MEDICAL SURGICAL NURSING 2 PRELIMS

LECTURE 07

[TRANS] TOPIC: ENDOCRINE SYSTEM

ENDOCRINE SYSTEM PITUITARY GLAND

1. Pituitary
● also known as the “master gland” Anterior Lobe
because it controls the activity of most
➔ Also known as “adenohypophysis”
other hormone-secreting glands.
2. Thyroid Gonadotropic also known as “growth
● located in the front of the neck, (somatostatin) or hormone”
Somatotropic
wrapped around the windpipe
Hormone
(trachea)
● plays a major role in the metabolism, Thyroid Stimulating stimulates thyroid gland when
growth, and development of the Hormone (TSH) its time to secrete the 3
human body hormones
● 3 hormones: Thyroxin (T4),
Triiodothyronine (T3), Thryrocalcitonin Adreno-Cortico regulates adrenal gland
Tropic Hormone
3. Parathyroid
(ACTH)
● located behind the thyroid glands in
the neck Melanocyte melanin (skin pigmentation); ↓
● produces parathyroid hormone, which Stimulating Hormone melanin = albinism
increases levels of calcium in the (MSH)
blood
4. Adrenal Luteinizing Hormone responsible for ovulation
(LH)
● also known as suprarenal glands,
● small, triangular-shaped glands Follicle Stimulating Female: helps stimulate
located on top of both kidneys Hormone (FSH) ovarian follicle release
● help regulate your metabolism,
immune system, blood pressure, Male: spermatogenesis
response to stress and other essential
functions Interstitial Cell primarily affect males;
Stimulating Hormone regulates secretion of
5. Pancreas
(ICSH) testosterone
● located in the abdomen
● release substances to help with Prolactin responsible for milk
digestion and control blood sugar production
● 2 hormones: insulin and glucagon growth of mammary tissues
6. Gonads
● primary reproductive organs, are the Posterior Lobe
testes in the male and the ovaries in
the female ➔ Also known as “neurohypophysis”
Antidiuretic Hormone responsible for water
(ADH) or Vasopressin regulation
Primary Thyroid Secondary Thyroid
Disorder Disorder
Oxytocin for milk ejection; uterine
contraction; sperm transport
the problem is in the the problem lies in the
gland itself (thyroid) pituitary gland
*nipple-rolling (or
breastfeeding) stimulates the
release of oxytocin after
delivery

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 THYROID
inside cell via active transport

Thyroxin (T4) heat production; catabolic Glucagon Alpha cells

hyperglycemic agent
Triiodothyronine metabolic stores glycogen
(T3) hypothyroidism – weight gain helps increase blood sugar level
hyperthyroidism – fast
metabolism; weight loss GONADS
Thyrocalcitonin regulates calcium
↓ Ca = ↑ P Ovaries

*when there’s too much serum Estrogen and stimulates female secondary sex
Ca, it helps the bones absorb Progesterone characteristics
excess Ca
Testes
PARATHYROID Testosterone stimulates male secondary sex
characteristics
Parathormone ↑ Ca = ↓ P

*when serum Ca gets too low DIAGNOSTIC ASSESSMENT

it takes Ca from the bones Hematologic
and puts it in the blood
➔ checks on adrenal and gonads
Hyperparathyroidism – prone
to pathological fracture Radiologic
(brittleness of bones)
➔ one of the most common diagnostic
assessment
ADRENAL ➔ X-Ray
● remove metallic objects
➔ MRI
Cortex
● if with contrast dye, assess for
Glucocorticoids Glucogenesis – conversion allergies (seafood)
of simple sugar to glucose ➔ CT scan
● assess if claustrophobic
Mineralocorticoids seretes aldosterone ● instruct the the patient will hear noise
(regulates sodium)
↑ aldosterone = Na retention
Water Deprivation Test
= K excretion
➔ to determine if (+) for Diabetes Insipidus
Androgens and secondary sex ➔ NPO – for 4 to 18 hours
Estrogens characteristics
➔ (+) if: ↑ urine output; ↓ urine specific gravity
Medulla

