secondary adrenocortical insufficiency may be due to ___________
     disease or to suppression of hypothalamic-pituitary axis from administration of
     exogenous corticosteroids; corticosteroids and androgens are deficient, but
     ________ are rarely deficient.

     In Addison’s disease, skin hyperpigmentation is most likely due to inc.
     secretion of B-lipotropin which contains _______ _______ hormone or ACTH.
     These tropic hormones are ________ (increased or decreased) due to
     _________ (inc. or dec.) negative feedback and resulting _____ (low or high)
     corticosteroid levels.

     Addison’s disease is more common in adults under age of ______ .
     Addison’s disease, if due to an autoimmune disorder, is more common in
     ________ (women or men). *Basal glucocorticoid secretion is normal, but
     does not increase in response to stress, low blood sugar or altered fluid
     volume; can precipitate an adrenal crisis. As destruction of adrenal cortex
     continues, even basal secretion of glucocortiicoids and mineralocorticoids are
     deficient.

     If secondary adrenocortical hypofunction (due to lack of pituitary ACTH
     secretion); is the patient’s skin hyperpigmented? ______(yes or no). Are
     ACTH levels and related peptide levels _______ low or high? p. 1316

     Addisonian crisis (p. 1316-1317 & Notes) is a life-threatening response to
     acute adrenal _____________; most commonly precipitated by major
     ___________ , abrupt withdrawal of _________ hormone replacement
     therapy, or hemorrhage into the adrenal glands. *May follow sudden pituitary
     gland destruction.

     **Primary symptoms of Addisonian crisis are: ____________,
     ___________, ____________, ____________, __________, __________;
     may lead to _________. How is Addisonian crisis treated:
     rapid___________of fluids and electrolytes and administration of
     _____________intravenously.




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20.  Complete the table identifying primary, untreated Manifestations of Addison’s
     Disease: *important to know-summary
               SYSTEM                                  MANIFESTATIONS
*Integumentary

*Cardiovascular

*CNS

*Musculoskeletal

*GI

Reproductive

*Metabolic Effects


21.  Identify findings of key diagnostic tests in untreated Addison’s Disease
     (*primary): (p. 1316, 1250-1251 Tab. 48-8 & notes)
TEST                                         RESULTS
ACTH Stimulation test with cosyntropin

Plasma ACTH

Free cortisol (urine 24 hr test)

Serum cortisol level

K, Na, Blood glucose, CBC, BUN

CT Scan/MRI/EKG


22.   The primary medical treatment of Addison’s disease (p. 131, notes) is
      administration of ____________ which has both ______________ and
      mineralocorticoid properties. _________ is given to replace mineralcorticoids.

      What time/s should this replacement therapy be administered?


      *Corticosteroid replacement therapy requires careful management-
      Read/review cortisosteroid replacement therapy. p. 1318-1319




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23.  Identify key nursing problems/interventions for the patient with Addison’s
     Disease (focus-teaching.)
           NURSING DIAGNOSIS                       NURSING INTERVENTIONS
R/F for fluid volume deficit
(results from loss of water & sodium &
vomiting & diarrhea)

In crisis: decreased cardiac output,
hypotension and hypovolemic shock
Knowledge deficit RT therapeutic regimen
Management, safety
(lifelong care needed, with many
components)



24.   Fill in the blanks (see text p. 1320 and notes)

      Pheochromocytomas are tumors of the _______ _______. These tumors
      produce excessive ___________that stimulate the __________nervous
      system. The most striking clinical features are severe unexplained
      ____________, severe pounding ________ ________, profuse _________ &
      unexplained _________or _______ pain. Attacks are precipitated by many
      medications, including __________, opioids, _________ _________
      ________ and ________ __________.

      (p. 1320) Pheochromocytoma is diagnosed by measurement of urinary
      fractionated ____________ (catecholamine metabolites) & ________
      ___________ levels and _______ levels, usually done as a 24 hr urine
      collection, is the simplest and most reliable test. (p. 1320 & 1251 Tab 48-8) A
      less sensitive test is the _________ ________ and requires a 24 hour sample.
      When should serum plasma catecholamines be measured? ______________

      The primary treatment consists is __________ ________ of the tumor(s).

      Identify several classes of medication/and examples of meds that may be used
      pre-operatively to control BP and excess catecholamines symptoms.

      a.
      b.
      c.

25.   Hyperaldosteronism (p. 1319) is characterized by excessive production of
      ___________ . The primary disease characteristics include ________ with
      ________ alkalosis. *May also be known as Conn’s disease)


26. In primary hyperaldosteronism, (pre-operatively) what diet and what
   type of diuretics are indicated and why?




8  RNSG 2432

								
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