Acromegaly Exam By Rnpedia

1. Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia?

Acromegaly

Type 1 diabetes mellitus

Hypothyroidism

Deficient growth hormone

Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn’t associated with hyperglycemia, nor is growth hormone deficiency.

Explanation

Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn’t associated with hyperglycemia, nor is growth hormone deficiency.

2. Of the following disorders, which results from excessive secretion of somatotropin?

Acromegaly

Cretinism

Dwarfism

Adrenogenital syndrome

The patient with acromegaly demonstrates progressive enlargement of peripheral body parts, most commonly the face, head, hands, and feet. Cretinism occurs as a result of congenital hypothyroidism.Dwarfism is caused by insufficient secretion of growth hormone during childhood. Adrenogenital syndrome is the result of abnormal secretion of adrenocortical hormones, especially androgen.

Explanation

The patient with acromegaly demonstrates progressive enlargement of peripheral body parts, most commonly the face, head, hands, and feet. Cretinism occurs as a result of congenital hypothyroidism.Dwarfism is caused by insufficient secretion of growth hormone during childhood. Adrenogenital syndrome is the result of abnormal secretion of adrenocortical hormones, especially androgen.

3. A patient suspected of having acromegaly has an elevated plasma growth hormone level. In acromegaly, the nurse would also expect the patient's diagnostic results to include

Hyperinsulinemia

A plasma glucose of less than 70

Decreased growth hormone levels with an oral glucose challenge test

A serum sometomedin C (insulin-like growth-factor) of more than 300

a serum somatomedin C (Insulin-like-growth-factor) of more than 300
(rationale- a normal response to growth hormone secretion is stimulation of the liver to produce somatomedin C which stimulates growth of bones and soft tissue. The increased levels of somatomedin C normally inhibit growth hormone, but in acromegaly the pituitary gland secretes GH despite elevated somatomedin C levels.)

Explanation

a serum somatomedin C (Insulin-like-growth-factor) of more than 300
(rationale- a normal response to growth hormone secretion is stimulation of the liver to produce somatomedin C which stimulates growth of bones and soft tissue. The increased levels of somatomedin C normally inhibit growth hormone, but in acromegaly the pituitary gland secretes GH despite elevated somatomedin C levels.)

4. During assessment of the patient with acromegaly, the nurse would expect the patient to report

Infertility

Dry, irritated skin

Undesirable changes in appearance

An increase in height of 2 to 3 inches per year

undesirable changes in appearance
(Rationale- the increased production of growth hormone in acromegaly causes an increase in thickness and width of bones and enlargement of soft tissues, resulting in marked changes in facial features, oily and coarse skin, and speech difficulties. Height is not increased in adults with growth hormone excess because the epiphyses of the bones are closed, and infertility is not a common finding because growth hormone is usually the only pituitary hormone involved in acromegaly.)

Explanation

undesirable changes in appearance
(Rationale- the increased production of growth hormone in acromegaly causes an increase in thickness and width of bones and enlargement of soft tissues, resulting in marked changes in facial features, oily and coarse skin, and speech difficulties. Height is not increased in adults with growth hormone excess because the epiphyses of the bones are closed, and infertility is not a common finding because growth hormone is usually the only pituitary hormone involved in acromegaly.)

5. The nurse is caring for a client with acromegaly. Following a transphenoidal hypophysectomy, the nurse should:

Monitor the client’s blood sugar

Suction the mouth and pharynx every hour

Place the client in low Trendelenburg position

Encourage the client to cough

Growth hormone levels generally fall rapidly after a hypophysectomy, allowing insulin levels to rise. The result is hypoglycemia.

Explanation

Growth hormone levels generally fall rapidly after a hypophysectomy, allowing insulin levels to rise. The result is hypoglycemia.

6. A patient with acromegaly is treated with a transphenoidal hypophysectomy. Postoperatively, the nurse

Ensures that any clear nasal drainage is tested for glucose

Maintains the patient flat in bed to prevent cerebrospinal fluid leak

Assists the patient with toothbrushing Q4H to keep the surgical area clean

Encourages deep breathing and coughing to prevent respiratory complications

a transphenoidal hypophysectomy involves entry into the sella turcica through an incision in the upper lip and gingiva into the floor of the nose and the sphenoid sinuses. Postoperative clear nasal drainage with glucose content indicates CSF leakage from an open connection to the brain, putting the patient at risk for meningitis. After surgery, the patient is positioned with the head elevated to avoid pressure on the sella turcica, coughing and straining are avoided to prevent increased ICP and CSF leakage, and although mouth care is required Q4H toothbrushing should not be performed for 7-10post sx.

Explanation

a transphenoidal hypophysectomy involves entry into the sella turcica through an incision in the upper lip and gingiva into the floor of the nose and the sphenoid sinuses. Postoperative clear nasal drainage with glucose content indicates CSF leakage from an open connection to the brain, putting the patient at risk for meningitis. After surgery, the patient is positioned with the head elevated to avoid pressure on the sella turcica, coughing and straining are avoided to prevent increased ICP and CSF leakage, and although mouth care is required Q4H toothbrushing should not be performed for 7-10post sx.

7. The nurse is planning room assignments for the day. Which client should be assigned to a private room if only one is available?

The client with Cushing’s disease

The client with diabetes

The client with acromegaly

The client with myxedema

The client with Cushing’s disease has adrenocortical hypersecretion. This increase in the level of cortisone causes the client to be immune suppressed. In answer B, the client with diabetes poses no risk to other clients. The client in answer C has an increase in growth hormone and poses no risk to himself or others. The client in answer D has hyperthyroidism or myxedema and poses no risk to others or himself.

Explanation

The client with Cushing’s disease has adrenocortical hypersecretion. This increase in the level of cortisone causes the client to be immune suppressed. In answer B, the client with diabetes poses no risk to other clients. The client in answer C has an increase in growth hormone and poses no risk to himself or others. The client in answer D has hyperthyroidism or myxedema and poses no risk to others or himself.