1) Explain the goiter. Describe goiter.
2) Explain the etiology, clinical manifestation, and diagnostic evaluation of goiter. (Write the causes of goiter, its signs and symptoms, its diagnostic evaluation.)
3) Explain the management of goiter. (Write management of goiter.)
1) define/explain the goiter. (Describe a goiter.)
=> Goiter is a disease of the thyroid gland in which the size of the thyroid gland increases.
=> (goiter is a condition in which enlargement of the thyroid gland is seen)
=> Goiter can be found in any person but mainly it is more common in women.
=> Goiter alters the normal function of the thyroid gland.
2) Explain the etiology/cause of goiter. (State the cause of goiter)
Due to iodine deficiency.
(Iodine helps in the production of thyroid hormone from the thyroid gland, but if the body does not have adequate amount of iodine, the thyroid gland has to work extra hard to produce thyroid hormone, so the size of the thyroid gland increases)
Due to hyperthyroidism,
Grave’s disease (Grave’s disease := autoantibody that activates TSH Receptor),
Hashimoto’s thyroiditis
goitrogen ingestion (lithium tablets, prophyle lithovacil, sulphonamides, salicylates, amiodarone)
critinism,
nodules (Nodules:= Nodules are solid and filled with fluid. These nodules look like hard structures from the outside but are filled with fluid inside. These nodules are non-cancerous but enlarge the thyroid).
thyroid cancer.
3) Explain signs and symptoms/clinical manifestation of goiter.
In goiter clinical manifestation includes hyperthyroidism + hypothyroidism
in hyperthyroidism:=
Tachycardia (tachycardia),
palpitation,
nervousness,
weight loss,
Blood pressure increases,
heat intolerance,
in hypothyroidism:=
Bradycardia
weight gain,
Cold intolerance,
constipation,
lethargy,
Other symptoms:=
hoarseness of voice,
Dysphagia (difficulties in swallowing)
Coughing,
Dyspnea (difficulty in breathing),
Swelling in the neck,
Nodules are seen on the neck side.
Dizziness.
3) Explain the risk factor:= Describe the risk factor
hereditary,
Having a family history of thyroid cancer,
Due to iodine being in inadequate amount,
Due to iodine deficiency,
women’s are high risk,
if any radiation therapy,
4) Explain the diagnostic evaluation. (Write diagnostic evaluation)
history taking and physical examination (visible enlargement of thyroid gland),
assess the TSH, T3,T4 hormone level,
blood test,
thyroid scan,
ultrasound,
Biopsy
5) Explain the management of goiter. (Write management of goiter.)
medical management
1)if hyperthyroidism:=
radio active iodine therapy.
methimazole,
propylthiouracil.
2)if hypothyroidism:=
provide levothyroxin,
3)if iodine deficiency:=
provide Lugol’s iodine,
provide potassium iodine.
6) Explain the nursing management of patients with goiter. Write the nursing management of a patient with goiter disease.)
Maintain proper airway of the patient.
Assess the patient for any signs of airway obstruction.
Proper suctioning of the patient.
Properly intubate the patient and take proper care of him.
Provide high fowler’s position to the patient while eating and provide high fowler’s position to the patient for at least 30 minutes after the meal. To prevent the patient from aspirating.
Ask the patient to wear loose cloth on the neck side.
Ask the patient not to wear tight clothes on the neck side.
Ask the patient to take iodized. at least 30 micrograms.
Ask the patient to take medicine regularly.
Assess whether the patient has any signs and symptoms of thyrotoxicosis crisis like:=neck swelling, weight loss, difficulty in breathing and swallowing.
Disorder of Adrenal gland (A gland which should be present above the renal/kidney it’s called adrenal gland. )
1) Explain/define Addition disease. Describe Addison’s Disease.
2) Explain Etiology, Clinical manifestation, And diagnostic evaluation of addition’s disease. (Write the causes of Addison’s disease, its signs and symptoms tome and diagnostic evaluation.)
3) Explain the management of addition disease. (Write management of Addison’s disease.)
1) Explain/define Addition disease. Define Addison’s disease.)
=> Addison disease is a rare and chronic disease.
=> Addison’s disease occurs when the adrenal gland does not produce its own hormones in adequate amounts.
=> Hence Addition Disease to Adrenal Insufficiency
(adrenal insufficiency) and hypocortisolism (hypocortisolizm) are also called.
=> Therefore, there is a deficiency of the hormones of the cortex part (outer part) of the adrenal gland such as glucocorticoids, mineralocorticoids.
=> This condition is Dr. was given in 1855 after the name of Addition.
=> Addition disease is mainly seen during the age of 30 – 50 years.
2) Explain the etiology/cause of addition’s disease. (Write the cause of Addison’s disease.)
1) Primary adrenal insufficiency (primary adrenal insufficiency)
:= This is mainly due to the problem in the adrenal gland itself, the hormone does not get secreted.
(Due to disorder of the adrenal gland themselves.)
2) secondary adrenal insufficiency (secondary adrenal insufficiency):=
=>Due to inadequate secretion of ACTH by the pituitary gland.
1) Primary adrenal insufficiency (primary adrenal insufficiency)
:= This is mainly due to the problem in the adrenal gland itself, the hormone does not get secreted.
(Due to disorder of the adrenal gland themselves.)
=> This is mainly seen due to damage to the outer layer of the adrenal gland.
=> It is mainly damaged due to autoimmune diseases.
Other cause :=
due to infection,
cancer of adrenal gland,
tuberculosis,
bleeding into adrenal gland,
Due to use of anticoagulant.
2) secondary adrenal insufficiency (secondary adrenal insufficiency):=
=>Due to inadequate secretion of ACTH by the pituitary gland.
=> This is mainly due to some other reasons, the adrenal gland cannot secrete the hormone in an adequate amount.
=> Due to any pituitary gland disease.
=> Due to taking some kind of medication.
=> Due to radiation,
=> Due to infection,
=> Due to reduced blood flow,
=> Due to any neurosurgery (neurosurgery) if done.
=> Due to stress.
=> Due to an accident.
=> Due to nausea and vomiting due to dehydration.
other cause :=
=> Due to industrialized world.
=> due to cushing syndrome.
=> hypopituitarysam,
=> due to myasthenia gravis.
=> Due to pernicious anemia.
3) Explain the clinical manifestation/sign and symptoms of additional diseases. (Write the symptoms and signs of Addiction Disease.)
Low blood pressure (low blood pressure),
tachycardia,
Muscle weakness,
weight loss,
nausea,
vomiting,
diarrhea,
Hyperpigmentation (dark colors in some places).
feeling very weak,
feel tired,
hyponatremia (low level of sodium in blood stream)
hypercalcemia
(Increase level of calcium in blood)
hypoglycemia (low blood glucose level)
Hyperkalemia (high level of potassium in blood.)
slow, sluggish movement,
loss of appetite,
lesion on the side of cheek,
extreme weight loss,
Edison crisis,
kidney failure,
Loss of consciousness.
Low blood pressure.
4) Explain the diagnostic evaluation of additional diseases. Write the diagnostic evaluation of addition diseases
history tacking and physical examination,
assess the laboratory investigation,
Evaluate the sodium, potassium, and cortisol levels.
X Ray,
ct scan,
MRI TEST,
CRH stimulating test (corticotrophin releasing hormone),
ACTH stimulating test. (Adreno coetico trophines releasing hormone),
insulin induce hypoglycemia test,
17-hydroxycorticosteroid test,
17-ketosteroids,
blood eosinophil count,
24-hour urinary aldosterone excretion rate,
Aldosterone test,
5) Explain the management of additions disease
medical management
provide Hormonal replacement therapy to the patient,
provide hydrocortisol to the patient,
provide prednisolone to the patient,
provide glucocorticoids and mineralocorticoid to the patient.