Epinephrine or released when stressed

Adrenaline ↑ blood pressure
↑ heart rate
bronchodilation

PANCREAS

Islets of Langerhans – GABI

Insulin Beta cells

hypoglycemic agent
↓ blood sugar – glucose goes directly

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 DISORDERS OF THE PITUITARY GLAND
GROWTH AND DEVELOPMENT
ANTERIOR PITUITARY GLAND DISORDERS
Hypersecretion of Anterior Pituitary Gland
(Hyperpituitarism)
GIGANTISM
➔ Hypersecretion of growth hormone
(somatostatin)
➔ hypersecretion happened when the epiphyseal
plate is still open (closes at 18-20 years old)
➔ Problem: anterior pituitary tumor
Epidemiology:
● Occurs equally in men and women
● 3 cases per 1 million per year
Assessment Findings:
● Height beyond maximum upper percentile
● Proportional (symmetrical) weight and muscle
growth
Medical Management:
● Surgery to remove tumor
● Radiation therapy if there is no tumor
● WOF: Signs of ↑ ICP (projectile vomiting,
altered LOC, lethargy)
ACROMEGALY
➔ is the hypersecretion of growth hormone by
the anterior pituitary gland in adult (when the
epiphyseal plate is closed)
Epidemiology:
● Occurs equally in men and women
● 3 cases per 1 million per year
● Average age of diagnosis is 42 years old
● 5 to 10 years before diagnosis
Assessment Findings:
● Increased growth – bone growth is vertical
● Large, thick hands and feet – prominent jaw
● Visual disturbances
● Hypertension, hyperglycemia
● Organomegaly – enlarged organs
● Metabolic problem – ↓ metabolism
Diagnosis:
● Serum groth hormone
● CT scan or MRI
● Bromocriptine
➢ Admnistered SQ 3 times a day or;
➢ IM once a month
➢ dopamine-receptor agonist
➢ prevents overproduction of groth
hormone
● Surgery – transsphenoidal hypophysectomy
(at the soft palate – sphenoid sinus)
Nursing Interventions:
● Provide emotional support to clients and family
● Provide frequent skin care
● Prepare patient for surgery
Post-operative Care:
● Monitor VS, LOC, and neurologic status
● Instruct patient to AVOID sneexing, coughing,
and nose-blowing – risk for intracranial
bleeding
● Monitor development of DI – monitor I & O
● Administer prescribed medication – antibiotics,
analgesics, and steroids
● Position: Semi-Fowler’s
HYPERPROLACTINEMIA
➔ is a prolactin secreting pituitary tumor
➔ this condition is the most common pituitary
disorder
Clinical Manifestations:
● Galactorrhea – excessive milk production
● Amenorrhea or oligomenorrhea
● Decrease in testosterone in men
➢ ↓ libido, shrinking testicle, infertility,
impotence, gynecomastia
● Decrease facial and body hair, erectile
dusfunction
Diagnosis:
● Prolactinoma
● Gonadal function
● CT scan or MRI – determines exact location of
tumor
Management:
● Bromocriptine (Parlodel) – dopamine receptor
agonists. It treats hyperprolactinemia by
decreasing the amount of prolactin in the body.
● Cabergoline – lesser side effects; ↓ prolactin
secretion
● Transsphenoidal hypophysectomy
● Stereotactic radiosurgery (gamma knife)
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 Hyposecretion of Anterior Pituitary Gland Diagnostic Evaluation:
(Hypopituitarism) ● Serum osmolality – high
➢ hematocrit is concentrated –
DWARFISM hemoconcentration
➔ hyposecretion of growth hormone by the ● Urine osmolality – low
anterior lobe of the pituitary gland ➢ urine is diluted
➔ can be associated with tumor ● Measurements of serum and urine ADH
➔ not obvious after birth ● Water deprivation test
➔ noticeable if 1-year-old height is below the 3rd
percentile Nursing Interventions:
➔ delayed puberty ● Monitor VS, neurologic status, and
➔ underdeveloped jaw cardiovascular status
➔ proportioned body ● Monitor I&O
➔ if diagnosed at an early age – administration of ● Monitor urine specific gravity
growth hormone ● Provide adequate fluids
● Administer Chlorpropamide or Clofibrate (help
ACHONDROPLASIA increase the release of ADH)
➔ Abnormal bone growth that results in short ● Administer VASOPRESSIN
stature with disproportionately short arms and ➢ Desmopressin is a man-made form of
legs, and a large head. vasopressin and is used to replace a
➔ Large head with prominent forehead low level of vasopressin
➔ Normal-sized torsi with short arms and legs
➔ Frontal bossing – an unusually prominent SYNDROME OF INAPPROPRIATE ANTIDIURETIC
forehead HORMONE (SIADH)
➔ Involving oversecretion of ADH, results in
Nursing Intervention: excessive water conservation
● Interact with the child according to chronologic ➔ water retention
age or developmental level and not according
to physical appearance Assessment:
● Monitor for s/sx of additional neurologic ● Mental status changes
disorders ● Abnormal weight gain
● Keep careful records of height and weight ● Hypertension
● Encourage child/parents to express feeling ● Anorexia, nausea, and vomiting
● Dilutional hyponatremia – changes in mental
FLUID, ELECTROLYTES, AND ACID-BASE status, lethargy, seizure (severe)
BALANCE ● Hypervolemia – crackles upon auscultation of
the lungs, peripheral edema, bounding pulse
POSTERIOR PITUITARY GLAND DISORDERS
Diagnostics:
● Specific urine gravity – high because water is
DIABETES INSIPIDUS
retained (urine is concentrated)
➔ is a disorder of water metabolism caused by
● F & E – sodium (hyponatremia)
deficiency of ADH, also called vasopressin,
● Serum osmolality – low due to too much water
secreted by the posterior pituitary or inability of
(hemodilution)
the kidneys to respond to ADH (nephrogenic
DI)
Nursing Interventions:
● Monitor VS and neurologic status – sodium
Assessment Findings:
● Provie safe environment (seizure precaution)
● Signs of dehydration
● Administer diuretics and IVF carefully – KVO;
➢ severe: aphonia
Heplock
➢ urine output: 20 L per day
● Administer prescribed Demeclocycline to
● Muscle pain and weakness
inhibit action of ADH in the kidney
➢ ↓ K – also prone to cardiac arrest
➢ DOC: Demeclocycline
● Postural hypotension and tachycardia
● Strict I & O monitoring

