HUMAN NEEDS

hypophysectomy (consideration) treatment for ___

• patient will need life long replacement therapy for thyroid and sex hormones and clucocorticoids

• risk of DI d/t decrease of ADH

• monitor OUP and electrolytes

• report OUP >200m;/>3hr

post-op hypophysectomy (interventions) treatment for ___

• keep HOB elevated 30 degrees

• oral care q4h

  • no tooth brushes at least 10 days

post-op hypophysectomy monitoring and assessments

monitor:

• neuro / LOC

• PERRLA

• CSF fluid

• Strict I/O

• fluids

• pain

assess

• extremity strength and reflexes

• dressing

• s/s of SIADH/ DI

post-op hypophysectomy (patient teaching)

• encourage incentive spirometer (prevent atelectasis)

avoid

• vigorous coughing/ sneezing/ nose blowing

• bending over/ straining

• toothbrushes until incision heals (at least 10 days)

Assess for CSF leakage

• monitor dressing placed under nose

• assess for frequent swallowing or nasal drop and complains of persistent HA

TEST

• urine dipstick test for glucose and protein (if positive, alert HCP)

• HOB elevated and rest if positive

• discourage all the same straining movements (nothing to increase ICP)

acromegaly

hypophysectomy

• causes immediate decrease in GH

• tissue hypertrophy reversed

• sleep apnea/ DM/ cardiac problems may persist

SIADH

(could occur after any intracranial surgery)

!!seizure precautions & fluid restriction 800-100ml/day)

monitor

• I/O

• daily weights (teach patient to take daily weight

• VS

• heart and lung sounds

D.I.

goal= hydration and electrolytes

??fluid replacemt?

Hyperthyroidism

**ABCs

• maintain airway / adeqaute ventilation

• supply oxygen

• connect to cardiac monitor and start IV

!!monitor OUP hourly

give anti-thyroid med and monitor dysrhythmias

**ensure adequate rest

• cool/ quiet room

• ice packs/ cooling blankets

• light bed coverings

prevent corneal injury (if exopthalmos)

• artificial tears

• decrease Na and increase HOB

• dark glasses

thyroidectomy indications

• large goiter causing tracheal compression

• unresponsive to antithyroid therapy

• thyroid cancer

surgery causes= rapid decrease in T3 and T4

• subtotal is preferred

thyroidectomy: preop care

**best time to educate the patient - teach back method (reinforce in post op)

• comfort and safety measures

• leg exercises and neck ROM

• head support

• post-op care routine

• review chapter 18

thyroidectomy: post op care

1. maintain patent airway and respiratory status

   1. o2/ suction equipment (safety checks!)

**assess q2h for first 24hr for signs of hemorrhage or tracheal compressions (assess site/dressing/monitor for drainage

• avoid: flexion to prevent tension on suture line

• assess speech

interventions

• assist with coughing and deep breathing

• semifowlers

• support hear and neck with pillows

monitor calcium (signs of hypocalcemia

• keep iv calcium available for immediate use

safety check

working suction

• source

• yanker

• canister

ambu bag (bag-valve mask)

oxygen source

check ABCs and be prepared (working IV/ airway)

• post surgery!!: tracheostomy tray should be added to the emergency equipment available in patients room

thyroidectomy: ambulatory care

discharge teaching

• decrease caloric intake (or rapid weight gain)

• monitor hormone balance

• some hoarseness is expected— maintain semi-fowlers

• regular exercise

• regular follow up

hypothyroidectomy- pt/caregiver teaching

importance of thyroid hormone therapy (about 6 weeks to start feeling better and may need to adjust dose in the future)

• life long adherence- written instruction (slow to process at first)

• avoid abruptly stopping and dont double up

• take in AM before breakfast

• need for regular follow up care and hormone monitoring

prevent constipation

• gradual increase in activity

• increase fiber

• stool softeners

• regular elimination times

• avoid enemas (vagal stimulation- bad if pt has heart disease)

!!comfortable and warm environment

avoid sedatives or use at lowest dose

myxedema coma

medical emergency

1st priority: ABCs

• mechanical respiratory support

• cardiac monitoring

• IV thyroid hormone replacement

• monitoring core temp

cushings symptoms

• HTN

• hyperglycemia

• hypokalemia

• buffalo hump

• moon face

• petechiae

• striae

• edema

cushing treatment

depends on cause

• if pituitary adenoma: surgical removal of tumor by transsphenoidal approach

acute care:

• pts are seriously ill

• monitor: vs/ daily wt/ glucose

• assess: s/s of inflamm/infection, pt may not have typical signs like fever

  • assess for possible DVZT/PE (sudden chest pain/dyspnea/tachypnea (increase risk of clots)

cushings pre op care (tumor removal)

• control HTN and hyperglycemia

• correct hypokalemia (monitor for arrythmias)

• HIGH protein diet to correct decrease protein

• sensitive to pts feelings about appearance (reassure appearance will return mostly back to normal)

cushings post op care (tumor removal)

initiate VTE prophylaxis

• increase risk for

  • hemorrhage

  • large release of hormones into blood (instabilized BP/ fluid balance/ lyte levels)

    • BED REST UNTIL BP IS STABILIZED

  • problems with glycemic control

  • infection (subtle signs- may not be normal fever, normal inflammatory responses are suppressed)

Addison’s disease symptoms

• hypoglycemia

• hyperkalemia

• postural hypotension

• hyponatremia

• fatigue and weakness

• bronze skin pigmentation

Addison’s disease (acute care)

• frequent monitoring

• prevent infection and injury

  • stresses increase need for steroid and may precipitate crisis

  • assist with daily hygiene

  • protect from extremes (light/noise/temp)

• correct fluid and electrolyte imbalance

  • vs and neuro

  • daily wt/ i/o

• watch for signs of cushings!!

Addison’s disease (patient teaching)

• report s/s of cortisol deficiency (worsening addisons)

• most common cause of cushings is LT steroid therapy for chronic condition (never stop abruptly)

• may need to increase dose in time of stress

  • fever/flu/tooth pull/ vigourous activity

  • written instructions on when to change to dose

addisonian crisis

shock!!
- if pt is profoundly hypotensive DO NOT MOVE THE CLIENT unless necessary until stabilized

pheochromocytoma

• rare

• excess catecholamines

• priority-= severe HTN

• monitor glucose levels