2) If patient has adrenal crisis (symptoms like low blood pressure, low sugar level, high potassium level) so provide intra venous glucocorticoids and provide large volume of saline dextrose.
6) surgery like: =
AdrenalecTOmy
7) Explain the nursing management of patients with additional diseases.
nursing assessment
Taking complete history and physical examination of the patient.
To check patient’s vital sign.
Maintaining intake output chart of patient.
Assess the patient’s sleeping pattern.
Monitoring the patient’s weight daily.
Assess the patient for signs and symptoms of Addison’s disease.
nursing diagnosis
1) Risk for imbalance nutritionally related to decrease gastro intestinal enzyme and decrease gastric acid production.
maintain nutritional needs of patients
Assess the nutritional status of the patient.
Monitoring the patient’s weight daily.
Monitor the patient’s serum glucose level.
Provide high protein, low carbohydrate and low sodium diet to the patient.
Ask the patient to take food in small and frequent amounts.
Ask the patient to rest after eating to increase digestion.
2) Risk for fluid volume deficit related to disease condition.
Maintain fluid and electrolyte balance of patients
Assess the patient’s fluid level.
Assessing the patient’s skin turgor.
Assess the mucous membrane of the patient.
To monitor patient’s vital signs.
To assess the color, amount of urine of the patient.
Ask the patient to take adequate amount of fluid.
Providing parenteral fluid to the patient.
Assessing the patient’s body for any petechaie-like signs.
3) Risk for decreased cardiac output related to disease condition.
Maintain adequate cardiac output of patients
To monitor patient’s vital signs.
To assess the patient’s peripheral pulse.
Maintaining intake output chart of patient.
Ask the patient to take adequate rest.
Provide intravenous fluid to the patient.
4) Knowledge deficit related to self administration of steroid medication.
improve the knowledge of patients
To provide adequate information to the patient about his situation.
Discussing drug therapy with the patient including action regarding prescribed hormone.
Communicate the principles of patient medicine.
Tell the patient that an intramuscular self-injection administration kit is available for the client.
Demonstrate the procedure to the patient.
1) Define/explain cushing syndrome. Define Cushing syndrome.#
2) Explain etiology, clinical manifestation, and diagnostic evaluation of cushing syndrome. (Write the causes, symptoms and signs and diagnostic evaluation of Cushing’s syndrome.)
3) Explain the management of cushing syndrome. (Write management of Cushing’s syndrome.)
1) Define/explain cushing syndrome. Define Cushing’s syndrome.)
=> Cushing syndrome is an endocrine disorder.
=> Cushing’s syndrome is mainly seen due to prolonged exposure of body tissues to high level of cortisole hormone.
=> Cushing’s syndrome is mainly seen due to excessive secretion of adrenocorticophic hormone (ACTH) from the pituitary gland and cortisol (cortisol) hormone from the cortex of the adrenal gland.
=> Cushing’s syndrome is called hypercortisolism.
Also called
Hypercortisolism is a condition described by Harvey Cushing in 1922.
=> Cushing’s syndrome is mainly observed between the ages of 20 to 50 years.
=> ( Cushing syndrome occurs due to excessive secretion of cortisol hormone from the adrenal gland cortex. )
2) Explain the etiology/cause of cushing syndrome. (State the cause of Cushing’s syndrome.)
Due to excisional secretion of cortisole hormone from cortex of adrenal gland.
Due to excessive secretion of adrenocorticotrophin releasing hormone (ACTH) from the pituitary gland.
Due to taking too much corticosteroid medicine (ex:= prednisone and prednisolone).
Due to tumor in pituitary gland.
Adrenal hyperplasia.
Due to tumor in other part of the body (ex: = pancreas, lung,
thyroid).
pseudo Cushing’s syndrome
(temporary over production of cortisol) is due to (depression,
Due to anorexia nervosa, alcoholism ) etc.
3) Explain the clinical manifestation/sign and symptoms of cushing syndrome. (Write the symptoms and signs of Cushing’s syndrome.)
Increase in body weight.
Upper body obesity occurs and arms and legs become thin.
The patient’s face is round and red.
fatty buffalo hump in the neck region.
Its growth is also seen slow in children.
Skin infection is seen.
Acne is found in the body.
Straie (white color stretch marks on the abdominal skin) are seen on the skin of the abdomen, thigh, and breast.
skin with easily brushing.
Skin becomes thin, fragile.
Backache while doing routine activities.
Pain and tenderness in the bone.
Difficulty climbing stairs due to proximal muscles weakness.
Collection of fat between two shoulders (buffalo hump).
Fractures in rib and spinal cord due to bone thinning.
Muscle weakness.
Cushing’s syndrome in women causes excessive growth of hair on the face, neck, chest, thigh (hirsutism).
Irregular menstrual cycle.
decrease or no desire of sexual activity.
impotence
(ejaculatory failure).
Psychological problem: Depression, anxiety and behavioral changes are seen.
Blood pressure increases.
Bon a week.
Sleep disturbances are seen.
Excessive catabolism of proteins occurs.
Muscle wasting is seen.
Retention of sodium and water occurs.
A moon face appearance of the patient is seen.
Hyperglycemia in the patient
(hyperGlycemia) condition is seen.
polyuria (increased frequency of urination).
Polydypsia (Increase thirst).
4) Explain the diagnostic evaluation of cushing syndrome.
history taking and physical examination.
assess serum sodium level.
assess blood glucose level.
Urinary cortisol level is monitored.
ACTH production is tested.
=> In this test, patient’s 24 hour urine is collected and tested for cortisol.
=> If the cortisol level is more than 50 to 100 microgram, it suggests Cushing syndrome.
overnight 1mg dexamethasone suppression test:=
=> In this test 1 mg dexamethasone is administered to the patient at 11 pm.
=> In the next morning
Serum cortisol is monitored at 8 am.
=> If a healthy individual then the cortisol level is less than 2-3 mcg/dl but if a person has Cushing syndrome then the cortisol level is greater than 1.8 mcg/dl.
assess the CRH stimulating test.
ct scan.
MRI.
5) Explain the management of Cushing syndrome.
If the cause of Cushing’s syndrome is a tumor in the pituitary gland, remove the tumor.
Providing radiation therapy to remove the tumor in the pituitary gland.
If hyperplasia of the adrenal cortex
If (hyperplacia) has happened, perform adrenalectomy (adrenalectomy := surgical removal of one or both adrenal gland).
Providing cortisole inhibiting drug to the patient.
If Cushing’s syndrome is caused by corticosteroid medication, the dose of the medication should be gradually reduced.
use of drug which should be reduce the synthesis of corticosteroids like,
Mitotane,
Ketoconazole,
metyrapone,
Aminoglutethimide,
Trilostane and etomidate etc.
6) Explain the nursing management of patients with cushing syndrome.
nursing assessment
To assess the patient’s vital signs.
Monitoring the patient’s daily weight.
Maintaining intake output chart of patient.
Assess the patient’s abdominal girth.
Inquiring about the patient’s dietary habit.
Assess the patient’s sleeping pattern.
Assess the patient’s mood and mental activity.
nursing diagnosis
1) Altered nutritional pattern related to disease condition.
meet nutritional need of patient :=
Assess the nutritional status of the patient.
Asking about the patient’s food likes and dislikes.
Ask the patient to take food in small and frequent amounts.