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 ➢ Fluid intake: approx. 500 cc per day Medical Management:
divided by 3 ● Pharmacologic Therapy
➢ Time: 6-2; 2-20; 10-6 ➢ Synthetic levothyroxine – to increase
➢ to regulate excess fluid in the body thyroid hormone in the body
● Weigh the client daily – to check for signs of ➢ Thyroxine
hypovolemia ● Supportive Therapy
➢ Blood gas monitoring
ENERGY METABOLISM ➢ Application of external heat – due to
cold intolerance; give heat pads
DISORDERS OF THE THYROID GLAND
Nursing Management:
● Promoting Physical Comfort
HYPOTHYROIDISM
➢ Extra clothing and blankets
➔ A condition that arises from inadequate
● Monitoring Physical Status
amounts of thyroid hormone in the
Monitors the patient’s vital signs and
bloodstream.
cognitive level to detect the following:
➔ Hyposecretion of the Thyroid Gland
➢ S/sx indicating that treatment has
➔ affects women more than men
resulted in the metabolic rate
➔ prone for ↓ metabolism = weight gain
exceeding the ability of the
cardiovascular and pulmonary
Etiology:
systems to respond
1. Primary hypothyroidism – results from
➢ Monitor BP and HR
pathologic changes in the thyroid gland
➢ Massive vasodilation → shock
● may be related to surgery
(thyroidectomy)
MYXEDEMA COMA
● complication of radiation therapy
➔ A rare but serious disorder that results from
● overuse of antithyroid drugs
persistently low thyroid production.
2. Secondary hypothyroidism – results from
➔ Possible cause:
failure of the pituitary gland to secrete
➢ rapid withdrawal of medication
adequate TSH.
➢ under anesthesia
● tumor formation
➢ hypothermia (< 36°C)
Assessment:
Assessment:
● Slowed physical, mental reactions; apathy (no
● Hypotension
reaction)
● Bradycardia
● Dull. expressionless, masklike
● Hypothermia
● Irregular menstruation (amenorrhea,
● Hyponatremia
dysmenorrhea)
● Hypoglycemia
● Husky, hoarse voice
● Respiratory failure
● Slow speech (monotonous)
● Coma
● Cold intolerance – T3 & T4 is responsible for
heat production and metabolism
Interventions:
● Increased sensitivity to sedatives, narcotics,
● Main goal: MAINTAIN A PATENT AIRWAY,
and anesthetics
and increase BP
● Constipation
● Administer IV fluids as prescribed – because
● Dry hair
pt. is hypotensive
● Brittle nails
● Administer levothyroxine sodium (Synthroid)
● Bradycardia
intravenously as prescribed.
● Keep client warm – because pt. is
Diagnostic Test Results:
experiencing hypothermia
● Blood chemistry shows decreased T3 T4 and
● Monitor changes in mental status – there is CV
sodium levels, and increased TSH and
deterioration (may lead to coma)
cholesterol levels
● Monitor electrolytes and glucose levels.
● RAIU (radioactive iodine uptake) is decreased
● Administer glucose as medication – dextrose
● Electrocardiogram (ECG) – to monitor
(IV)
bradycardia

