Medical-Surgical Nursing: Concepts & Practice 3rd edition Chapter 35 The Endocrine System Copyright © 2017, Elsevier Inc. All rights reserved.

Functions of the Endocrine System Alter chemical reactions and control the rates at which chemical activities take place within cells Change the permeability of cell membranes and select the substances that can be transported across cell membranes Activate a particular mechanism in the cell, such as the system that controls cellular growth and reproduction

Effects of Hormones from the Pituitary Gland See Figure 35-2 on p. 823.

Endocrine System Structure and function Effects of aging Pituitary hormones Thyroid hormones Parathyroid gland Adrenal glands Endocrine pancreas Effects of aging

Effects of Epinephrine and Control of Its Secretion See Figure 35-4 on p. 825 From Applegate E: The anatomy and physiology learning system, ed 4, Philadelphia, 2011, Saunders.

Regulation of Aldosterone and Cortisol Secretion See Figure 35-5 on p. 825. From Applegate E: The anatomy and physiology learning system, ed 2, Philadelphia, 2000, Saunders.

Blood Glucose Regulation See Figure 35-6 on p. 826 Adapted from Applegate E: The anatomy and physiology learning system, ed 2, Philadelphia, 2000, Saunders.

Major Endocrine Glands See Figure 35-1 on p. 822

Basic Concepts Hormones and target tissues Negative feedback Hypothalamus and the pituitary gland

Causes of Endocrine Disorders Primary dysfunction Hypersecretion and hyposecretion Tumors and inflammation Infection, mechanical damage, or autoimmune response Secondary dysfunction Medications, trauma, hormone therapy Temporary or permanent

Endocrine Disorders Preventing goiter Diagnosis Thyroid panel Parathyroid function—serum calcium and phosphate levels Adrenal gland function—electrolyte panels, glucose levels, hormone levels, and 12-lead electrocardiogram (ECG)

Effects of Aging on the Endocrine System Pituitary gland smaller Thyroid lumpy or nodular Hormones decrease or increase Blood glucose levels rise Thyroid hormone levels decrease

Diagnosis of Diabetes Mellitus Presence of symptoms and Random blood glucose level greater than or equal to 200 mg/dL, OR Fasting glucose level greater than or equal to 126 mg/dL, OR Glucose tolerance test revealing postprandial glucose greater than or equal to 200 mg/dL 2 hours after 75 g of glucose is administered

Diagnosis of Diabetes Mellitus (Cont.) Glucose tolerance test Hemoglobin A1c (A1C) test Healthy People 2020: Increase the proportion of adults with diabetes who have an A1C test at least twice a year Fructosamine assay In a glucose tolerance test, the patient is given a set amount of glucose to evaluate insulin secretion and ability to metabolize glucose. A1C test (formerly called the glycosylated hemoglobin test) measures blood glucose over a period of many weeks. Glucose in the bloodstream attaches itself to the hemoglobin A (red blood cell) molecule and remains there for the life span of the red blood cell. Physicians use A1C test results to prescribe adjustments to a patient’s treatment program for managing diabetes. Fructosamine assay monitors blood glucose over a shorter time frame than the A1C test because the assay measures sugar attached to the protein albumin, which has a shorter life than hemoglobin.

Degrees of Control of Blood Glucose Based on HbA1C Levels See Table 35-4 on p. 832.

Nursing Management of Endocrine Disorders Thorough focused assessments Nursing diagnosis Goals of care Evaluation Community care

General Nursing Goals Prevention of injury Maintenance of fluid and electrolyte balance Maintenance of hormone balance Reduction of stress Use of effective coping mechanisms

General Nursing Goals (Cont.) Knowledge of self-care Tolerance of physical activity Promotion of normal bowel function Improvement of mental-emotional status Integration of body image