CARE OF CLIENTS WITH PROBLEM IN

NUTRITION, AND GASTRO-INTESTINAL,

METABOLISM AND ENDOCRINE,
PERCEPTION AND COORDINATION, (ACUTE
AND CHRONIC))
STUDENT’S ACTIVITY SHEET
BS NURSING / THIRD YEAR
Session # 13 (2 hours and 30 minutes)

Materials:
LESSON TITLE: DISORDERS OF PITUITARY AND THYROID Book, pen and notebook, projector
GLANDS

LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can:
1. Differentiate the clinical manifestations of the disorders.
2. Identify the different medical and nursing management of the References:
disorders.
Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K.
3. Recognize the characteristics of each disease.
(2008). Brunner &Suddarth’s Textbook of
4. Determine the appropriate nursing diagnoses of each
Medical-Surgical Nursing 12th Edition.
disease.
Lippincott Williams &Wilkins
5. Identify the medical-surgical and nursing management of
pituitary and thyroid tumors.

LESSON REVIEW / PREVIEW OR HOOK ACTIVITY (1 minute)

Encircle the hormones secreted by the posterior pituitary gland.
Vasopressin Follicle- stimulating hormone Growth hormone
Thyroid-stimulating hormone Prolactin Oxytocin

MAIN LESSON (2 hours and 4 minutes)

The students will study and read their book about this lesson (Chapter 42 of the book).

DISORDERS OF PITUITARY GLANDS

PITUITARY TUMORS
Pituitary tumors are usually benign and may be primary or secondary.

Clinical Manifestations
1. Eosinophilic tumors
- Occurs early in life: gigantism: more than 7 feet tall and large in all proportions; weak and lethargic; can
hardly stand
- Occurs during adult life: acromegaly: excessive skeletal growth in the feet, hands, superciliary ridge, molar
eminences, nose, and the chin
- Enlargement involves all tissues and organs; severe headaches; visual disturbances (central vision and
visual fields may reveal loss of color discrimination, diplopia, or blindness in a portion of a field of vision)
- Decalcification of the skeleton; muscular weakness; and endocrine disturbances, similar to those occurring
in patients with hyperthyroidism, also are associated with this type of tumor.
2. Basophilic tumors
- Give rise to Cushing’s syndrome with features largely attributable to hyperadrenalism, including
masculinization and amenorrhea in females, truncal obesity, hypertension, osteoporosis, and polycythemia
3. Chromophobic tumors
- Represent 90% of pituitary tumors; usually produce no hormones but destroy the rest of the pituitary gland,
causing hypopituitarism
- People with this disease are often obese and somnolent and exhibit fine, scanty hair; dry, soft skin; a pasty
complexion; and small bones.
- They also experience headaches, loss of libido, and visual defects progressing to blindness. Other signs
and symptoms include polyuria, polyphagia, a lowering of the basal metabolic rate, and a subnormal body
temperature.

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PHINMA Education (Department of Nursing) 1 of 10
 Assessment and Diagnostic Tests
1. Careful history and physical examination: assessment of visual acuity and visual fields
2. CT and MRI - to diagnose the presence and extent of pituitary tumors
3. Serum levels of pituitary hormones along with measurements of hormones of target organs (thyroid, adrenal)
- assist in diagnosis

Medical Management
1. Stereotactic radiation therapy
- Used to deliver external beam radiation therapy precisely to the pituitary tumor with minimal effect on normal
tissue.
2. Other treatments
a. Conventional radiation therapy
b. Medications like Bromocriptine (Parlodel, a dopamine antagonist), and Octreotide (Sandostatin, a synthetic
analogue of GH).
- These medications inhibit the production or release of GH and may bring about marked improvement
of symptoms.
- Octreotide and Lanreotide (Somatuline Depot, a somatostatin analogue) may also be used
preoperatively to improve the patient’s clinical condition and to shrink the tumor.

Surgical Management
Hypophysectomy
Surgical removal of the pituitary tumor through a transsphenoidal (endoscopic transnasal)
approach is the usual treatment.

SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE (SIADH) AND DIABETES INSIPIDUS (DI

SIADH DI
Excessive secretion of antidiuretic hormone (ADH) – Characterized by a deficiency of antidiuretic hormone
vasopressin. Characterized by inability to excrete dilute (vasopressin), leading to polydipsia and large volumes of
urine, retention of fluids, and a dilutional hyponatremia dilute urine.

Causes
bronchogenic carcinoma in which malignant lung cells
synthesize and release ADH; head injury; brain surgery or
tumor, and infection; medications: Vincristine (Oncovin),
Phenothiazines, Tricyclic antidepressants, Thiazide
diuretics
Causes
head trauma, brain tumor, surgical ablation, or irradiation of
posterior pituitary gland, meningitis, encephalitis,
nephrogenic forms: hypokalemia, hypercalcemia, lithium,
demeclocycline

Clinical Manifestations Clinical Manifestations

concentrated urine; weight gain; edema; jugular vein very diluted or water-like urine; polyuria; polydipsia (2-
distention; tachypnea; tachycardia; rales; hypertension; 20L/day); weight loss; hypotension; dehydration; poor skin
mental status changes turgor; dry mucous membranes, muscle pain and
weakness
Assessment and Diagnostic Findings
1. Serum electrolytes: dilutional hyponatremia, Assessment and Diagnostic Findings
hyperkalemia 1. Fluid deprivation test: withholding fluids for 8 to 12 hours
2. Increased urine specific gravity, osmolality, sodium Findings:
3. Decreased serum osmolality - decreased urine specific gravity (1.006 or less),
4. Plasma levels of ADH osmolality, sodium
- increased serum osmolality
- hypernatremia, hypokalemia
2. Plasma levels of ADH
Medical Management
1. Pharmacologic Medical Management
Furosemide (Lasix) Objectives: (1) to replace ADH, (2) to ensure adequate
2. Electrolyte replacement fluid replacement, and (3) to identify and correct the
3. Fluid and Na restriction underlying intracranial pathology
4. Hypertonic IVF 1. Pharmacologic

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PHINMA Education (Department of Nursing) 2 of 10
 Desmopressin (DDAVP): a synthetic vasopressin,
Nursing Management intranasally every 12 to 24 hours; causes
1. Monitor vital signs vasoconstriction
2. Daily weights Vasopressin (Pitressin): used if the intranasal route is
3. Monitor intake and output not possible; IM every 24 to 96 hours; vial of
4. Monitor serum electrolytes medication should be warmed or shaken vigorously
5. Monitor urine values before administration; administered in the evening;
6. Assess neurologic status causes abdominal cramps
Clofibrate (Atromid-S): a hypolipidemic agent; with
antidiuretic effect
Chlorpropamide (Diabinese): used in mild forms of the
disease because they potentiate the action of
vasopressin; hyperglycemia is possible
2. IVF
3. Electrolyte Replacement

Nursing Management
1. Monitor vital signs
2. Daily weights
3. Monitor intake and output
4. Monitor serum electrolytes
5. Observe signs of dehydration
6. Monitor urine values
7. Encourage medical bracelet alert

DISORDERS OF THE THYROID GLANDS

THYROID TUMORS

ENDEMIC (IODINE-DEFICIENT) GOITER

The most common type of goiter, once encountered chiefly in geographic regions where the natural supply
of iodine is deficient.
- Caused by an iodine deficiency; intake of large quantities of goitrogenic substances (excessive
amounts of iodine or lithium, which is used in treating bipolar disorders).
- Such goiters usually cause no symptoms, except for the swelling in the neck, which may result in
tracheal compression when excessive.
- Many goiters of this type recede after the iodine imbalance is corrected.

Medical Management
1. Supplementary iodine, such as SSKI to suppress the pituitary’s thyroid-stimulating activity.
2. Ensure a preoperative euthyroid state through treatment with antithyroid medications and iodide to
reduce the size and vascularity of the goiter before surgery to minimize postoperative complications.
3. Provide children in iodine-poor regions with iodine compounds to prevent simple or endemic goiter.
Introduction of iodized salt has been the single most effective means of preventing goiter in at-risk
populations.