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 ● Monitor BP, HR, body temperature Nursing Management:
● Nutritional assessment to control weight loss
HYPERTHYROIDISM ● Assessment of physical limitations and plan to
➔ Also called “Grave’s disease”, “Basedow’s ensure adequate time for rest
disease”, thyrotoxicosis, or exophthalmic ● Maintains the environment at a cool,
goiter (toxic nodular goiter) comfortable temperature, and changes
➔ Hypersecretion of the Thyroid Gland bedding and clothing as needed (pt. is
diaphoretic)
Assessment: ● Goal: increase caloric intake
Thyroidal disturbances ➢ 4000 - 6000 kcal per day
● Restlessness, nervousness, irritability, ● Monitor weight every day
agitation
● Fine tremors Medical Management:
➢ place pt. hands on their lap and ● Pharmacologic Therapy
observe if the hands are moving even ➢ Radioactive Iodine Therapy
if it is at rest ➔ Resolution of symptoms in 3
● Tachycardia to 4 weeks
● Fine silky hair ➔ given to a patient who can’t
● Pliable nails take medications (e.g. elderly)
● Hypertension ➢ NPO: 8 hours
● Heat intolerant ➢ Give medication at let it stay in the
● Weight loss body for 12-24 hours
● Diaphoretic ➢ Thyroid scan: to check if there is
overreaction of iodine
Opthamopathy ➢ Check after 2 hours of administration
● Exophthalmos – accumulation of fats behind ➢ Check again after 6 hours of
the eyes pushing the eyes out administration
➢ prone to corneal ulceration because of ➢ Last check after 24 hours of
the inability to fully close the eyelids → administration
dry eyes ● Antithyroid Medications
➢ corneal ulcer may lead to blindness ➢ Propythiouracil (PTU) – decreases
● Von Graefe’s sign – lagging of the upper production/secretion of thyroid
eyelid on the downward rotation of the eye, hormone
indicating exophthalmic goiter (Graves' ➢ Methimazole – prevents
Disease) synthesis/action of thyroid hormone
➢ Lid lag phenomenon ● Adjunctive Therapy - alternative therapy
● Joffroy sign – absent wrinkling of the forehead ➢ Iodine and iodine compounds –
when a patient with Graves Ophthalmopathy potassium iodine
looks up with the head bent forwards ➢ Beta-blockers – controlling the
● Dalyrimple’s sign (thyroid stare) – Dalrymple sympathetic nervous system effects of
sign: Widened palpebral tissue (lid retraction) hyperthyroidism; ↓ BP, ↓ HR; check BP
or lid spasm causing abnormal wideness of do not give if its too low
the palpebral fissure. ➢ Lugol’s solution – contains iodine and
➢ As a result of the retraction of the potassium iodide; will try to shrink
upper eyelid, the white of the sclera is thyroid gland; prevents release of
visible at the upper margin of the thyroid hormone
cornea in direct outward stare ● Thyroidectomy
Dermopathy ➢ Pregnant women allergic to antithyroid
● Warm, flushed sweaty skin medications
● Skin is hyperpigmented ➢ Pt. with large goiters

