Question

1. Hypophysectomy-patient teaching and nursing considerations?
2. What is continuous bladder irrigation and what are your patient teaching and nursing considerations?

Answer 1

Hypophysectomy is a surgery done to remove the pitutory gland or hypophysis to remove cancerous or benign tumours. pitutory gland controls the hormones produced in the other important glands including adrenal gland and thyroid gland. it is a risky procedure with a long recovery time. During surgery the gland may be destroyed, leaving the endocrine system without regulation. If this happens, a person will require hormone replacement therapy.

Patient teaching before surgery:The day before surgery, a person need to  undergo blood tests, chest X-rays, or an electrocardiogram (ECG) to ensure that they are fit enough to have the anesthesia.

The surgery is carried out under general anesthetic, and it takes 1-2 hours to complete.The hypophysectomy can take up to 2 hours to complete. After this, the patient will spend another 2 hours in a recovery ward before returning to the neurosurgical ward. patient's nose is packed to stop bleeding, and he can go home next day.A follow-up appointment with a neurosurgeon and an endocrinologist (a doctor who specializes in hormone disorders) usually happens 6-8 weeks after surgery. This checkup may involve blood tests, eye checks, and a head scan

• nose bleeds
• internal cranial hemorrhage
• leaking of the cerebrospinal fluid

Nursing considerations: Postoperative care is done with precise monitoring of fluid and electrolyte balance, methods of nasal packing, treatment of cerebrospinal fluid leaks and tracking of hormone levels . A nurse should be aware of the fact that cerebrospinal fluid (CSF) is a clear fluid which surrounds the brain and spinal cord. Leakage may require a lumbar drain in the lower back to seal the leak and prevent infection. This procedure may take 2-3 days.

Continuous bladder irrigation is a continuous infusion of sterile solution into the urinary blader using a three-way irrigation  system with a triple-lumen catheter, to remove loose tissue, clots and mucous shreds from the bladder.

Patient teaching:Patient can expect some discomfort with the catheter in place. At the start of the irrigation, patient's urine will be bloody and may have blood clots in it. Patient should be educated that as the irrigation continues, his/her urine should become pink and clear. Healthcare providers will empty his drainage bag frequently. patient's bladder irrigation will be stopped when he/she has had clear or slightly pink urine for 1 to 2 days. Healthcare provider should be informed if he/she has bladder pain or your bladder feels full. Tell him/her if fluid is leaking around your catheter.

Nursing considerations: Postoperative care with precise monitoring of fluid and electrolyte balance, methods of nasal packing, treatment of cerebrospinal fluid leaks and tracking of hormone levels are to be examined in detail.Review the patient’s clinical record should be done to verify physician’s order and to become familiar with reasons for performing continuous bladder irrigation. Check the patient’s medication history for hypersensitivity to antibiotics, and report significant findings to professional nurse. Assess outflow for blood clots and/or changes in appearance. Document in the patient’s clinical record. Record procedure, significant nursing observations, and amount of fluid instilled and drained. Report same to professional nurse.