Serving food to the patient in an attractive manner.
Ask the patient to take high fiber, hypotensive and calcium rich food.
Maintain patient’s intake output chart.
2) Fluid volume excess related to sodium and water retention.
maintain fluid and electrolyte balance of patients:=
To monitor patient’s vital signs.
To maintain intake output chart of patient.
Recording the patient’s body weight daily.
Providing the prescribed medicine to the patient.
3) Altered sleeping pattern related to disease condition.
improve sleeping pattern of patients: =
Assess the patient’s sleeping pattern.
To provide a calm and comfortable environment to the patient.
To involve the patient in daily routine activities little by little during day time.
Maintain patient hygiene.
Ask the patient to read a book.
Ask the patient to do prayer and meditation before sleeping time.
4) Anxiety related to disturbed body image.
relieve anxiety of the patient:=
Assessing the patient’s anxiety level.
Actively listen to the patient.
To clear all the doubts of the patient.
To involve family members in the patient’s care.
5) Risk for infection related to disease condition.
improve the health of the patient and prevent from the infection:=
To monitor patient’s vital sign.
Maintaining client’s personal hygiene.
Provide neat and clean and ventilated room to the patient.
Ask the patient to wear a clean cotton cloth.
Maintain aseptic technique before any invasive procedure.
Proper hand washing before and after patient meditation.
Ask the patient to take a well balanced diet.
1) Define/explain pheochromocytoma. (Define pheochromocytoma.)
2) Explain etiology, clinical manifestation, and diagnostic evaluation of pheochromocytoma.
(Write the causes of pheochromocytoma, its symptoms and signs, and diagnostic evaluation.)
3) Explain the management of pheochromocytoma. (Write the management of in pheochromocytes.))
1) Explain/define pheochromocytoma.
Describe pheochromocytoma.
=> It is a tumor of adrenal gland in pheochromocytes.
=> Due to pheochromocytoma, epinephrine and norepinephrine hormones are released in large amounts which play an important role in maintaining heart rate, metabolism, blood pressure.
=> Pheochromocytes can become a life threatening condition if not diagnosed and treated.
=> In pheochromocytes it is seen at any age but mainly it is seen more in middle age (40 to 60).
2) Explain Etiology/cause of pheochromocytoma. State the cause of pheochromocytoma.
Being a family history.
Being a genetic disease.
von hipple-Lindu disease.
Multiple endocrine neoplasia.
Neurofibromatosis type 1.
3) Explain the clinical manifestation of pheochromocytoma.
Describe the symptoms and signs of pheochromocytoma
Abdominal pain.
Chest pain.
headache.
Work up a sweat.
palpitation.
Irritability.
Increase appetite.
Nausea.
Vomiting.
constipation.
Difficulty breathing.
feel tired
Weight loss.
sleeping difficulty.
Difficulty seeing.
Seizures occur.
Tingling, burning and numbness in legs.
pallor.
Rapid heart rate.
Very headache.
Sweat it out.
Hand tremor (hand tremor).
sleeping difficulty.
4) Explain the diagnostic evaluation of pheochromocytoma.
Write the diagnostic evaluation of pheochromocytoma.
24-hour urine testing,
clonodine suppression test,
ultrasound,
ct scan,
MRI,
adrenal biopsy,
catecholamines blood test,
glucose test,
meta iodobenzylguanidine (MIBG) scanning,
fluorodopamine PET scan,
urinary catecholamines,
urine menephrines.
5) Explain the management of pheochromocytoma.
Write the management of in pheochromocytes.
medical management
Surgical removal of the tumor.
To monitor patient’s vital signs properly.
Radiation therapy.
chemotherapy.
6) Explain the nursing management of patients with pheochromocytoma. Write the nursing management of pheochromocytoma.
To monitor patient’s vital signs.
Provide antihypertensive medicine to the patient.
Ask the patient to take continuous rest.
Assess the patient’s urine test.
Do not ask the patient to prolong exercise.
Provide high calorie and well balance diet to the patient.
Do not ask the patient to smoke.
Providing intravenous fluids to the patient.
Ask the patient to take adequate rest.
Ask the patient to take medicine properly.
Ask the patient to follow up properly.
1) Explain/define diabetic ketoacidosis (DKA).
Define diabetic ketoacidosis.
=> Diabetic ketoacidosis (DKA: = diabetes ketoacidosis) is a life threatening complication of diabetes mellitus (DM := Diabetes malitus).
=> Diabetes ketoacidosis is seen when there is inadequate amount of insulin in the body or insulin deficiency (Due to inadequate amount of insuline or absence of insuline).
•••{ insuline (insulin) :=
-> Insulin is a hormone.
-> Which is released from the beta cell of the pancreas (pancreas) which plays an important role in transporting glucose from the blood to the cell and converting the glucose into energy.
=> Diabetic ketoacidosis is mainly seen when there is inadequate amount of insulin in the body and insulin deficiency.
=> When there is a deficiency of insulin in the body, glucose is not transported from the blood to the cell, so the cell does not convert the glucose into energy.
=> So body cells use fat for energy and break down fat.
=> As a byproduct of the breakdown of this fat
Ketone bodies are released in the body.
=> The condition of diabetic ketoacidosis is seen due to the build up of these ketone bodies in the body.
2) Explain the etiology of diabetic ketoacidosis. State the cause of diabetic ketoacidosis.:=
Due to inadequate amount of insulin in the body or insulin deficiency.
Due to infection in the body (like diarrhea, vomiting, high fever).
Undetected diabetes mellitus (DM).
due to stress.
Certain medications such as corticosteroids
(corticosteroids), sympathomimetics (sympathomimetics), alpha and beta blocker (alpha and beta blocker) and diuretic medicine.
Due to pancreatitis (infection and inflammation of the pancreas).
Due to urinary tract infection.
Due to missed insulin injection or inadequate insulin dose.
Due to pneumonia.
Because of surgery.
Due to any physical or emotional trauma.
3) Explain the pathophysiology of diabetic ketoacidosis. Write the pathophysiology of diabetic ketoacidosis
1) due to insulin deficiency
=> Due to lack of insulin in the body, glucose is not transported from the blood to the cells.
=> So the cell does not get enough source of energy, (because glucose works as an energy source for the cell but when glucose is not transported from the blood to the cell, the cell does not get the source of energy).
2) increase glucose production
=> When allergy deficiency is found in the body, the production of glucose by the liver increases and the condition of hyperglycemia is found in the body.
3) break down of fats
=> Due to lack of insulin, the body cannot use glucose as a source of energy.
Then the breakdown of fat takes place in the body to get energy and due to the breakdown of fat, fatty acids are released.
4) ketogenesis
=> Fatty acids are converted into ketone bodies and ketone bodies are acidic in nature.
5) ketosis
=> Ketone bodies build up in the blood stream. And turns into ketosis.
6) osmosis diuresis
=> Due to the increase in the amount of glucose in the body, osmotic diuresis is seen, due to which excessive excretion of urine is seen from the body, therefore dehydration and electrolyte imbalance are also seen in the body. Mainly potassium (pottasium) imbalance is seen more.
7) Dehydration
=> Dehydration condition occurs due to excess fluid loss from the body.
8) Acidosis:=
=> As ketone bodies accumulate in the body, hydrogen ions are released and metabolic acidosis is observed in the body and blood pH is less than 7.35.
