How would you answer this question?
Your patient Mr. Lett has had a transsphenoidal resection of a pituitary tumor. As his nurse, an important nursing assessment to make is:
a. Carefully monitor I & O
b. Checking his dressing for serous drainage
c. Palpate for dependent pitting edema
d. Monitor his pulse oximetry
The correct answer is "a" carefully monitor I & O.
After pituitary surgery, Mr. Lett is at risk for diabetes insipidus caused by cerebral edema and removal of part of the pituitary. Diabetes insipidus (DI) causes a decrease in anti-diuretic hormone (ADH) production that can result in a dramatic increase in Mr. Lett's urine output, leading to hypovolemia.
Monitoring of urine output and urine specific gravity is essential to detect DI. With the onset of DI, you can expect a dramatic increase in urine volume and a decrease in specific gravity. In addition, the serum sodium will increase as Mr. Lett becomes dehydrated. The key to finding DI is a high serum sodium (normally associated with dehydration) and diuresis of copious amounts of dilute urine. These two findings are not usually found together.
There will be no dressing when the transsphenoidal approach is used. Mr. Lett is at risk for dehydration, not volume overload. This type of surgery does not cause respiratory issues, so pulse oximetry would not be necessary unless Mr. Lett has a history of respiratory problems such as COPD.
From: Porter, R.S. & Kaplan, J.L. (eds), (2010). Pituitary disorders, in The Merck Manual. Accessed at
http://merck.com/mmpe/index.html on February 5, 2010.