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:

• Pituitary disorders:
  • Anterior Pituitary:
    • Gigantism
    • Acromegaly
  • Posterior pituitary:
    • Syndrome of Inappropriate ADH (SIADH)
    • Diabetes Insipidus
• Adrenal disorders:
  • Cushing's Syndrome (adrenal cortex)
  • Hyperaldosteronism  (adrenal cortex)
  • Addison's Disease     (adrenal cortex)
  • Pheochromocytoma (adrenal medulla)

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: