Supercalafragalisticexpialadoshis
(Transphenoidal Hypophysectomy)
(Transphenoidal Hypophysectomy)
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
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