4) Explain clinical manifestation/sign and symptoms of diabetic ketoacidosis. Write the signs and symptoms of diabetic ketoacidosis
Polyuria (polyuria := increase frequency of urination)
Polydipsia
(polydypsia := excessive thirst)
Hyperglycemia (hyperglycemia := due to deficiency of insulin hormone)
Increasing the level of ketones in the body.
kussmaul’s breathing
(Kussmaul’s Breathing :=rapid and deep breathing)
Abdominal pain.
Nausea.
Vomiting.
Weakness.
feeling tired
Altered mental status.
Confusion.
Skin and mouse will become dry.
Acetone breath (fruity odor)
(acetone broth, fruity order),
Stiffness of muscles.
Anorexia
( Anorexia := Lack of appetite).
Blurred vision.
Decrease in blood pressure.
Orthostatic hypotension
(Orthostatic hypotension: Sudden fall in blood pressure when sitting or supine and taking standing position.)
Vic and rapid pulse.
Decreased level of consciousness.
headache
4) Explain diagnostic evaluation of diabetic ketoacidosis.
history taking and physical examination.
assess the blood glucose level.
Blood glucose level in the condition of diabetic ketoacidosis a
exceeds 250 mg.
Assess the blood for presence of ketone body in blood.
assess the urine for presence of ketone in urine.
Arterial blood gas analysis (for assessment of metabolic acidosis).
assess the electrolyte level of body like :=
sodium,
Potassium,
And other electrolytes.
Complete blood count test.
Assess the blood urea nitrogen level (BUN) (for assessing the kidney function).
CRP (C-reactive protein for assessment of any infection).
urinalysis.
ECG (electro cardiogram for assessing the heart Abnormalities).
assess the blood pH level is less than < 7.35.
Assess the serum creatinine level.
5) Explain the management of diabetic ketoacidosis. Write the management of diabetic ketoacidosis.
6) medical management
Attempts to correct insulin deficiency in the management of diabetic ketoacidosis.
1) Insulin therapy :=
=> Provide regular insulin (Regular insulin) intravenously to the patient.
=> Dose of insulin should be provided based on blood glucose level and ketone bodies.
2)Fluid replacement:=
=> Intravenously to correct the patient’s dehydration
(intravenously) isotonic
(isotonic)
Administer 0.9% normal saline.
0.5 to 1 liter/hour.
=> Fluid infusion should be continued until the condition of dehydration is treated or for 24-36 hours.
=> Continuously monitor patient’s blood glucose level when blood glucose level is less than 300mg/dl Provide 5% dextrose to prevent blood glucose level from declining.
3) maintain electrolyte level:=
=> Monitor the patient’s electrolyte level.
=> Keep assessing the level of potassium specially because potassium in mejor amount is transported from extracellular place to intracellular place (Due to transport of pottasium from extracellular place to intracellular place).
=> Provide potassium replacement therapy to the patient.Check urine output before potassium replacement.
4) correction of acidosis :=
=> Metabolic acidosis can be corrected by giving insulin therapy and fluid resuscitation to the patient.
Other :=
=> Continuously monitor patient’s blood glucose level and ketone level.
=> If the body has developed a condition of diabetic ketoacidosis due to any other reason, treat it like any infection in the body.
=> Provide bicarbonate therapy to the patient.
=> Monitor patient’s vital signs regularly.
=> To conduct laboratory tests of the patient.
=> When the condition of diabetic ketoacidosis is under control, insulin should be provided by subcutaneous route while keeping the patient under observation.
7) Explain complication of diabetic ketoacidosis. Write the complications of diabetic ketoacidosis
In cerebral oedema,
Fluid and electrolyte imbalances are seen.
Hypoglycemia.
Acute kidney problem.
Respiratory distress.
Cardiac complications.
Pulmonary oedema.
Hypokalemia (hypokalemia := deficiency of potassium in blood stream) Diabetic retinopathy.
8) Explain the nursing management of patients with diabetic ketoacidosis. (Write the nursing management of a patient with diabetic ketoacidosis.)
1.Assessment
Properly assess the patient.
To check patient’s vital signs properly.
Assess the patient’s neurological status.
Assess the patient’s respiratory status.
Assess patient’s intake output chart.
Checking the patient for any signs of dehydration.
Checking the patient’s electrolyte level.
2) Continuous monitoring of patients
Continuously monitor the patient’s blood glucose level.
To assess the amount of ketone bodies present in the patient’s blood.
To check the patient’s vital signs including respiratory rate,
To check heart rate and pulse.
Continuously monitor the patient’s blood pressure.
Assess the patient for any complications like respiratory distress, cardiac arrhythmias, mental status.
3)Fluid and electrolyte balance:=
Provide intravenous fluid to treat the patient’s dehydration condition.
Checking the electrolyte level of the patient, especially the potassium level.
4) Insulin therapy:=
Provide intravenous fluids to the patient.
Continuously monitor the patient’s blood glucose level.
5)Neurological status:=
To check the neurological status of the patient and his level of consciousness.
Assess the patient for cerebral oedema, headache and any changes in mental status.
6) Patient Education:=
Provide education to the patient and his family members about the signs and symptoms of diabetic ketoacidosis and its treatment.
Ask the patient to take proper diet.
Collaborate with other health care professionals for patient treatment.
Providing emotional support to patients and their family members.
Ask the patient’s family members to clear all doubts.
Continuously monitor the patient when the patient is transitioned from intravenous insulin to subcutaneous injection.
1) Explain/define the diabetes insipidus. (Describe diabetes insipidus)
Diabetes insipidus is seen due to deficiency or inadequate amount of antidiuretic hormone.
••{ ANTIDIURETIC HORMONE:= Regulation of body water is done by antidiuretic hormone. This hormone is produced from the hypothalamus and secreted from the posterior pituitary gland. }••
=> Diabetes insipidus is a condition in which antidiuretic hormone is secreted in inadequate amount or there is a deficiency of antidiuretic hormone.
=> Due to this the body water level is impaired and the urine output from the body increases.
There are two main symptoms in diabetes insipidus.
1) polyuria (excessive urination due to antidiuretic hormone deficiency),
2) Polydypsia (excessive thirst := due to excretion of excess urine from the body.)
2) Explain the causes and types of diabetes incipitus
There are four main types of diabetes insipidus.
1) NEUROGENIC DIABETES INCIPIDUS OR CENTRAL DIABETES INCIPIDUS (Neurogenic Diabetes Incipidus or Central Diabetes).
2) NEPHROGENIC DIABETES INCIPIDUS
3) PSYCOGENIC DIABETES INCIPIDUS
4) GESTATIONAL DIABETES INCIPIDUS
1)NEUROGENIC DIABETES INCIPIDUS OR CENTRAL DIABETES INCIPIDUS.
=> Central diabetes insipidus is mainly seen due to production of inadequate amount of antidiuretic hormone (ADH hormone) and due to non-release in adequate amount.
=> Antidiuretic hormone that plays an important role in regulating body water.
etiology/cause of central diabetes incipitus:=
=> Due to any lesion in hypothalamus and pituitary gland.
=> Due to any head injury.
=> Due to any head surgery.
=> Due to infection and inflammation of the central nervous system.
=> Due to any genetic condition.
=> Due to developmental abnormality.
=> Due to aneurysm in the head. (aneurysm := aneurism is called aneurism due to the wall of the blood vessels forming a bulge or balloon-like structure from that area).
=> Due to skull fracture.
=> Thus central diabetes insipidus is seen due to deficiency or inadequate amount of antidiuretic hormone in the body.
2) NEPHROGENIC DIABETES INCIPIDUS
=> Nephrogenic diabetes insipidus is seen when antidiuretic hormone (antidiuretic hormone) is in adequate amount in the body but kidney/kidney does not respond to antidiuretic hormone due to any reason, nephrogenic diabetes insipidus is seen.