Diagnotic Test Results:

● Serum thyroid function test revealed increased
T4 and T3 levels.
● RAIU increased uptake.

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 THYROID STORM Assessment Findings:
➔ A form of severe hyperthyroidism, usually of ● Signs of HYPOcalcemia
abrupt onset. ➢ Trousseau's sign (carpopedal spasm)
➔ Critically ill and requires astute observation induced by pressure applied to the
and aggressive and supportive nursing care arm by an inflated
during and after the acute stage of illness sphygmomanometer cuff
➢ Chvostek's sign (twitching of facial
Clinical Manifestations: muscles in response to tapping over
● High fever (> 38.5 °C) – monitor body the facial nerve
temperature ● Numbness and tingling sensation on the face
● Extreme tachycardia (̴ 130 bpm) ● Muscle cramps – increased neuromuscular
● Exaggerated symptoms of hyperthyroidism excitability that triggers the involuntary
with disturbances of a major system contraction of the muscles, which eventually
● if left unrated, it could be fatal leads to tetany
● Diarrhea, weight loss ● Cardiac dysrhythmias – Ca is needed for heart
● Psychosis, comatose contraction
● Hypotension
Management: ● Anxiety, irritability, and depression
Immediate objectives ● Increased bone density – serum Ca went into
● Goal: ↓ BP, ↓ body temperature the bones
● A hypothermia mattress or blanket, ice packs, ● WOF: dysphagia – a sign of laryngospasm
a cool environment, hydrocortisone, and ● Pt. is prone to LARYNGOSPAM and
acetaminophen BRONCHOSPASM
● Humidified oxygen
Things to have on-standby at the bedside:
● IV fluids containing dextrose
● PTU or Methimazole 1. Tracheostomy set
● Hydrocortisone 2. Incubation set
● Iodine 3. Suction & oxygen
4. Calcium gluconate
Medical Management:
Total Thyroidectomy – after surgery: Diagnotic Test:
● radioactive ablation therapy ● Decreased PTH
● thyroid hormone in suppressive doses to lower ● Decreased serum Ca and elevated serum P
TSH levels
● exogenous thyroid hormone permanently to Medical Management
avoid hypothyroidism ● Raise the serum calcium level
● total body scan 2 to 4 months to detect ● Eliminate the symptoms of hypoparathyroidism
metastasis (thyroid cancer) and hypocalcemia
● Administer calcium gluconate intravenously
Nursing Management: ● Parenteral parathormone
Providing Preoperative Care ● Goal: increase Ca intake
● High daily caloric intake (4000-6000 kcal), high ➢ best source: green-leafy vegetable
in carbs and proteins ➢ fish (tuyo, dilis); not just milk because
● Avoid tea, coffee, cola, and other stimulants – it contains phosphate
because they increase HR
● Check for bleeding Nursing Interventions
● Monitor VS and signs of HYPOCALCEMIA
DISORDERS OF THE PARATHYROID GLAND ● Initiate seizure precautions and management
● Provide a HIGH-calcium and LOW-phosphate
HYPOPARATHYROIDISM diet
➔ Disorder characterized by hypocalcemia ● Advise client to eat Vitamin D-rich foods (for
resulting from a deficiency of parathormone calcium absorption)
(PTH) production.
➔ May be due to surgery – accidental removal of
the parathyroid gland during thyroidectomy

