Nursing care of pituitary surgery: an example of advanced clinical practice

Because we have one of the leading pituitary surgeons in Canada, Dr. Harley Smyth, on our neurosurgical service we have nursed over 53f cases of pituitary tumor resection at the Wellesley Hospital. This series of patients represents a major ongoing international research project in Endocrinology and Neurosurgery and involves close teamwork between these two services and the nursing service. The paper gives a brief overview of pituitary surgery from its beginnings with Sir Victor Horsley in 1904 and details major breakthroughs since the 1960's. The three principal clinical groups of pituitary problems treated at the Wellesley are then outlined. The preoperative work-up on the endocrinology ward delineating clinical symptoms and precise hormonal values, the operation with the new anatomical approach developed by Dr. Smyth, and 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 all examined in detail. We explain new developments such as the move to less steroid coverage and the better understanding of the ultrastructure and functional microbiology of pituitary tumors. We conclude by pointing out the excellent management of these patients, with a short hospital stay and much of the preoperative work-up done on an outpatient basis. As well these patients are an extremely satisfying group to nurse because of the high correction rate achieved. Finally, as nursing protocols constantly change and as we continually learn more from this research project, we emphasize the need for the flexibility and knowledge of the advanced nursing practitioner.