RNSG 2432 - Enhanced Concepts of Adult Health

Module 18:  Nursing Care of the Individual Experiencing an Endocrine Disorder:  Pituitary and Adrenal

 

Module Objectives:  

Utilizing critical thinking and the nursing process, the student is expected to:

1. Compare and contrast risk factors associated with endocrine disorders:

  • Pituitary

  • Adrenal

2. Analyze the etiology and pathophysiology for the following disorders:

3. Analyze signs and symptoms and complications of the following disorders:

  • Pituitary disorders

    • Anterior pituitary: excessive growth; reproductive/sexual changes
    • Posterior pituitary: serum osmolality- fluid and electrolyte changes
  • Adrenal disorders

    • Cushing's: exaggerated cortisol action on all body systems
    • Hyperaldosteronism (may be known as Conn's disease): excessive aldosterone release
    • Addison's: elevated ACTH, decreased aldosterone and cortisol, on all body systoms, Addisonian crisis.
    • Pheochromocytoma: adrenal medulla; increased catecholamines, paroxysmal hypertension (life threatening)

4. Integrate the diagnostic tests with the etiology, pathophysiology, and signs and symptoms for the following disorders:

  • Pituitary disorders: endocrine testing; posterior-osmolality/electrolytes

  • Adrenal disorders

    • Cushing's: Plasma cortisol and ACTH levels; 24 hr urine; serum electrolytes and glucose, ACTH suppression test.
    • Hyperaldosteronism: Serum electrolytes, plasma aldosterone, urine potassium, adrenal scan.
    • Addison's: Serum cortisol, glucose, sodium, potassium, ACTH; BUN; urine 17-KS, 17-OHCS, head CT.
    • Pheochromocytoma: Serum and urine catecholamine levels; X-ray.

5. Formulate relevant prioritized nursing diagnoses that address physical, psychosocial, and learning needs.

  • Pituitary

    • Anterior:

      • Ineffective coping

    • Posterior:

      • Fluid and electrolyte imbalance

  • Adrenal disorders

    • Cushing's:

      • Fluid volume excess

      • Impaired skin integrity

      • Risk for infection

      • Disturbed body image

    • Addison's:

      • Deficient fluid volume
      • Risk for ineffective therapeutic regimen management
    • Hyperaldosteronism
      • Risk for fluid and electrolyte imbalance
      • Risk for injury/ arrhythmias.
    • Pheochromocytoma:
      • Hypertension

6. Formulate client and family centered goals that assist toward health promotion, maintenance, and/or restoration

7. Prioritize and evaluate nursing interventions related to:

  • Drug therapy

    • Pituitary disorders: symptom control

    • Adrenal disorders

    • Cushing's: symptom control
      • Hyperaldosteronism: symptom control
      • Addison's: replacement corticosteroids and mineralocorticoids
      • Pheochromocytoma: symptom control
  • Diet therapy

    • Pituitary disorders
    • Adrenal disorders
      • Cushing's
      • Hyperaldosteronism: potassium supplements
      • Addison's: increase sodium in diet
      • Phenochromocytoma
  • Surgical/Medical interventions

    • Pituitary disorders:
      • Removal or radiation of pituitary tumor
      • Transsphenoidal hypophysectomy
    • Adrenal disorders
      • Adrenalectomy
  • Patient teaching; therapeutic communication

  • Consider human and material resources, including delegation
  • Referrals
  • Other

8. Evaluate and revise goals and modify the nursing care plan specific to the individual experiencing pituitary or adrenal disorders.

9. Integrate associated issues and trends into nursing practice

  • Legal
  • Ethical considerations

Learning Activities:

1. Review module objectives.

2. Learning Resources:

Required: 

  • *Access Lewis Student Resources-Ch50> Prepare for Class, Clinical,Lab> Case Studies-complete Case Study-Ch50-Patient with Addisons, Patient with Cushings

3. Complete Critical Thinking Exercises:

Case studies/Critical thinking

Interactive/games

4. Supplemental Learning:

Web sites/References (opt)

5. Review module objectives and check for knowledge gaps.

  • Bridge to NCLEX questions-Lewis p. 1217 ck rationale- Student Resources Ch 48; click on Prepare for Class, Clinical, Lab

6. Complete module quiz

  • Blackboard: Adrenal and Pituitary
  • Bridge to NCLEX p.1285 ck rationale- Student Resources Ch 50; click on Prepare for Class, Clinical, Lab
  • Lewis- Student Resources ch 50>Prepare for Exam; complete exam