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 HYPERPARATHYROIDISM ➢ to prevent loss of Ca in the bones
➔ Overproduction of parathyroid hormone by the ● Diet and Medications
parathyroid glands characterized by bone ➢ prune juice, stool softeners, and
decalcification. physical activity, along with increased
➔ Complication: kidney stones/renal calculi fluid intake
➢ decrease or restrict Ca
Pathophysiology of Hyperparathyroidism
➔ Excessive PTHY promotes an increased bone Nursing Interventions:
resorption (bone “destruction”) or ● Monitor VS, cardiac rhythm, I&O
hypercalcemia and hypophosphatemia. ● Monitor for signs of renal stones (i.e.
hematuria, flank pain), skelatal fractures (due
Assessment Findings: to decreased bone density)
● Signs of HYPERcalcemia ● Strail all urine – monitor stone formation
● Fatigue and muscle weakness/pain – due to ● Provide adeqaute fluids – force fluids (2-3 L
decreased bone density per day)
● Skeletal pain and tenderness
● Fractures DISORDERS OF THE ADRENAL GLANDS
● Anorexia, N/V. epigastric pain
ADRENAL CORTEX DISORDERS
● Constipation
● Hypertension
HYPOALDOSTERONISM
● Cardiac dysrhythmias
➢ Addison's disease, also called adrenal
● Renal stones
insufficiency
➢ Hyposecrestion of adrenal cortex hormones
Diagnostic Study Findings:
(glucocortcoids and mineralocorticoids)
● Total and ionized serum calcium levels are
➢ Decreased aldosterone (regulates Na,
elevated
removes excess K)
● Radiograph or bone mineral densitometry
➢ Common cause: TB, fungal infection,
detects bone demineralization
malignant/benign neoplasms
● PTH levels are elevated
● Parathyroid scan possibly detects abnormal
findings ADRENAL CORTEX ADRENAL MEDULLA
(OUTER) (CENTER)
Complication:
produces hormones that produces hormones
HYPERCALCEMIC CRISIS controls sex (androgens, involved in the
➔ results in neurologic, cardiovascular, and renal estrogens), salt balance fight-or-flight response
symptoms that can be life-theratening in the blood (catecholamines, or
➔ serum Ca: 15 mg/dL (aldosterone), and sugar adrenaline type
Treatment: balance (cortisol) hormones such as
● Rehydration with large volumes of IV fluids epinephrine and
● Diuretic agent norepinephrine)
➢ Loop diuretics
➢ never give thiazides because it retains Assessment:
Ca ● Hyponatremia
● Hyperkalemia
Medical Management: ● Hypoglycemia
● Hydration Therapy ● Fatigue, muscle weakness
➢ fluid intake of 2000 mL or more ● Anorexia, N/V, weight loss (where Na goes,
➢ cranberry juice (acid-ash diet) to lower water follows)
urinary pH – to prevent calcium ● Signs of dehydration
oxalate ● Hypotension, weak pulse
● Mobility ● Bronze pigmentation of skin – stimulates
➢ mobility of the pt. with walking or use pituitary to produce MSH
of a rocking chair for those with limited ➢ skin color: eternal tan
mobility
➢ active/passive ROM

