Question

1. Frank Smith is a 42-year-old patient diagnosed with pituitary prolactinoma, a benign

tumor that arises from the pituitary gland, resulting in a decrease in libido and impotence

and increased milk production of the breast. The patient also has complaints of headache

and drowsiness and the presence of visual field changes and papilledema preoperatively.

(Learning Objective 6)

a.What postoperative care should the nurse provide the patient?

b.The patient’s family asks the nurse how will they know that the problems the

patient had before surgery have stopped; what is the nurse’s best response?

c.What management strategies should the nurse anticipate will be ordered to care

for diabetes insipidus if it occurs?

d.What discharge instructions should the nurse provide the patient and family?

Answer 1

a.Prolactinomas is a pituitary tumour which produces excessive amount of prolactin.It is the most common type of pituitary tumour which is hormonally active.Symptoms are galactorrhea and reduced sex drive.When the tumor grows it result in visual loss and headaches.Soon after surgery when the patient is recieved in the post operative care unit nurse will assess his vital signs.After recovering from the effects of anaesthesia patients maybe given fluids to drink.Softer foods are advised for the first few day of surgery if the patient can tolerate.Patients will feel nauseated after surgery due to draining of blood through the throat into the stomach during surgery.Antiemetics are administered to relieve from nausea.The nurse regulary check the urine output.As soon as the patient is recovered from the effects of anaesthesia they will be encouraged to walk as well as they are given a incentive spirometry to clear the lungs and prevent pneumonia.Analgesics are ordered to relieve from the pain due to headache.

b The nurse responds by saying"the patient will able to recognize if it recur again,as the tumor produced the hormones which causes the symptoms.if the patient experience similar symptoms before surgery the hormone level in blood and urine need to checked along with MRI scan"

cDiabetes insipidus(DI) is the most common complication which can arise after the surgery.It is mainly due to impaired Anti diuretic hormones(ADH) due to vascular alterations of the pituitary and hypothalamus.This phenomenon usually begins within 24-48 hours after surgery and resolves in 72hours.DI is dangerousif not treated immediately.Therefore the nurse needs to identify early signs and symptoms of dehydration,hypernatremia and hypokalemia to start treatment quickly following critical care pathways as mentioned in the individual institutional standard for the surgery.Serum electrolytes and urine-specific gravity needs to be checked every 4 hours until stable.Nurses need to check that the patient has access to oral fluid by monitoring urine output,urine specific gravity,urine osmolality,serum sodium level,serum osmolality and mental status.

d.

• The patient is instructed to check a morning cortisol level 1 week after discharge without taking hydrocortisone within the prior 24 hours.
• .The nurse should spend sometime with the the patient to analyze whether the patient has understood the instructions by reviewing,reinforcing and asking for a written demonstration of understanding the instructions.
• Explaining to the patient the importance for follow-up with the endocrinologist for hormone assessment and replacement therapy.
• The patient is advised to visit the neurosurgeon for follow-up after the MRI Scanning of sella turcica.
• The patient is instructed to report signs and symptoms of hypopituitarism,rhinorrhoea and other infections.
• The patient is advised not to lift weight for the first 4 weeks after surgery.
• They are refrain fro airtravel which could result in the patient to unable to equalize pressure due to sinus inflammation following surgery.
• Patient is advised not to engage themselves in adventourous sporting activities.
• The nurse teaches the patient to report flu-like symptoms which signals possible hyponatremia.