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Tampilkan postingan dengan label Hypopituitarism. Tampilkan semua postingan

Kamis, 01 Mei 2014

Ineffective Individual Coping and Self-Care Deficit related to Hypopituitarism


Nursing Diagnosis and Interventions for Hypopituitarism

Signs and symptoms :

Anterior pituitary insufficiency (Panhypopituitarism) in general, will affect all of hormone that is normally secreted by the anterior pituitary gland. Therefore, the clinical manifestations of the combined effect of metabolic Panhypopituitarism is due to reduced secretion of each hormone hypophysis.

Clinical syndrome caused by Panhypopituitarism in children and adults differently. In children, somatic growth disturbances due to release growth hormone deficiency . Midget ( dwarfism ) is a consequence of the deficiency. When the child reaches puberty, it is a sign of secondary sksual and external genetalia tools fail to grow . Additionally often found slow intellectual development. The skin is usually pale in the absence of MSH.

In adults known as Simmonds disease characterized by general weakness, intolerance to cold, poor appetite, weight loss and hypotension, women who have the disease will be the cessation of Hait cycles or amenorrhea, later followed by breast trophy and external genetalia. While the men will show progresiof reduction in body hair and reed, beard, and reduced muscle growth, impotence and loss of libido. Also the skin will look pale due to the lack of MSH.

1. Ineffective Individual Coping related to the chronicity of the disease condition.

Goal: After nursing action was done to increase the level of individual coping.

Outcomes:
  • Express feelings related to emotional state.
  • Identify personal coping patterns and the consequences resulting behavior.
  • Identifying personal strengths and to receive support through the nursing relationship.
  • Make decisions and proceed with the appropriate action / change the provocative situation in the personal environment.

Intervention:
1. Assess the status of the existing individual coping.
R /: Improving the process of social interaction because the client has increased communicative.

2. Provide support if the individual speaking.
R /: Increasing confidence to others.

3. Helps individuals to suss out problems (problem solving).
R /: With less tension, fear will decrease and not isolate themselves from the environment.

4. Instruct individuals to perform technical relations, in the process of learning the techniques of stress management.
R /: The precision handling and healing process.

5. Collaboration with experts in the process of counseling psychology.
R / Client understand about the disease.


2. Self-Care Deficit related to reduced muscle strength.

Goal: After nursing actions clients can be active in self-care activities.

Outcomes:
  • Identify the ability of self-care activities.
  • Optimal hygiene after aid in the treatment given.
  • Participate in physical / verbal activities, personal care / fulfillment of basic needs.
Intervention:
1. Assess factor of causation declining self-care deficit.
R / Inhibit causal factors can improve self-care.

2. Increase optimal participation.
R / optimal to maximize the participation of self-care.

3. Evaluation of the ability to participate in any activity of the treatment.
R / Can foster client confidence.

4. Give encouragement to express the feelings of lack of self-care.
R / can give the client a chance to perform self-care.
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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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