NODULAR GOITER
Some thyroid glands are nodular because of areas of hyperplasia (overgrowth). No symptoms may arise
as a result of this condition, but not uncommonly these nodules slowly increase in size, with some descending into
the thorax, where they cause local pressure symptoms. Some nodules become malignant, and some are associated
with a hyperthyroid state. Therefore, the patient with many thyroid nodules may eventually require surgery.

THYROID CANCER
Cancer of the thyroid is much less prevalent than other forms of cancer; however, it accounts for 90% of
endocrine malignancies.
- With one fourth of the cases occurring in men and three fourths in women.
- External radiation of the head, neck, or chest in infancy and childhood increases the risk of thyroid
carcinoma. The incidence of thyroid cancer appears to increase 5 to 40 years after irradiation.

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PHINMA Education (Department of Nursing) 3 of 10
 Consequently, people who underwent radiation treatment or were otherwise exposed to radiation as
children should consult a physician, request an isotope thyroid scan as part of the evaluation.

Assessment and Diagnostic Findings

1. Lesions that are single, hard, and fixed on palpation or associated with cervical lymphadenopathy suggest
malignancy.
2. Thyroid function tests
3. Needle biopsy of the thyroid gland - used as an outpatient procedure to make a diagnosis of thyroid cancer, to
differentiate cancerous thyroid nodules from noncancerous nodules, and to stage the cancer if detected.
4. Additional diagnostic studies: Ultrasound, MRI, CT, Thyroid scans, Radioactive iodine uptake studies, and
Thyroid suppression tests.

Surgical Management
Total or Near-total Thyroidectomy
- The treatment of choice for thyroid carcinoma is surgical removal.
- Efforts are made to spare parathyroid tissue to reduce the risk of postoperative hypocalcemia and
tetany.

DIAGNOSTIC TESTS for Thyroid Problems

The most widely used tests are serum immunoassay for TSH and free T4. Measurement of TSH has a
sensitivity of 98% and specificity of greater than 92%.

1. Thyroid-stimulating hormone (TSH): Normal 0.4 to 4.0 mU/L

Best screening test for thyroid function; used for monitoring thyroid hormone replacement
2. Serum Free T4: Normal: 0.9 to 1.7 ng/dL
Active fraction and most commonly used to confirm an abnormal TSH; a direct measurement of unbound Thyroxine;
the procedure of choice for monitoring changes in T4 secretion during treatment of hyperthyroidism
3. Serum T3: Normal: 70 to 220 ng/dL
More accurate indicator of hyperthyroidism
4. Serum T4: Normal range: 4.5 to 11.5 ug/dL
5. T3 Resin Uptake Test: Normal: 25%-35%
Useful in the evaluation of thyroid hormone levels in patients who have received diagnostic or therapeutic doses of
iodine.
6. Thyroid Antibodies
Are positive in chronic autoimmune thyroid disease (90%), Hashimoto’s thyroiditis (100%), Graves’ disease (80%)
7. Radioactive Iodine Uptake
Measures the rate of iodine uptake by the thyroid gland. The patient is administered a tracer dose of iodine
123 (123I) or another radionuclide, and a count is made over the thyroid gland with a scintillation counter, which
detects and counts the gamma rays released from the breakdown of 123I in the thyroid.
8. Fine-Needle Aspiration Biopsy
Accurate method of detecting malignancy.
9. Thyroid Scan, Radioscan, or Scintiscan
Are helpful in determining the location, size, shape, and anatomic function of the thyroid gland, particularly
when thyroid tissue is substernal or large. Identifying areas of increased function (“hot” areas) or decreased function
(“cold” areas) can assist in diagnosis.

