Brad Johnson (BJ) is a 54-year-old diagnosed with pituitary adenoma He undergoes a transsphenoidal hypophysectomy to...

Brad Johnson (BJ) is a 54-year-old diagnosed with pituitary adenoma He undergoes a transsphenoidal hypophysectomy to remove the tumor.

Before surgery, what conditions might BJ’s pituitary adenoma precipitated?
After surgery, he has huge urinary outputs of 500 to 600 ml/hr. What is the most likely cause of his high urine output? What other clinical data would support this diagnosis?
BJ receives subcutaneous Desmopressin (DDAVP) to manage his high urine output. What is the rationale for this therapy? How can effectiveness be assessed?
It is expected that after his transsphenoidal hypophysectomy, all of BJ’s anterior pituitary hormones will be deficient (panhypopituitarism). What type of hormone replacement will be needed?

Expert Solution

1) Before surgery, Mr. BJ might have the condition of DNA mutation may leads to cells in the pituitary gland grow and devide uncontrollable. the exact cause is unkown rarely it cause due to history of family illness.

2) High urine output is due to deficiency or excess of ADH ( antidiuretic hormone) which is produced by pituitary gland , removal of gland leads to increased urine output.

supporting symptoms like muscle wasting , loss of libido

3) Desmopressin act as a selective agonist of V2 receptors expressed in the renal collecting duct to increase water re-absorption and reduce urine production. Desmopressin increases urine osmolality , decreased nocturnal total urine volume, reduced the ratio of nocturnal urine volume to whole day urine volume and decreased nocturnal voiding frequency.

4)Hormone replacement therapy include glycocorticoids. which helps to improve further condition and avoid complications.

Nightingale answered 4 months ago

Case 4 Seth Johnson is a 54 year old college physics professor with a history of...

Case 4 Seth Johnson is a 54 year old college physics professor with a history of coronary artery disease who was admitted to the hospital for increasing lower extremity edema, abdominal swelling, and shortness of breath. Professor Johnson noted a 30-pound weight gain over the past month, and during the past week he has had three-pillow orthopnea. Professor Johnson is in moderate respiratory distress in the hospital. His skin is cool, pale, and clammy. His pulse is 95, irregular, and...

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

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...

BJ. is a 5-year-old boy who has suffered from repeated upper respiratory infections since he was...

BJ. is a 5-year-old boy who has suffered from repeated upper respiratory infections since he was 16 months old. At 4 years of age, he was diagnosed with allergic asthma. The following winter, at age 5, he was admitted to the hospital twice for acute asthma with a secondary bacterial pulmonary infection. At the second admission, a complete blood count, sputum culture, and immune status work-up were ordered. Laboratory Data Assay Patient Results Reference Range Hemoglobin 13.5 g/dL 11.5-14.5...

Brad is a 25-year-old living with cystic fibrosis. He has spent much of his life dealing...

Brad is a 25-year-old living with cystic fibrosis. He has spent much of his life dealing with the harsh symptoms of the disease and the reality that his life would probably be short. However, he received a double lung transplant and can now do things he wasn't able to do before, like going on trips and even rock climbing! He writes a blog about living with the illness and is president of the Northern California chapter of the Lung Transplant...

BJ is an 8mos old Caucasian infant. He was born at 27 wk gestation weighing 1.2...

BJ is an 8mos old Caucasian infant. He was born at 27 wk gestation weighing 1.2 kg to an 18yo single mother. His mother brings him into the office today for his routine immunizations. She is teary-eyed as she gives the history to DR. BJ continues to have significant head lag, never has rolled over and is unable to sit up. Recently, mom has noticed feeding difficulties during meals. When BJ's diaper is being changed, mom has noticed increased stiffening...

3. Bobbie is a 54-year-old woman who has been diagnosed with bipolar disorder. Her husband, Larry,...

3. Bobbie is a 54-year-old woman who has been diagnosed with bipolar disorder. Her husband, Larry, has been very supportive and accepting of the mental illness diagnosis. Her two children, ages 15 and 17 are worried that they might also develop bipolar disorder but are also very supportive of their mother. The family feels that they do not have the knowledge and skills to handle the condition and decide to enroll in family consultation. a. Why do you believe it...

A 47-year old man is diagnosed with a primary Glioblastoma Multiforme Stage IV. He is not...

A 47-year old man is diagnosed with a primary Glioblastoma Multiforme Stage IV. He is not expected to live but a few months. He is an organ donor. Would you or would you not take his organs? Explain. Describe the management of a 36-year old man who has third degree burns over 15% of his body. Comment on his prognosis. A 31-year old man is brought to the ER with a deep stab wound to the right thorax at 1...

The psychiatric nurse is initiating an interview with Mr. Johnson. He is a 33-year-old male patient...

The psychiatric nurse is initiating an interview with Mr. Johnson. He is a 33-year-old male patient admitted to the Behavioral Center with a diagnosis of schizophrenia. The nurse begins the interaction by saying, “What shall we talk about today?” (Learning Objective: 2) a. Explain why this is an appropriate opening statement to initialize a clinical interview session. b. Why should the nurse use simple, concrete, and direct messages with the patient?

John Smith, 68 year-old male, is diagnosed with heart failure. He is also an asthmatic and...

John Smith, 68 year-old male, is diagnosed with heart failure. He is also an asthmatic and diabetic. He is usually on 2 liters of oxygen, but is now requiring 6 liters of oxygen by nasal cannula. John experiencing significant dysp upon exertion. You are caring for him and are responsible for nea interpreting his medication orders and subsequent nursing implications. Here are John's current vitals and medications: Vitals: HR: 58 BP: 168/90 RR: 24 Spo2: 90%, 6 Liters per Nasal...

The Case: Ali is a 26-year-old type 1 diabetic. He was originally diagnosed at the age...

The Case: Ali is a 26-year-old type 1 diabetic. He was originally diagnosed at the age of 14, and currently manages his disease with an intensive regimen of insulin injections. Ali is employed as a schoolteacher and soccer coach. He presents today with a 2-day history of vomiting and diarrhea. He has been closely monitoring his blood glucoses and is using regular insulin for high blood glucose levels. He has only been able to tolerate liquids such as Gatorade, but...

Question