=> So the water balance in the body is impaired.
cause/Etiology of nephrogenic diabetes insipidus:=
=> Due to any defect in the kidney tubules, excess water is excreted from the body.
=> Due to any impairment in kidney structure.
=> Having any genetic disorder.
=> Due to taking certain types of medication like lithium, diuretic.
=> Due to having any kidney disease.
=> Due to general anesthesia.
=> Due to any developmental abnormality.
=> Thus nephrogenic diabetes insipidus is seen due to impairment in kidney structure.
3) PSYCOGENIC DIABETES INCIPIDUS
=> Psychogenic diabetes insipidus is also called primary polydypsia.
Psychogenic diabetes insipidus occurs due to excessive fluid intake for any reason because antidiuretic hormone is supprrssed due to excessive fluid intake.
=> Being a mental health disorder.
=> Due to the habit of taking too much fluid.
=> Thus, psychogenic diabetes insipidus is seen due to excessive fluid intake.
4) GESTATIONAL DIABETES INCIPIDUS
=> Gestational diabetes insipidus is mainly seen during pregnancy.
=> Because at the time of pregnancy, due to the release of enzymes from the patient, the antidiuretic hormone is destroyed.
3) Explain clinical manifestation of diabetes insipidus. (State the symptoms and signs of diabetes insipidus)
1)Polyuria (Polyuria := passing excess urine)
=> Too much diluted urine is passed.
2) Polydipsia (Polydipsia := excessive thirst)
=> Due to excessive amount of urine passing from the body, the body fluid is lost, so the body feels more thirsty to maintain the fluid.
(Fluid intake is 5 to 20 liter/day.)
3) Nocturia (Nocturia)
=> During night time more urine is passed so sleep pattern is altered.
4) Dehydration
=> Due to loss of more amount from the body, the body gets dehydrated, so conditions like dry mouth, dry skin, impaired skin turgur are seen.
5) hypernatremia (hypernatremia)
=> Hypernatremia means increase in sodium content in the body and this is mainly seen due to excess amount of fluid loss from the body.
Due to this, confusion, irritability, and in severe cases many neurological symptoms such as seizure-like conditions are also seen in the body.
6) Hypotension
Hypotension is seen due to excessive amount of fluid loss from the body, due to which conditions like dizziness and fainting are seen.
7) weight loss
Due to continuous fluid loss from the body
(Due to polyuria) body weight
It decreases.
other symptoms:=
feel tired,
Fever,
Tachycardia,
difficulty seeing,
Electrolyte imbalance,
Loss of appetite (anorexia)
Electrolyte imbalance.
diarrhea,
Vomiting.
bed wetting.
4) Explain diagnostic evaluation of diabetes insipidus. (Write diagnostic evaluation of diabetes insipidus.)
history taking and physical examination.
1) Water deprivation test.
=> This test is done to assess the cause of diabetes insipidus.
=> In this test, the patient is asked to stop drinking fluids for two to three hours.
=> Then what kind of changes are seen in the body due to not taking fluid intake, such as changes in body weight, urine output,
Urine concentration etc.
=> The amount of antidiuretic hormone present in the blood is also assessed in this test.
=> Keep in mind that when this test is done in children and pregnant women, close observation is done and the body weight should not be lost more than five percent.
2) Antidiuretic hormone (ADH) Test.
=> Antidiuretic hormone test is done after water deprivation test.
=> In this test, antidiuretic hormone (Desmopressine := synthetic antidiuretic hormone) is provided in small doses by injection.
=> Then it is seen how the body reacts to this hormone.
=> This test is done to assess the type of diabetes insipidus a patient has.
=> In this test, when antidiuretic hormone is provided to the patient and the urine production of the patient is stopped, the condition of diabetes insipidus is seen due to the shortage of antidiuretic hormone.
=> This primarily detects central diabetes insipidus (neurogenic diabetes insipidus) in the patient.
=> It detects if the urine production remains in the same amount even after providing antidiuretic hormone to the patient,
An adequate amount of antidiuretic hormone is produced in the body but due to any kidney abnormality the kidney does not respond to the antidiuretic hormone.
=> So nephrogenic diabetes insipidus is detected.
3)urin analysis:=
=> In this test, when the amount of water in the urine is high and salt and waste products are low, it detects the condition of diabetes insipidus.
4)MRI (Magnetic Resonance Imaging)
=> This test mainly hypothalamus and
It is done to detect any problem in pituitary gland.
5)serum osmolality:=
=> This test is mainly done to assess the amount of solutes in the blood.
6) Fluid intake output monitoring:=
=> This test is mainly done to assess how much fluid intake and how much urine is output by the patient.
7) Genetic testing:=
=> This test is mainly done to assess any genetic abnormality.
8) Check the electrolyte level
=> It is done to detect if there is any electrolyte imbalance in the patient’s body.
5) Explain the management of diabetes insipidus.
medical management
central diabetes insipidus:=
=> The cause of central diabetes insipidus is seen due to inadequate amount of antidiuretic hormone.
=> So providing synthetic antidiuretic hormone (Desmopressine) to the patient.
=> Synthetic antidiuretic hormone nasal spray,
Oral tablets,
And is taken in the form of injection.
=> Providing this synthetic antidiuretic hormone reduces the excessive urine output.
2) Nephrogenic diabetes insipidus:=
=> If the cause of diabetes insipidus is due to kidney abnormality then synthetic desmopressine is not used as treatment.
=> If there is condition of diabetes insipidus due to kidney then take low salt diet.
=> Do not take medicines that damage the kidneys.
=> People who have Nephrogenic Diabetes Incidence should take prostaglandin inhibitor group drugs.
3)psychogenic diabetes insipidus:=
If a person has psychogenic diabetes insipidus i.e. the condition of diabetes insipidus due to any mental illness then that mental illness should be treated.
4) Gestational diabetes insipidus.
=> Provide synthetic desmopressin to the patient if the condition is gestational diabetes insipidus.
6) Explain the nursing management of patients with diabetes insipidus.
nursing assessment
To monitor patient’s vital signs.
Asking if the patient has any history of head injury.
Inquiring about the patient’s eating habits.
To assess the patient’s urine output and fluid intake.
Assessing the patient’s skin turgor.
Asking the patient whether polyuria is a polydipsia-like sign.
nursing management
nursing diagnosis
1) Electrolyte level imbalance related to hypernatremia.
2) Fluid volume deficit related to polyuria.
3) Disturbed sleeping pattern related to disease condition.
4) Altered tissue perfusion related to disease condition.
5) Risk of complications related to disease condition.
nursing interventions
maintain fluid and electrolyte balance of patients:=
To monitor patient’s vital sign.
Maintaining intake output chart of patient.
Provide intravenous fluid to the patient.
Following trick aseptic technique.
maintain tissues perfusion of patient:=
Assess the patient’s skin integrity.
Providing skin care to patients.
Ask the patient to wear a net and clean cloth.
Change the patient’s position every two hours.
Ask the patient to do active and passive exercises.
relief anxiety level of patient
Assess the patient’s anxiety level.
Ask the patient to clear all his doubts.
Providing information to the patient about the disease and its symptoms.
To involve family members in the client’s care.
maintain hygiene of patients:=
Ask the client to maintain his personal hygiene.
Ask the patient to change his clothes daily.
Ask the patient to wear a clean cotton cloth.
Assess the patient’s discomfort level.
promote comfort and sleep of patient:=
Assess the patient’s sleeping habit.