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 ● Inability to cope with stress – decreased ➢ do NOT give loop diuretics
cortisol, a hormone released during stressful ● Maintain sodium-restricted diet
situations ● Prepare patient for possible surgical
● Note the generalized skin pigmentation (in a interventions (removal of a pituitary tumor or
Caucasian pt.) but especially the deposition in adrenal gland)
the palmer skin creases, nails, and gums.
CUSHING’S DISEASE
Nursing Interventions: ➔ A condition resulting from the hypersecretion
● Administer hormone replacement therapy of glucocorticoids from the adrenal cortex
(HRT) as ordered.
➢ Glucocorticoids – to stimulate diurnal Assessment Findings:
rhythm of cortisol release; ● Generalized muscle weakness and wasting
Hydrocortisone ● Truncal obesity
➢ Mineralocorticoids – ● Moon face
Fludrocortisone Acetate (increase ● Buffalo hump
the release of cortisol and glucose) ● Easy bruisability
● Monitor vital signs – HR, BP (there’s ● Reddish-purplish striae on the abdomen and
hypotension); arrhythmia d/t excess potassium thigs – stretch marks d/t water retention
● Decrease stress in the environment ● Hypertension
● Prevent exposure to infections – due to ● Hyperglycemia
decreased cortisol ● Osteoporosis
● Provide rest periods
● Monitor intake and output Nursing Interventions:
● Weigh daily – expect weight loss ● Monitor I&O, weight, and VS
● Monitor lab values
HYPERALDOSTERONISM ● Provide meticulous skincare (stretch marks)
➔ also called Conn's syndrome ● Protect patient from infection
➔ Hypersecretion of aldosterone from the ● Improve body image
adrenal cortex of the adrenal gland.
➔ May be due to tumor: primary (adrenal) or RESPONSE TO STRESS AND INJURY
secondary (pituitary)
➔ Expect: ↑ Na; ↓ K PHEOCHROMOCYTOMA
➔ Due to an increased secretion of
Assessment Findings: cathecolamines
● Signs of HYPOkalemia ➔ Peak incidence: ages 20 to 50 years
➢ muscle weakness ➔ The main catecholamines are epinephrine
➢ arrhythmias (adrenaline), norepinephrine (noradrenaline),
➢ paralytic ileus and dopamine.
● Hypervolemia
● Hypertension
5 H’s
● Hypernatremia 1. Hypertension
● Headache, N/V 2. Headache
● Visual changes 3. Hyperhydrosis
● Muscle weakness, fatigue, and nocturia 4. Hypermetabolism
5. Hyperglycemia
Nursing Interventions:
● Monitor VS with I&O Assessment Findings:
● Monitor serum K and Na ● Severe headache, apprehension, palpitation,
● Provide potassium-rich foods and profuse sweating, nausea
supplements ● Hypertension, tachycardia, vomiting,
➢ Kalium Durules hyperglycemia
➢ KCl drip ● Dilation of pupils, cold extremities
● Administer prescribed diuretic
➢ potassium-sparing (Spironolactone)
– retains K, removes excess water

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Diagnotic Test:
● Vanillylmandelic Acis Test (VMA) – checks
for the presence of catecholamines in the
blood
➢ avoid stimulants (e.g coffee)
➢ insert the needle, delay blood
collection for 30 minutes
● Clonidine Suppression Test – centrally actin
adrnergic blockers suppress the release of
catecholamine
➢ blocks catecholamine
➢ decreases BP, HR
● CT scan, MRI, and ultrasound – localizes the
pheochromocytoma
● Urinalysis: glycosuria (increased serum
glucose)

Collaborative Management:
Medical Management
● Pharmacologic Therapy
➢ Phentolamine (Regitine)
➢ Na Nitroprussine (Nipride)
● Surgery
➢ Adrenalectomy
➢ Monitor for shock d/t sudden drop of
catecholamines in the body

Nursing Interventions:
● Monitor VS
● Administer medication as ordered to control
hypertension
● Promote rest; decrease stressful stimuli
● Provide high calorie, well-balanced diet
● Provide care for the client with adrenalectomy
as ordered
● Teaching the client self-care:
➢ emphasize the importance of periodic
follow-up care
➢ provide instructions on corticosteroid
therapy
➢ teach the client and family on how to
measure the client’s BP

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