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Nursing Care Plan for Hypopituitarism

Definition of Hypopituitarism


Hypofunction of the pituitary gland (hypopituitarism) can occur due to diseases of the gland or the hypothalamus. (Robbins Cotran Kumar)

Hypopituitarism refers to the state of the anterior pituitary secretion of several hormones, which is very low. (ElizabethC Erorwin)

Hypopituitarism is hypersecretion of one or more anterior pituitary hormones. (Barbara C. Long)


Hypopituitarism is a condition that arises as a result of pituitary hypofunction. Definition of anterior pituitary hormones may occur from 3 pathways:
  1. Abnormalities in the gland that can damage the secretory cells.
  2. Abnormalities within or adjacent to the pituitary stalk which can lead to termination of the spread of the factors that originate from the hypothalamus.
  3. Abnormalities in the hypothalamus which may impair the release of the regulator on the front hypofyse.


Etiology

Hypopituitarism may occur due to a malfunction of the pituitary gland or hypothalamus. Cause concerns:
  • Infection or inflammation by: fungal, pyogenic bacteria.
  • Autoimmune diseases (autoimmune lymphoid pituitary)
  • Tumors, for example of a type of hormone-producing cells that can interfere with the formation of one or another hormone arbitrarily.
  • Feedback from the target organ experiencing malfunctions. For example, there will be a decrease in the secretion of TSH from the pituitary gland when the thyroid is diseased secrete excessive levels of HT.
  • Hypoxic necrotic (death due to lack of O2) pituitary or oxygenation can damage some or all of the hormone-producing cells. One of them sheecan syndrome, which occurs after maternal hemorrhage.


Clinical Manifestations
  • Headache and visual disturbances or signs of increased intracranial pressure.
  • Overview of the production of growth hormone excess include acromegaly (large hands and feet as well as the tongue and jaw), profuse sweating, hypertension and arthralgia (joint pain).
  • Hyperprolactinemia : amenorrhea or oligomenorrhea, galactorrhea (30 %), infertility in women, impotence in men.
  • Chusing syndrome : central obesity, hirsutism, striae, hypertension, diabetes mellitus, osteoporosis.
  • Growth hormone deficiency : (growt hormone = GH) growth disorders in children.
  • Gonadotropin deficiency : impotence, decreased libido, body hair loss in men, amenorrhea in women.
  • TSH deficiency : fatigue, constipation, dry skin laboratory picture of hyperthyroidism.
  • Corticotropin Deficiency : malaise, anorexia, fatigue is real, pale, the symptoms are very severe for ordinary mild systemic disease, laboratory overview of the decline in adrenal function.
  • Vasopressin deficiency : polyuria, polydipsia, dehydration, unable to concentrate urine.


Physical Examination
1. Physical examination
  • Inspection : Observe the shape and size of the body, measuring weight and height, observe the shape and size of the breast, axillary and pubic hair growth in male clients, observe also the growth of facial hair (beard and mustache).
  • Palpation : Palpation of the skin, the woman usually becomes dry and rough.Depending on the cause hipopituitary, other data should also be assessed as a concomitant of data as if the cause is a tumor it is necessary to check the function of the cerebrum and cranial nerve function and the presence of headaches.
2. Assess the physical changes also impact on the ability of clients to meet their basic needs.
3. Supporting data of the diagnostic workup such as :
  • X-ray of cranium to see the dilation and erosion of the sella turcica or .
  • Examination of blood serum : LH and FSH GH, prolactin, alsdosteron, testosterone, cortisol, androgens, which include test stimulation of insulin tolerance test and thyroid releasing hormone stimulation.


Complication
1. Cardiovascular.
  • Hypertension.
  • Thrombophlebitis.
  • Thromboembolism.
  • Acceleration uterosklerosis.
2. Immunology.
  • Increased risk of infection and disguise any signs of infection.
3. Changes in the eye.
  • Glaucoma.
  • Corneal lesions.
4. Musculoskeletal.
  • Muscle wasting.
  • Poor wound healing.
  • Osteoporis with vertebral compression fractures, long bone pathologic fractures, aseptic necrosis of the femoral head.
5. Metabolic. Changes in glucose metabolism of steroid withdrawal syndrome.
6. Changes in appearance.
  • Such as moon face (moon face).
  • Weight gain.
  • Acne.


Nursing Diagnosis for Hypopituitarism

1. Disturbed Body Image related to changes in body structure and function of the body due to deficiency of gonadotropin and growth hormone deficiency.

2. Ineffective individual coping related to the chronicity of the disease condition.

3. Low Self-Esteem related to changes in body appearance.

4. Disturbed Sensory perception (visual) related to impaired transmission of impulses as a result of suppression of tumor on the optic nerve.

5. Anxiety related to threat or change in health status.

6. Self care deficit related to the decrease in muscle strength.

7. Risk for impaired skin integrity (drought) related to declining hormonal levels.

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