(Transphenoidal Hypophysectomy)
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Give a short description of a transphenoidal hypophysectomy and indications for use.

Removal of the pituitary gland via the nose, due to tumor, or dysfunction


Describe the purpose of radioactive iodine therapy.

Treatment for hyperthyroidism to destroy some of the thyroid hormone producing cells to decrease levels.


List pre op nursing considerations for a patient who will be having a thyroidectomy.

Explain purpose

Take MMI or PTU 4-6 weeks before surgery

Receive iodine 10-14 days before surgery

Beta blockers are given to control hypertension, tachycardia, and dysrhythmias

Consume high carb and protein diet prior to surgery


List post-op management interventions for a patient who underwent a transphenoidal hypophysectomy

vitals, neuro checks, monitor dressing, limit coughing, humidified O2, head of bed 45-60 degrees, mouth care, replacement hormones, monitor fluid and electrolytes


If a patient asks how many treatments of radioactive iodine is needed and how long it will take to see the effects, how would the nurse respond?

Often one dose is enough, but sometimes two or three are required.

Effects take about 6-8 weeks to be seen.


List post op nursing considerations for a patient who underwent a thyroidectomy.

VS, HOB semifowlers, support head/neck, avoid extension/flexion, monitor dressing for excessive bleeding and excessive swelling, check for laryngeal nerve damage, pain management, monitor for hypocalcemia and tetany, suction, trach kit at the bedside


What are the complications of the transphenoidal hypophysectomy?

CSF leak, meningitis, transient DI, increased intracranial pressure


For a patient on radiation precautions, what would the nurse tell the patient about being around infants, children, and pregnant women?

Avoid contact closer than 3 feet and less than 1 hour per day for the first week following treatment.


List complications following a thyroidectomy.

Hemorrhage at incision site

Thyroid storm/crisis (airway, cardiac monitor, tylenol, PTU/MMI, beta blockers, ivf, O2)

Airway obstruction, hypocalcemia/tetany, nerve damage


When monitoring the under nose dressing following a transphenoidal hypophysectomy, what specific will be monitored regarding a CSF leak?

halo sign, drainage is positive for glucose


What are radiation precautions in regards to toileting?

Avoid using the same toilet as others for two weeks following treatment

Males should sit to urinate

Flush the toilet 3 times

Take laxative for 2 to 3 days post treatment to rid body of stool contaminated with radiation


List post surgical management for a patient who underwent a parathyroidectomy

>2000m/L fluids per day-avoid dehydration, encourage ambulation, oral phosphates, avoid excess or restriction of calcium, stool softeners

What education should the nurse provide the patient post transphenoidal hypophysectomy?

Avoid activities that can increase pressure of the surgical site--coughing sneezing bending, report excessive post nasal drip and excessive swallowing, monitor for s/s of infection, hormone replacement therapy, high fiber diet and stool softeners to avoid straining


List any other radiation precautions.

Wash clothing separate from others

Avoid contamination with saliva, don't share toothbrushes or silverware. 


Describe a hypercalcemic crisis and what nursing interventions that would be preformed. 

Hypercalcemic crisis- calcium level >13

Rapid rehydration with isotonic fluids, calcitonin, loop diuretics (if edema occurs), biphosphonates (didronel, aredia)

Cytotoxic agents (mythramycin), dialysis can be used in an emergency as well as corticosteroids