HYPERTHYROIDISM HYPOTHYROIDISM
Excessive secretion of thyroid hormones. It is the second A deficiency in thyroid hormones
most prevalent endocrine disorder, after diabetes mellitus. Types
1. Primary Hypothyroidism
Graves’ disease: the most common type of 2. Secondary/Pituitary Hypothyroidism
hyperthyroidism 3. Tertiary/Hypothalamic Hypothyroidism
4. Cretinism

Risk Factors/Causes Risk Factors/Causes

Women; between 40 and 70 years; Autoimmune disease
(Hashimoto’s thyroiditis, post-Graves’ disease); Atrophy of

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PHINMA Education (Department of Nursing) 4 of 10
Women; Stress; Infection; Inflammation after irradiation of
the thyroid; Destruction of thyroid tissue by tumor;
Excessive administration of thyroid hormone for treatment
of hypothyroidism
Clinical Manifestations
Thyrotoxicosis: Nervousness; Emotionally hyperexcitable;
Irritable; Apprehensive; Cannot sit quietly; Palpitations;
Increased temperature, pulse, and blood pressure (heart
failure/atrial fibrillation); Heat intolerance; Flushed warm
skin; Dry skin and diffuse pruritus; Fine tremor of the hands;
May exhibit exophthalmos (bulging eyes: irreversible);
Increased appetite; Weight loss; Abnormal muscular
fatigability and weakness; Amenorrhea; Osteoporosis
and fracture; Diarrhea; Increased perspiration
Thyroid Storm
A life-threatening condition manifested by cardiac
dysrhythmias, tachycardia, fever, and neurologic
impairment
Assessment and Diagnostic Findings
Thyroid gland invariably is enlarged, soft and may pulsate;
a thrill often can be palpated, and a bruit is heard over the
thyroid arteries.
1. TSH: decreased
2. Free T4: increased
3. T3: increased
4. T4: increased
5. T3 Resin Uptake Test: increased
6. Thyroid Antibodies: Are positive in chronic autoimmune
thyroid disease (90%), Hashimoto’s thyroiditis
(100%), Graves’ disease (80%)
7. Radioactive Iodine Uptake: high uptake
Medical Management
Objective: to reduce thyroid hyperactivity, relieve symptoms
and preventing complications.
1. Radioactive iodine therapy (131I)
- used to treat toxic adenomas, multinodular goiter,
thyrotoxicosis, patients beyond the childbearing
years who have diffuse toxic goiter
- to destroy the overactive thyroid cells
- tasteless, colorless radioiodine
- 95% of patients are cured by one dose
- symptoms subside in 3 to 4 weeks
- monitor for signs of hypothyroidism
Contraindicated: during pregnancy and breast-
feeding; pregnancy should be postponed for at
least 6 months after treatment.
A major advantage: less side effects than antithyroid
medications.
3. Propylthiouracil (PTU) or Methimazole (Tapazole)
- blocks conversion of T3 and T4
- watch for fever, rash, urticaria, agranulocytosis and
thrombocytopenia
- stop medication if with pharyngitis and fever or mouth
ulcers
- PTU: drug of choice during pregnancy
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PHINMA Education (Department of Nursing)
thyroid gland with aging; Therapy for hyperthyroidism;
Thyroidectomy; Medications: Lithium, Iodine compounds,
Antithyroid medications; Radiation to head and neck;
Infiltrative diseases of the thyroid (amyloidosis,
scleroderma, lymphoma); Iodine deficiency and iodine
excess
Clinical Manifestations
Extreme fatigue; Hair loss, brittle nails, and dry skin are
common; Numbness and tingling of the finger; Husky and
hoarseness of voice; Menorrhagia or Amenorrhea; Loss of
libido: Decreased temperature, pulse rate, and blood
pressure; Weight gain; Anorexia: Expressionless and
masklike face; Cold intolerance; Apathetic; Speech is slow;
Tongue enlarges; Hands and feet increase in size;
Deafness may occur; Constipation.
Severe case:
Dementia; Inadequate ventilation and sleep apnea;
Pleural effusion; Pericardial effusion; Respiratory muscle
weakness; Hypercholesterolemia; Atherosclerosis,
Coronary artery disease, Hypothermic; Abnormally
sensitive to sedatives, opioids, and anesthetic agents
Myxedema Coma
Is a rare life-threatening condition; a decompensated
state of severe hypothyroidism in which the patient is
hypothermic, with depressed respiration, and unconscious.
Occurs most often among elderly women, precipitated by
cold.
Assessment and Diagnostic Findings
1. TSH: increased
2. Free T4: decreased
3. T3: decreased
4. T4: decreased
5. T3 Resin Uptake Test: decreased
6. Thyroid Antibodies: Are positive in chronic autoimmune
thyroid disease (90%), Hashimoto’s thyroiditis
(100%), Graves’ disease (80%)
7. Radioactive Iodine Uptake: low uptake
Medical Management
Objective: to restore a normal metabolic state by replacing
The missing hormone.
1. Synthetic levothyroxine (Synthroid or Levothroid)
The nurse must be alert for signs of angina,
especially during the early phase of treatment; it
must be reported and treated at to avoid myocardial
infarction.
Severe/Myxedema:
2. IV fluids with caution
3. ABG analysis
4. Oxygen saturation determination
5. Avoid heating pads
6. Coma: Levothyroxine [Synthyroid]) intravenously
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 4. Adjunctive Therapy
A. Iodine or iodide compounds
- decrease the release of thyroid hormones from the
thyroid gland and reduce the vascularity and size of
the thyroid (in preparation for surgery)
- are more palatable in milk or fruit juice and are
administered through a straw to prevent staining of
the teeth
- observe for the development of goiter
- cough medications, expectorants, bronchodilators,
and salt substitutes may contain iodide and should
be avoided

