Medical Surgical Interventions

I. Pharmacologic Treatment

Treatment for Sheehan's syndrome is lifelong hormone replacement therapy.

One or more of the following medications are recommended:

• Corticosteroids. These drugs, such as hydrocortisone or prednisone,

replace the adrenal hormones that aren't being produced because of
an adrenocorticotropic hormone (ACTH) deficiency. Medications are
needed to be adjusted if the patient become seriously ill or experience
major physical stress.
Ex. Hydrocortisone 100 mg q6h IVTT

• Levothyroxine (Levoxyl, Synthroid, others). This medication

boosts deficient thyroid hormone levels caused by low or deficient
thyroid-stimulating hormone (TSH) production.

• Estrogen. These are a group of steroid compounds, named for their

importance in the estrous cycle, and functioning as the primary female
sex hormone.

• Growth hormone. Some studies have shown that replacing growth

hormone in women with Sheehan's syndrome — as well as in people
with other forms of hypopituitarism — can help normalize weight,
lower cholesterol levels and improve overall quality of life.
Other medications taken by the client:
• Piperecillin Tazobactam 4.5g IVTT q8h
• Arithromycin 500mg OD
• KCl tab 1 tab TID
• Salbutamol + Ipratropium ½ tab + .5 cc PNSS q6h
• Clonidine 75mg/tab 1tab OD

I. Diagnostic Tests

• Radiology. Branch of medicine that uses ionizing and nonionizing

radiation for the diagnosis and treatment of disease.
Sella Turcica – usually the target of the radiology, a bony box in
the middle of the head where the pituitary gland sits.

Potential risk of the procedure is radiation.

• Cranial CT Scan. A cranial computed tomography (CT) scan is an
imaging method that uses x-rays to create cross-sectional pictures of
the head, including the skull, brain, eye sockets, and sinuses.

Nursing considerations:

1. Nothing per orem 4-6 hours prior to procedure.

2. Assess for hypersensitivity if dye is to be used. Client will feel a
slight burning sensation in the arm and a metallic taste but will
disappear after a few seconds.
3. No metals as it may obscure the images.
4. Client should lay still during the procedure.

• MRI (Magnetic Resonance Imaging). Magnetic resonance imaging

(MRI) is a noninvasive way to take pictures of the body. It uses
powerful magnets and radio waves.

Nursing considerations:

1. Nothing per orem 4-6 hours prior to procedure.

2. Assess for hypersensitivity if dye is to be used.
3. No metals and clients who have metals within the body such as
artificial pacemakers are contraindicated to the procedure.
4. Claustrophobic clients may be given sedatives as ordered by
physician to decrease anxiety.
5. Client should lay still during the entire procedure.

• Radioimmunoassay. Used to measure hormone levels, and both

trophic pituitary and target hormones must be assessed.

Assays quantitative or qualitative tests of a substance to determine its

components; and to determine the presence or concentration of
infectious agents or antibodies etc.

• Urinalysis. The physical, chemical, and microscopic examination of

urine. It involves a number of tests to detect and measure various
compounds that pass through the urine.

• Hematology. The diagnosis, treatment, and prevention of diseases of

the blood and bone marrow as well as of the immunologic, hemostatic
(blood clotting) and vascular systems.

• Blood Chemistry. Routine blood work to check the chemical

composition of the blood. The levels of various substances in the blood
can provide clues to a patient's condition, ranging from the presence of
a liver disorder to a pregnancy.
 I. IV Therapy

Intravenous therapy or IV therapy is the giving of liquid substances

directly into a vein. It is the fastest way to deliver fluids and medications
throughout the body.

• D5NSS 1L x KVO + D5W 2 vials

• D5W 500cc + 2 amps Apresoline + 2 amps Clonidine x 20
gtts/min
Restores acid-base balance replenished blood volume provide faster
administration route for meds, maintain body stores @ H2O electrolytes,
vitamins, proteins, minerals and calories in patient who cannot adequate
intake by mouth.
I. Special Orders

• Monitor vital signs hourly

• Monitor neurologic vital signs
• Turn to sides every 2 hours
• Don’t resuscitate
• Moderate to high back rest
• For CVP insertion
• Encourage to compliance of meds
• Titrate AC drip if BP is more than 160/80 mmHg

I. Diet and Activities of Daily Living

• NGT

Nasogastric intubation is a medical process involving the insertion of a

plastic tube (nasogastric tube, NG tube) through the nose, past the throat,
and down into the stomach. The main use of a nasogastric tube is for feeding
and for administering drugs and other oral agents.

800 kcal divide by 6 feedings = 133 kcal/feeding

• When on Diet as Tolerated (DAT)

No special diet is necessary unless dictated by an underlying disease

process. Salt (NaCl) use in adrenal insufficiency may be liberalized in
special circumstances (e.g. diaphoresis).

• Activities of Daily Living (ADL)

No restrictions are necessary unless dictated by underlying disease
process.