Acromegaly is a rare endocrine disorder characterized by excessive growth hormone (GH) production, typically caused by a pituitary adenoma. This nursing diagnosis focuses on identifying and managing symptoms, preventing complications, and improving the quality of life for patients with acromegaly.
Causes (Related to)
Acromegaly can affect patients through various mechanisms and contributing factors:
- Pituitary adenoma (most common cause)
- Excessive growth hormone production
- Elevated insulin-like growth factor 1 (IGF-1)
- Endocrine system disorders such as:
- Multiple endocrine neoplasia type 1
- McCune-Albright syndrome
- Carney complex
- Complications including:
- Cardiovascular problems
- Type 2 diabetes
- Sleep apnea
- Joint problems
- Visual impairment
Signs and Symptoms (As evidenced by)
Acromegaly presents with distinctive signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Enlarged hands and feet
- Joint pain and arthritis
- Excessive sweating
- Headaches
- Fatigue
- Voice changes
- Snoring and sleep problems
- Visual disturbances
Objective: (Nurse assesses)
- Enlarged facial features
- Protruding jaw and forehead
- Increased ring or shoe size
- Thickened skin
- Enlarged tongue
- Widened spaces between teeth
- Carpal tunnel syndrome
- Elevated blood pressure
- Enlarged internal organs
Expected Outcomes
The following outcomes indicate successful management of acromegaly:
- The patient will demonstrate improved symptom control
- The patient will maintain normal blood glucose levels
- The patient will show reduced complications
- The patient will report an improved quality of life
- The patient will demonstrate an understanding of the medication regimen
- The patient will maintain cardiovascular stability
- The patient will exhibit proper self-care management
Nursing Assessment
Monitor Growth Hormone Levels
- Check IGF-1 levels
- Monitor growth hormone suppression test results
- Track treatment response
- Document medication compliance
Assess Cardiovascular Status
- Monitor blood pressure
- Check heart rate and rhythm
- Assess for heart failure signs
- Document ECG changes
- Track exercise tolerance
Evaluate Metabolic Status
- Monitor blood glucose levels
- Check thyroid function
- Assess for diabetes symptoms
- Track weight changes
- Monitor nutrition status
Check for Complications
- Assess visual fields
- Monitor for sleep apnea
- Evaluate joint function
- Check for carpal tunnel syndrome
- Screen for colon polyps
Review Psychological Status
- Assess coping mechanisms
- Monitor for depression
- Evaluate body image concerns
- Check social support system
- Document quality of life changes
Nursing Care Plans
Nursing Care Plan 1: Imbalanced Growth Pattern
Nursing Diagnosis Statement:
Imbalanced Growth Pattern related to excessive growth hormone production as evidenced by enlarged extremities and facial features.
Related Factors:
- Pituitary adenoma
- Elevated growth hormone levels
- Altered endocrine function
- Tissue overgrowth
Nursing Interventions and Rationales:
- Monitor physical changes regularly
Rationale: Tracks disease progression and treatment effectiveness - Assist with medication administration
Rationale: Ensures proper control of growth hormone levels - Document changes in body measurements
Rationale: Provides objective data for treatment evaluation
Desired Outcomes:
- Patient will show stabilization of physical changes
- Patient will demonstrate compliance with treatment regimen
- Patient will report improved comfort with appearance
Nursing Care Plan 2: Risk for Decreased Cardiac Output
Nursing Diagnosis Statement:
Risk for Decreased Cardiac Output related to cardiovascular complications of acromegaly.
Related Factors:
- Cardiomegaly
- Hypertension
- Altered cardiac structure
- Increased metabolic demands
Nursing Interventions and Rationales:
- Monitor cardiovascular status regularly
Rationale: Detects early signs of complications - Implement cardiac health promotion strategies
Rationale: Reduces risk of cardiovascular complications - Administer prescribed medications
Rationale: Controls blood pressure and cardiac workload
Desired Outcomes:
- Patient will maintain stable blood pressure
- Patient will demonstrate improved exercise tolerance
- Patient will show no signs of heart failure
Nursing Care Plan 3: Disturbed Sleep Pattern
Nursing Diagnosis Statement:
Disturbed Sleep Pattern related to sleep apnea and physical discomfort as evidenced by daytime fatigue and reported poor sleep quality.
Related Factors:
- Sleep apnea
- Enlarged soft tissues
- Physical discomfort
- Anxiety
Nursing Interventions and Rationales:
- Implement sleep hygiene measures
Rationale: Promotes better sleep quality - Monitor sleep patterns and apnea episodes
Rationale: Identifies need for intervention - Assist with CPAP compliance
Rationale: Ensures effective management of sleep apnea
Desired Outcomes:
- Patient will report improved sleep quality
- Patient will demonstrate decreased daytime fatigue
- Patient will maintain CPAP compliance
Nursing Care Plan 4: Chronic Pain
Nursing Diagnosis Statement:
Chronic Pain related to joint involvement and tissue overgrowth as evidenced by reported joint pain and decreased mobility.
Related Factors:
- Joint enlargement
- Arthritis
- Carpal tunnel syndrome
- Tissue compression
Nursing Interventions and Rationales:
- Assess pain levels regularly
Rationale: Guides pain management interventions - Implement pain management strategies
Rationale: Reduces discomfort and improves function - Teach proper body mechanics
Rationale: Prevents further joint stress
Desired Outcomes:
- Patient will report decreased pain levels
- Patient will demonstrate improved mobility
- Patient will use appropriate pain management techniques
Nursing Care Plan 5: Deficient Knowledge
Nursing Diagnosis Statement:
Deficient Knowledge related to complex treatment regimen as evidenced by questions about disease process and management.
Related Factors:
- Complex medical condition
- Multiple treatment modalities
- Need for lifestyle modifications
- Limited exposure to condition information
Nursing Interventions and Rationales:
- Provide disease education
Rationale: Improves understanding and compliance - Teach medication management
Rationale: Ensures proper treatment implementation - Discuss lifestyle modifications
Rationale: Promotes better disease management
Desired Outcomes:
- The patient will demonstrate an understanding of the condition.
- The patient will correctly manage medications
- The patient will implement appropriate lifestyle changes
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Kumari Y, Bai P, Waqar F, Asif AT, Irshad B, Raj S, Varagantiwar V, Kumar M, Neha F, Chand S, Kumar S, Varrassi G, Khatri M, Mohamad T. Advancements in the Management of Endocrine System Disorders and Arrhythmias: A Comprehensive Narrative Review. Cureus. 2023 Oct 4;15(10):e46484. doi: 10.7759/cureus.46484. PMID: 37927670; PMCID: PMC10624418.
- Ogedegbe OJ, Cheema AY, Khan MA, Junaid SZS, Erebo JK, Ayirebi-Acquah E, Okpara J, Bofah D, Okon JG, Munir M, Alugba G, Ezekiel A, Okun O, Ojo TK, Mejulu EO, Jimoh A. A Comprehensive Review of Four Clinical Practice Guidelines of Acromegaly. Cureus. 2022 Sep 3;14(9):e28722. doi: 10.7759/cureus.28722. PMID: 36105896; PMCID: PMC9453869.
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