Compounds: Potassium iodide (KI), Lugol’s

solution, and Saturated solution of potassium iodide
(SSKI)
B. Beta-adrenergic blocking agents
Propranolol is used to control nervousness,
tachycardia, tremor, anxiety, and heat intolerance

Thyroid Storm:
5. Electrocardiographic (ECG) monitoring
6. ABG analysis
7. Pulse oximetry
8. Oxygen administration
9. IV fluids
10. Antipyretic
11. Cooling blanket
12. Patent airway

Surgical Management
Performed soon after the thyroid function has returned to
normal (4 to 6 weeks). Administration of PTU, Iodine
solutions, and Beta-blockers before surgery is needed.
Thyroidectomy
- needs thyroid hormone and calcium replacement
after surgery
- hormone levels should be monitored every 6 weeks
Complications: Hypothyroidism; Hypocalcemia;
Hypoparathyroidism

CHECK FOR UNDERSTANDING (20 minutes)

The instructor will prepare 10-15 questions that can enhance critical thinking skills. Students will work by themselves to
answer these questions and write the rationale for each question.

Multiple Choice
(For 1-15 items, please refer to the questions in the Rationalization Activity)

RATIONALIZATION ACTIVITY (DURING THE FACE TO FACE INTERACTION WITH THE STUDENTS)
The instructor will now rationalize the answers to the students (including Quiz activity) and will encourage them to ask
questions and to discuss among their classmates for 20 minutes.

1. When caring for a male client with diabetes insipidus, nurse Juliet expects to administer:
A. Vasopressin (Pitressin Synthetic).
B. Furosemide (Lasix).
C. Regular insulin.

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PHINMA Education (Department of Nursing) 6 of 10
D. 10% dextrose.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
____________________________________________________

2. Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include
information about which hormone lacking in clients with diabetes insipidus?
A. Antidiuretic hormone (ADH).
B. Thyroid-stimulating hormone (TSH).
C. Follicle-stimulating hormone (FSH).
D. Luteinizing hormone (LH).
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
____________________________________________________

3. Which outcome indicates that treatment of a male client with diabetes insipidus has been effective?
A. Fluid intake is less than 2,500 ml/day.
B. Urine output measures more than 200 ml/hour.
C. Blood pressure is 90/50 mm Hg.
D. The heart rate is 126 beats/minute.
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
_____________________________________________________