To provide a conductive environment to the patient.
prevent the occurrence of complication to the patient
Monitor the patient for symptoms such as dehydration, metabolic acidosis.
If the patient experiences these symptoms, report them to the physician immediately.
Providing the prescribed medicine to the patient.
Providing reassurance to clients.
Monitoring the patient for any complications.
Explain the disorder of pituitary gland
1) define/explain hypopituitarism. Define hypopituitarism
=> Hypopituitarism is a disorder of the pituitary gland in which the pituitary gland is underactive.
(underactive) happens.
=> Pituitary gland is called master endocrine gland.
which is present in the base of the brain. (pituitary gland present at the base of the brain).
=> Pituitary gland secretes many hormones of the body and works to regulate body functions (growth, metabolisam, regulations, and many other vital functions).}••
=> Hypopituitarism is a condition in which the secretion of one or more hormones of the pituitary gland occurs in an inadequate amount (low amount).
=> This is a condition that mainly affects the anterior lobe of the pituitary gland.
=> the hormone that are produced by the pituitary gland may be affected in hypopitutarism are:=
1) ADRENO CORTICOTROPHIN HORMONE (ACTH),
2) ANTIDIURETIC HORMONE (ADH),
3) FOLLICAL STIMULATING HORMONE (FSH),
4) THYROID STIMULATING HORMONE (TSH),
5) LEUTENIZING HORMONE (LH),
6)GROWTH HORMONE (GH),
7) PROLECTINE ..
2) Explain the etiology/cause of hypopituitarysam. State the cause of hypopituitarism.)
1) Due to tumor of pituitary gland
Pituitary gland tumors (benign:= non cancerous) benign or malignant (malignant:= cancerous) cause the pituitary gland to be affected and the production of hormones is impaired.
2) Pituitary infraction (pitutary infraction/sheehans syndrome) :=
=> In this there is insufficient supply of blood to the pituitary gland.
=> This is mainly seen at the time of child birth and due to excessive amount of blood loss.
=> It causes pituitary necrosis and hormone deficiency.
3)pituitary trauma (pituitary trauma) :=
=> Head injury or trauma
Also affects the pituitary gland due to this
occurs and therefore hormonal
Deficiency is observed.
4) Infection and inflammation: =
=> Impairment in pituitary gland hormone is also seen due to infection in any brain.
5) Due to any autoimmune condition.
6) Due to radiation therapy.
7) Due to surgery.
8) Due to genetic abnormality.
9) Due to certain types of medication (like := corticosteroids).
10) Due to occurrence in pituitary ED.
11) Due to post partum hypopituitarism (pituitary gland damage due to severe blood loss during child birth.).
3) Explain the clinical manifestation of hypopituitarism. Describe the symptoms and signs of hypopituitarism
1) due to thyroid stimulating hormone deficiency:=
weight gain,
bradycardia,
hypotension,
sensitivity to cold,
energy depletion,
muscle weakness,
hair loss,
dry skin,
hoarseness,
Growth retardation is seen in children.
2) Due to ACTH Deficiency:=
feel tired,
pallor,
loss of appetite,
weight loss,
dizziness,
weakness,
depression,
nausea,
vomiting,
shock,
hypoglycemia,
anemia,
hyponatremia,
3) due to gonadotrophin deficiency:=
Irregular menstrual periods,
dyspareunia,
infertility,
Osteoporosis
(fragile bone),
Puberty is delayed in children.
4) due to growth hormone deficiency:=
feel tired,
Height is short,
low energy,
growth retardation,
visceral obesity,
decrease muscle mass and strength,
5) due to deficiency of prolectin hormone.
Decreased milk production,
feel tired,
loss of underarm and pubic hair,
6) due to deficiency of ADH (anti diuretic hormone) :=
2p syndrome:=
=>Polyuria,
=> Polydypsia.
Decreased osmolarity of urine.
Hypernatremia.
4) Explain the diagnostic evaluation of hypopituitarism. Write the diagnostic evaluation of hypopituitarism.
history tacking and physical examination,
serum ACTH test,
Serum cortisole test,
serum estrogen test,
serum follicle stimulating hormone test,
serum luteinizing hormone test,
X Ray,
ct scan,
MRI,
blood test,
vision test,
stimulating or dynamic testing.
5) Explain the management of hypopituitarism. (Write management of hypopituitarism.)
If there is deficiency of adrenocorticotrophic hormone (ACTH Deficiency) in the body, the patient should be provided with corticosteroid (ex := prednisone, hydrocortisone) medicine.
If there is thyroid stimulating hormone decrease (TSH deficiency) in the body, then the patient should be provided livothyroxin medicine.
If the patient has antidiuretic hormone deficiency (deficiency of ADH), Desmopressine medicine should be provided.
Desmopressin is available in nasal spray, oral tablet and injection form.
If the patient has deficiency of growth hormone (deficiency of GH), genotropin (genotropin) and humatrope (humatrope) medicine should be provided.
If the patient has deficiency of sex hormone (if the deficiency of sex hormone), then testosterone replacement therapy (Testosterone replacement therapy) and estrogen replacement therapy (Estrogen replacement therapy) should be provided.
Explain the nursing management of patients with hypopitutarisam. Write the nursing management of patients with hypopituitarism.
1) Disturbed body image related to changes in the hormones of the body.
Asking the client to explain his feelings.
Providing psychological support to Kalites.
Ask the patient to describe any issues he or she is facing.
Asking the client to improve his coping abilities.
2) Anxiety related to changes in the health status of patients.
Providing light comfort.
Asking the client to do moderate amounts of activity.
Provide education to patients on relaxation techniques.
3) Impaired skin integrity related to declining hormone level.
Providing education to patients for regular skin care.
Ask the client to use a moisturizing lotion.
Tell the client not to scratch the skin.
Ask the patient to take plenty of fluids.
Ask Light to do range of motion exercises.
Provide education to patients for regular skin care.
4) Ineffective individual coping related to the disease condition.
Ask the client to explain his feelings.
Providing education to the patient on how to solve his problem.
Providing education to clients in relaxation techniques.
5) Low self esteem related to changes in the body appearance.
Properly building up the nurse-patient relationship with the patient.
Providing psychological support to clients.
Involving the client’s family members in his care.
Ask the patient to explain his feelings.
Asking the patient to improve his coping ability.
1) Explain Acromegaly.
Define acromegaly
=> Acromegaly is a word derived from the Greek vada.
=>Acromegaly means :=
“extremities” and “enlargement”
=> Acromegaly is a cronic metabolisam disorder in which the secretion of growth hormone in too much amount from the pituitary gland.
(Acromegaly:= means secretion of too much growth hormone from the pituitary gland.)
=> Acromegaly is seen after epiphyseal plate closure.
=> Bone thickening and transverse growth occurs in acromegaly.
=> This is mainly seen in men and women between the age of 30 to 50 years.
=> Acromegaly is an abnormality of the pituitary gland,
which is seen due to excessive amount of secretion of growth hormone from the pituitary gland.
And the extremities of the body grow in an excessive amount.
2) Explain the Etiology of Acromegaly.
=> State the cause of acromegaly.
1) Pituitary tumor :=
=> due to tumor in pituitary gland ex:=
pituitary adenoma
=> Due to the presence of tumor in the pituitary gland, the pituitary gland is pressurized due to which the hormone of the gland is secreted in excessive amount.
2)Non pituitary gland tumor :=
=> In many people, Acromegaly is mainly a benign and non-cancerous tumor that spreads from other parts of the body.
=> Like Lungs, Pancreas and Adrenal Gland.
3) Excessive production of growth hormone from the pituitary gland.
