468 UNIT IV / Responses to Altered Endocrine Function

DISORDERS OF THE PITUITARY GLAND

The pituitary gland produces hormones that affect multiplebody systems through regulation of endocrine function. Targettissues include the thyroid, adrenal cortex, ovary, uterus, mam-mary glands, testes, and kidneys. Disorders result from an ex-cess or deficiency of one or more of the pituitary hormones dueto a pathologic condition within the gland itself or to hypothal-amic dysfunction.

Although disorders of the pituitary cause diverse and seri-ous problems, they are not as common as disorders of other en-docrine glands. Hyperpituitarism and hypopituitarism are dis-cussed in this section.

THE CLIENT WITH DISORDERS OF THEANTERIOR PITUITARY GLAND

Hyperfunction of the anterior pituitary gland, characterizedby excess production and secretion of one or more trophichormones, is usually the result of a pituitary tumor or pitu-itary hyperplasia. The most common cause of hyperpitu-itarism is a benign adenoma. The manifestations result froman excess of growth hormone (GH), prolactin (PRL), orACTH.

Nursing Care PlanA Client with Addison’s Disease

A 51-year-old unemployed salesman, Mr. DonSardoff, is brought to the emergency room by his

wife, Ellen, at 8 A.M. Mrs. Sardoff tells the emergency room nursethat her husband has not been feeling well for the last week, butthat when he got up this morning, he was so weak he couldn’tdress himself and didn’t know where he was. Mrs. Sardoff also tellsthe nurse that her husband has been taking a cortisone drug fortreatment of his rheumatoid arthritis for the past 2 years, butnotes,“We didn’t have the money to buy it this month.”

ASSESSMENTOn admission to the emergency room, Mr. Sardoff is dehydrated,with dry oral mucous membranes and tongue, poor skin turgor,and sunken eyeballs. His blood pressure is 94/44, and his pulse israpid and thready. He is weak, dizzy, and disoriented about timeand place.Diagnostic tests reveal the following abnormal findingsat 8:30 A.M.:

• EKG: widening QRS complex and increased PR interval• Sodium: 129 mEq/L (normal range: 135 to 145 mEq/L)• Glucose: 54 mg/dL (normal range: 70 to 110 mg/dL)• Potassium: 5.3 mEq/L (normal range: 3.5 to 5 mEq/L)• Cortisol: 2 mg/dL (normal for A.M.: 5 to 23 mg/dL)

The medical orders for Mr. Sardoff include intravenous adminis-tration of 5% dextrose in normal saline (D5NS) at 250 mL/h and hy-drocortisone (Solu-Cortef ) 200 mg. After the fluids and medica-tion are initiated, Mr. Sardoff is moved to an in-hospital medicalbed.

DIAGNOSIS• Deficient fluid volume, related to hypovolemia secondary to ad-

renal insufficiency• Ineffective tissue perfusion: Peripheral, related to fluid volume

deficit• Anxiety, related to lack of knowledge about the effects and

treatment of adrenal insufficiency

EXPECTED OUTCOMES• Regain normal fluid balance.

• Regain normal peripheral perfusion with blood pressure withinnormal range.

• Verbalize knowledge of the causes and effects of adrenal insuf-ficiency.

PLANNING AND IMPLEMENTATION• Monitor intake and output closely.• Take and record weight at the same time daily.• Monitor blood pressure, pulses, and skin turgor every 2 hours

until stable, then 4 times a day.• Monitor electrolytes, and report abnormal results.• Discuss a diet that is high in sodium, low in potassium, and has

an increased fluid intake (3000 mL per day).Discuss the types offluids desired and the best times for intake of increased fluids.

• Assist during activity to prevent falls.• Provide verbal and written instructions, and encourage verbal

feedback about the causes and effects of the disease, the ef-fects of medications, the effects of not taking long-term corti-sone drugs, the diet, and self-care at home.

EVALUATIONFollowing treatment for acute adrenal insufficiency, Mr. Sardoff isno longer dehydrated, and his blood pressure has returned to hisnormal reading of 132/88. He is alert and oriented, and anxious tolearn to care for himself at home. After dietary instructions andteaching for self-care that included his wife, Mr. Sardoff verbalizesan understanding of his illness and the need to take his medica-tion carefully and accurately. A referral is made to a social workerfor assistance with costs of medications.

Critical Thinking in the Nursing Process1. Adrenal insufficiency is often diagnosed only when the client

becomes seriously ill in response to a stressor. Explain whythis statement is or is not true.

2. Describe the physical assessments that are found in the se-verely dehydrated client.

3. Outline a teaching plan for Mr. Sardoff with foods for a high-sodium, low-potassium diet.

See Evaluating Your Response in Appendix C.