4. An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad.
Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and
nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby
prepares to take emergency action to prevent the potential complication of:
A. Thyroid storm
B. Cretinism
C. Myxedema coma
D. Hashimoto’s thyroiditis
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
____________________________________________________

5. Vasopressin is administered to the client with diabetes insipidus (DI) because it:
A. Decreases blood sugar.
B. Increases tubular reabsorption of water.
C. Increases release of insulin from the pancreas.
D. Decreases glucose production within the liver.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
____________________________________________________

6. A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing
intervention is appropriate?
A. Infusing I.V. fluids rapidly as ordered.
B. Encouraging increased oral intake.
C. Restricting fluids.
D. Administering glucose-containing I.V. fluids as ordered.
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
_____________________________________________________

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PHINMA Education (Department of Nursing) 7 of 10
7. What test should be ordered if hypothyroidism is suspected?
A. Liver function tests
B. Hemoglobin A1c
C. T4 and thyroid-stimulating hormone
D. 24-hour urine free cortisol measurement
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
____________________________________________________

8. Which of the following conditions is caused by excessive secretion of vasopressin?

A. Thyrotoxic crisis
B. Diabetes insipidus
C. Primary adrenocortical insufficiency
D. Syndrome of inappropriate antidiuretic hormone (SIADH)
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
_____________________________________________________

9. A client represents with flushed skin, bulging eyes, and perspiration, and states that he has been irritable and having
palpitations. This client is presenting with symptoms of which disorder?
A. Pancreatitis
B. Hypothyroidism
C. Hyperthyroidism
D. Diabetes insipidus
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
_____________________________________________________

10. The appropriate nursing diagnosis for a patient with SIADH is:
A. Fluid volume deficit related to excessive fluid loss
B. Fluid volume excess related to fluid retention
C. Risk for injury related to decreased blood pressure
D. Impaired skin integrity related to dehydration
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
____________________________________________________

11. A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar),
20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin?
A. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs.
B. It interacts with plasma membrane receptors to inhibit enzymatic actions.
C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate
metabolism.
D. It regulates the threshold for water resorption in the kidneys.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
____________________________________________________

12. A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup.
Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the
surgery, nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative
instruction should the nurse emphasize?
A. “You must lie flat for 24 hours after surgery.”
B. “You must avoid coughing, sneezing, and blowing your nose.”

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PHINMA Education (Department of Nursing) 8 of 10
C. “You must restrict your fluid intake.”
D. “You must report ringing in your ears immediately.”
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
____________________________________________________

13. A somatotropin-secreting tumor of which of the following glands would lead to the development of acromegaly, Cushing’s
syndrome, and hypopituitarism?
A. Adrenal gland
B. Hypothalamus
C. Pituitary gland
D. Thyroid gland
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
____________________________________________________

14. Surgical management for large, invasive pituitary tumors is a transphenoidal hypophysectomy. The nurse would explain
that the surgery will be performed through an incision in the:
A. Nose
B. Back of the mouth
C. Sinus channel below the right eye
D. Upper gingival mucosa in the space between the upper gums and lip
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
____________________________________________________

15. Initial treatment for a CSF leak after transphenoidal hypophysectomy would most likely involve:
A. Repacking the nose.
B. Returning the client to surgery.
C. Enforcing bed rest with the head of the bed elevated.
D. Administering high-dose corticosteroid therapy.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
____________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help
you track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

Quiz
A. Answer the items below.
Instruction: Write A – for SIADH, and B – for DI. Write your answers on the spaces provided.

1. excessive vasopressin:
2. hypotension:
3. weight gain:
4. deficient vasopressin:
5. rales:

B. Instruction: Match the symptoms. Put an arrow next to the sign or symptom.
Arrow up = hyperthyroidism
Arrow down = hypothyroidism

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PHINMA Education (Department of Nursing) 9 of 10
 1. dry skin:
2. heat intolerance:
3. constipation:
4. exophthalmos:
5. palpitations:

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