4) Due to genetic abnormality.
3) Explain the clinical manifestation/sign and symptoms of Acromegaly. (Write the symptoms and signs of acromegaly)
=> Swelling occurs in the finger.
=> 👞 shoe size increases.
=> Special features are Swelling.
=> Prominence of jaw and forehead increases.
=> The skin of palms and soles is thickened.
=> Swallowing occurs in the tongue.
=> There is pain in the joint (arthritis := infection and inflammation of joint).
=> There is swelling in the neck.
=> appearance of large number of skin tags.
=> Breathing difficulty occurs during sleep time.
=> Pain, numbness and tingling sensation occurs in hand and wrist (carpal tunnel syndrome).
=> Thirst and urination increase.
=> Body order (Body odor).
=> Weakness will be seen.
=> Height should increase a lot.
=> Sweat profusely.
=> Headache.
=>joint pain.
=> The size of hand and foot should increase.
4) Explain the diagnostic evaluation of Acromegaly.
history taking and physical examination.
X Ray.
CT scan.
MRI.
Echocardiogram.
IGF-1 and growth hormone level assessment.
genetic testing.
visual field testing.
5) Explain the management of Acromegaly. (Write management of acromegaly.)
surgical management
The main primary cause of acromegaly is a tumor so surgically remove the tumor.
Transphenoidal hypophysectomy
:= In this, the tumor is removed by making an incision through the nasal sinus.
5) medical management:=
=> When surgery is not impossible, it is treated with medication.
1) Somatostatin analog (Somatostatin analog) :=
=>Octerotide (Octerotide)
=> Somatostatin analogs reduce growth hormone.
2) Pegvisomant (Pegvisomant) Pegvisomant blocks the action of growth hormone.
3) Radiotherapy := Radiotherapy is used to reduce the size of the tumor.
4) Dopamine agonist
=> Dopamine agonist drugs prevent the release of growth hormone from tumor cells.
Ex:= carbagoline,
lanreotide
6) Explain the nursing management of patients with Acromegaly. Write nursing management of acro megali vada patient.
1) Disturbed body image related to enlargement of body part.
Assess the patient’s body image.
Provide psychological support to the patient.
2) Fluid volume efficiency related to polyuria.
Assess the patient’s fluid and electrolyte status.
Provide fluid orally to the patient.
Providing intravenous fluids to the patient.
3) Disturbed sleeping pattern related to soft tissue swelling.
Assessing the patient’s sleeping pattern.
Provide a comfortable position of the patient
Provide work and quiet environment to the patient.
4) ineffective coping related to changes in appearance.
Assessing the patient’s coping ability.
To provide psychological support to the patient.
5) Anxiety related to changes in appearance and treatment.
Assessing the patient’s anxiety level.
Diverting the patient’s attention.
To assess the patient’s coping ability.
Providing psychological support to the patient.
6) Knowledge deficit related to development of disease and treatment.
To assess the knowledge level of the patient.
Explain the patient about progressive features of the disorder.
To clarify doubts in the patient.
1) Explain/define the Gigantism. (Define gigantism.)
=> Gigantism is a condition in which the body grows abnormally large before the epiphysial plate (bone growth plate) of the body closes.
=> It is mainly seen during childhood due to excessive growth hormone secretion.
2) Explain the Etiology/cause of Gigantism. (State the cause of gigantism)
Due to benign tumor of pituitary gland.
Due to excessive secretion of growth hormone.
Carney complex is a hereditary disorder in which pigmentation of the skin is seen.
MC cune-albright syndrome (MAS := McCune All Bright syndrome is a genetic disorder that mainly affects bone, skin, and endocrine system. And cafe-au-lait skin pigmentation is seen.)
multiple endocrine neoplastic type :=1 ( MEN :=1)
Multiple endocrine neoplasia is an inherited endocrine disorder in which tumor formation occurs in parathyroid gland, pituitary gland, pancreas ilent.
Due to exposure to radiation.
3) Explain the clinical manifestation/sign and symptoms of Gigantism. (State the symptoms and signs of gigantism.)
Children’s muscle organ and its height grow.
Children are seen to be taller than their corresponding height.
Growth in children is seen in excessive amounts.
Facial features
Enlarge is seen.
The joint is enlarged.
Enlargement of organs and tissues is seen.
Delayed puberty is seen.
Obesity.
double vision.
Frontal bushing and if it is prominent.
headache.
Sweat profusely.
Menstruation period becomes irregular.
Hand and feet become large and fingers and toes become thick.
Weakness.
4) Explain the diagnostic evaluation of Gigantism. Write a diagnostic evaluation of gigantism.)
history taking and physical examination.
ct scan.
MRI.
Assaying prodectin levels.
Assess the insulin growth factors (igf-1) level.
assess the cortisole level.
assess the estradiol level
(in girle). assess the Testosterone level (in boys).
Perform a thyroid function test.
Explain the nursing management of patients with gigantism. Write the nursing management of patients with gigantism
If there is a tumor in the pituitary gland, surgically remove it.
surgery like:= transphenoidal hypophysectomy. hypophysectomy (hypophysectomy).
medical management (somatostatin analog) Somatostatic analog
=>Somatostatic analogs are used to reduce the secretion of growth hormone.
Dopamine agonist (dopamineagonist := carbagoline, bromocriptine).
Used to reduce growth hormone.
growth hormone antagonist (ex:= pegvisomate)
=> This medicine reduces the effect of growth hormone.
provide radiation therapy to the patient.
Due to the provision of radiation therapy, learning disability, obesity, and emotional changes are seen in children, so radiation therapy is provided only if surgery and medication fail.
Nursing management of patients with gigantism Write nursing management of patients with gigantism
1) health assessment:=
=> Taking a comprehensive medical history of the patient.
=> Assess the patient’s physical status, emotional status, and psychological status.
=> To assess the patient’s growth pattern.
2) Psychological support:=
To provide psychological support to the patient and his family members.
Improving patient’s coping ability.
To clear all the doubts of the patient and his family members.
3) Education
To provide complete information about the disease to the patient and his family members.
To provide complete information about the disease, its causes and its treatment to the patient and his family members.
4) medication management
Medicine to the patient and his family members
dose, route and sign and symptom
5) monitoring and documentation.
Continuously monitoring the patient’s condition.
Continuously monitor the signs and symptoms of the patient’s disease condition.
6) Nutritional counselling:=
Continuously monitoring the nutritional status of the patient.
To provide education about healthy diet habit of patient by collaborating with diatetion.
7) joint care:=
Ask the patient to care for the joint continuously.
If the patient is in pain, providing medicine to relieve his pain.
8) Coordination of other health care providers:=
Collaborating with other health care personnel for patient care and providing adequate treatment to patients.
9) For health promotion:=
Asking the patient to do regular exercise to promote health.
Ask the patient to adopt healthy dietary habits.
Ask the patient to take a well balanced diet.
Ask the patient to make lifestyle changes.
1) Explain/define pituitary gland tumor. (Define pituitary gland tumor.)
=> Pituitarygland tumor is an abnormality of the pituitary gland, in which there is abnormal growth and uncontrollable mass in the pituitary gland.
A similar structure develops and a tumor forms.
=> Many types of tumors cause excessive production of hormones from the pituitary gland. And the hormone of the pituitary gland is produced in excess.
=> When many types of tumors restrict the hormones of the pituitary gland and due to this, the hormones of the pituitary gland are produced in less quantity.
2) Explain the division of pituitary gland tumor. (Write the division of pituitary gland tumor)
=> Tumor of pituitary gland is divided into three parts ##
=> 1) Benign pituitary adenomas
=> 2) Invasive pituitary adenomas (Invasive pituitary adenomas)
=> 3)pituitary carcinomas (pituitary carcinomas)
•••••>>
=> 1) Benign pituitary adenomas
=> This tumor is not cancerous.
=> This tumor is slow grow (slowly grow),
And it does not spread from the pituitary gland to other body parts.
There are other two types of benign pituitary adenomas
There are two other types of benign pituitary adenomas:
A) secreting pituitary adenoumas (secreting pituitary adenomas)
==> Secreting adenomas tumors produce excessive amounts of hormones from the pituitary gland over the normal amount.
B) Non-secretory pituitary adenomas
==> In non-secreting adenomas, pituitary gland hormones are not produced in excess amounts over the normal amount.
(don’t produce excessive amount of pituitary gland hormone).
=> 2) Invasive pituitary adenomas (Invasive pituitary adenomas)
=> Invasive pituitary adenomas include benign tumors in the skull.
Spreads in (skull bone).
=> 3)pituitary carcinomas (pituitary carcinomas)
=> Pituitary carcinomas tumors are cancerous/malignant tumors.
=> This tumor spreads to other parts of the central nervous system (brain and spinal cord) and also spreads to other parts of the body apart from the central nervous system.
=> Many pituitary tumors are malignant. Pituitary gland tumors are nonfunctioning and functioning.
=> 1)functioning
=> Functioning pituitary tumor is production of pituitary hormone in excessive amount than normal amount.
=>2) Non functioning pituitary tumor
=> A non-functioning pituitary tumor produces inadequate amounts of hormones as compared to normal production.
3) Explain the etiology/cause of pituitary gland tumor. State the cause of pituitary gland tumor
Idiopathic (actually cause is unknown).
Due to genetic abnormality.
Being a family history.
Multiple endocrine neoplasia type-1 (multiple endocrine neoplasia type-1)
Carney complex
somatic mutation
=> Any abnormality seen in somatic mutation.
due to Hormonal imbalance.
Radiation exposure
Exposure to ionizing radiation in childhood increases the chances of developing pituitary tumor.
due to age and gender.
3) Explain the sign and symptoms/clinical manifestation of pituitary gland tumor. (State the symptoms and signs of pituitary gland tumor.)
=> Pituitary gland tumor due to its formation damages the surrounding parts of pituitary gland tumor so its function is altered.
headache,
difficulty seeing,
Body hair is lost.
in women :=
=> Menstruation cycle becomes irregular.
=> Milk production decreases.
in man :=
=> Facial hair is lost.
=> There is growth of breast tissues.
in women man lower sex drive.
=> Growth and development is reduced in children.
★To much ACTH (Adreno Corticotrophin Releasing Hormone) may cause:=
headache.
Loss of vision.
cushing syndrome: =
Buffalo hump (Buffalo hump:= collection of fat between the two shoulder blades),
The skin becomes thin, stretch marks of purple and pink color can be seen on the abdomen and chest.
Anxiety.
Irritability.
Depression.
★ too much Growth Hormone (GH)
Gigantism,
Acromegaly,
enlargement of extremities,
headache,
loss of vision,
Tingling sensation in hands and feet,
joint pain,
Sweat profusely.
★ Too much Hyperthyroidism
Irregular heart beat,
sweat,
sleep disturbance,
Weight loss.
★To much prolectin may cause:=
headache,
loss of vision,
Flow of milk will be lower.
Cessation of menstrual cycle and secretion of breast milk.
in man have impotence (loss of ability to have erection).
Infertility (infertility).
★ Other anterior pituitary gland tumor:=
leutenising hormone and folical stimulating hormone are secreted in small amounts.
It causes infertility.
★Posterior pituitary gland tumor:=
diabetes insipidus,
★Other general signs and symptoms are:=
nausea,
Vomiting,
confusion,
dizziness,
Seizures,
“runny” and “drippy” nose.
4) Explain the diagnostic evaluation of pituitary gland tumor. (Write diagnostic evaluation of pituitary gland tumor.)
health history and physical examination,
X Ray,
ct scan,
MRI,
biopsy,
visual field examination,
24 hours urine test,
Neurological examination,
Complete endocrinological evaluation,
blood chemistry study,
Venus Sampling for Pituitary Gland Tumor,
Visual Field Examination,
electrocardiogram,
Radiological examination,
24 hour urine test,
lumbar puncture (spinal tap),
5) Explain the management of pituitary gland tumor. Write the management of pituitary gland tumor
surgical management
Removal of tumor by surgery in pituitary gland tumor.
Transphenoidal hypophysectomy
if small tumor := perform endoscopy
if large tumor
: =perform craniotomy
medical management
Active surveillance:=
=> A person who has a pituitary tumor needs to provide active treatment.
=> Keep a person with pituitary tumor under close observation.
Radiation therapy:=
In radiation therapy, high energy x rays are used to kill the tumor.
External beam radiation therapy is used in radiation therapy.
Chemotherapy Chemotherapy is the use of medicine to remove cancerous tumors.
When chemotherapy is provided through medication and injection, it is called systemic chemotherapy.
Chemotherapy provided directly into the cerebrospinal fluid abdomen, and body cavity is called regional chemotherapy.
medication
Providing hormonal replacement therapy to the patient.
Replacement of thyroid hormone,
Replacement of adrenal hormone,
growth hormone replacement,
Testosterone in men,
Estrogen in women,
Bromocriptine and carbegoline medicine should be provided to the patient.
octeripeptide :=
should be used for the patient with pituitary tumor that secretes thyroid stimulating hormone.
6) Explain the nursing management of patients with pituitary gland tumor
1) Provide education to the patient :=
Asking to limit the patient’s activity for a temporary period of time.
Explain to the patient the need for a follow-up visit.
Provide education to patients for radiation therapy and follow-up after surgery.
Provide education to notify health care provider immediately if patient has thyroid and cortisol imbalance conditions.
2) therapeutic regimens:=
Providing patient education about hormonal replacement therapy.
Provide patient education about the signs and symptoms of thyroid and cortisol hormone deficiency and to notify the health care provider immediately if they occur.
Demonstrating the correct method of administering a patient’s prescribed medication.
3) Care of patients after resection of pituitary tumor:=
1) Maintain Airway of patients
=> Patient’s airway should be kept properly patent.
=> Suctioning the mouth and throat to keep the patient’s airway patent.
=> Gently percuss the patient in the chest.
=> Administration of oxygen to the patient.
2)Neurological status:=
=> Continuously monitor the neurological status of the patient.
=> To monitor patient’s vital signs.
3) monitor intracranial pressure:=
=> Continuously monitor the patient’s intracranial pressure.
=> Provide neutral position to the patient.
=> Assess the patient for any signs and symptoms of increased intracranial pressure.
like
Administer minitol if intracranial pressure is increased.
4) Monitoring patient’s glucose level continuously.
5) Assess the patient for any signs and symptoms of meningitis.
6) Assessing patient’s serum electrolyte level.
7) Continuously monitor the patient’s urine output.
8) Monitor patient’s serum sodium level continuously.
9) Providing intravenously to the patient.
10) Continuously monitor intake output chart of patient.
11) To monitor the laboratory investigation of the patient.
hypokalemia,
hypophosphatemia,
hypoalbuminemia,
12) Assessment of patient’s cerebrospinal fluid.
13) To assess the patient’s protein level.
14) Monitoring patient’s glucose level.
15) Perform arterial blood gas analysis (ABG testing) of the patient. To assess respiratory parameters in it.