Assessing Clients with Endocrine Disorders

Endocrine Glands Pituitary Gland Thyroid Gland Parathyroid Glands Adrenal Glands Pancreatic Glands Reproductive Glands

Endocrine Glands Figure 18–1 Location of the major endocrine glands.

Endocrine Glands Figure 18–2 Location of the pituitary gland.

Endocrine Glands Figure 18–3 Actions of the major hormones of the anterior pituitary.

Endocrine Glands Figure 18–4 The thyroid gland.

Endocrine Glands Figure 18–5 Location of the adrenal glands.

Endocrine Glands Figure 18–6 Negative feedback.

Endocrine Glands Figure 18–7 Examples of three mechanisms of hormone release: A, hormonal; B, humoral; or C, neural.

Endocrine Glands Figure 18–8 Palpating the thyroid gland from behind the client.

Transportation of Hormones Endocrine glands release most hormones into the bloodstream (some require a protein carrier) Neurons release some hormones (epinephrine) into bloodstream (neuroendocrine route) Hypothalamus releases hormones directly to target cells in posterior pituitary by nerve cell extension released messengers diffuse through interstitial fluid

Topics Covered in Health History Interview Health Perception and Management: state of health, endocrine problems, use of drugs, alcohol, smoking Nutritional: diet, fluid intake, weight changes, change in energy level Elimination: changes in bowel, bladder habits Activity/Exercise: describe physical activities, energy level

Topics Covered in Health History Interview Sleep/Rest: how many hours of sleep/night, problems sleeping, night sweats Cognitive/Perceptual: memory problems, restlessness, confusion, anxiety, vocal changes, visual changes, heart palpitations, abdominal pain, pain, stiffness in joints Self Perception/Self Concept: feelings about self, medications Role/Relationships: family history of endocrine disorders? Does this condition affect your relationship with others?

Topics Covered in Health History Interview Sexuality/Reproductive: affects on sexual activities Coping/Stress Tolerance: does stress make condition worse? Has condition made stress worse? Value/Belief: how do relationships or activities help you cope? How do cultural beliefs or practices affect how you care for yourself? Are there any specific treatments you would not use to treat this condition?

Disorders of the Thyroid Gland An enlarged thyroid may indicate Graves disease or a goiter Exophthalmos (protruding eyes)seen in hyperthyroidism Brittle nails, dry hair, hair loss indicative of hypothyroidism

Disorders of the Thyroid Gland Restlessness, anxious, disturbed sleep pattern indicative of hyperthyroidism Age—related endocrine changes Pituitary: decreased production of ACTH, TSH, FSH Thyroid: decrease in gland activity Adrenal medulla: increase secretion and level of norepinephrine Pancreas: decreased absorption of fat soluble vitamins delayed and decreased insulin production

Normal Variation Normal variation in assessment findings for the older adult A higher than normal blood glucose levels are not unusual in nondiabetic older adults

Endocrine System Growth Hormone—deficiency indicates dwarfism and excess indicates gigantism, acromegly MRI—identifies tumors of the pituitary and hypothalamus Thyroid stimulating hormone (TSH) differentiates between pituitary and thyroid causes of hypothyroidism Thyroine T4-aid in diagnosis of thyroid function Triiodothyronine(T3)-compare T3 and T4 to diagnose thyroid disorder

Endocrine System indirect measure of free thyroxin Thyroid Antibodies-identifies thyroid immune disease Thyroid Scan-evaluates nodules Parathyroid Hormone-identifies hypoparathyroidism or hyperparathyroidism Fasting Blood Sugar-confirms diagnosis of diabetes mellitus CT Scan-identifies pancreatic tumors or cysts

Nursing Care of Clients with Endocrine Disorders

Nursing Care for Clients with Endocrine Disorders Directed toward meeting physiologic needs Providing education Ensuring psychologic support for client and family Holistic approach is essential

Hyperfunction and Hypofunction Disorders Hyperthyroidism: palpataions, increased sweating, increased appetite, weight loss Hypothyroidism: lethargy, weight gain, depression, dry skin Hyperparathyroidism: hypertension, psychosis, muscle weakness, renal calculi Hypoparathyroidism: tetany, muscle spasms, Arrhythmia: hyperactive reflexes Cushing’s Syndrome: weakness, easily bruised, poor wound healing, glycosuria

Hyperfunction and Hypofunction Disorders Figure 19–1 Exophthalmos in a client with Graves’ disease. The disease causes edema of fat deposits behind the eyes and inflammation of the extraocular muscles. The accumulating pressure forces the eyes outward from their orbits.

Hyperfunction and Hypofunction Disorders Figure 19–2 Toxic multinodular goiter. The formation and growth of numerous nodules in the thyroid gland cause the characteristic massive enlargement of the neck.

Nursing Implications for Selected Endocrine Medications Hyperthyroidism Medications: assess for hypersensitivity to iodine or shellfish prior to giving medication Antithyroid Drugs: monitor for side effects such as pruritis rash, elevated temperature, anorexia, loss of taste, menstrual changes, fatigue, and weight gain

Nursing Implications for Selected Endocrine Medications Hypothyroidism Treatments Administer 1 hour prior to eating or at least 2 hours after eating Monitor for minor bruising, bleeding gums, and blood in the urine Monitor for coronary insufficiency, chest pain, dyspnea, and tachycardia Hyperparathyroidism Therapy Education to avoid OTC medications with calcium, drink fluids, and remain active

Nursing Care Client teaching to support the neck postoperatively, to increase comfort and to decrease straining of the suture line Teaching effective coughing and deep breathing exercises Reassurance concerning the scar Encourage verbalization of concerns

Nursing Care Postoperative care Assess the client for complications Comfort measures Assess pain Client in the semi-Fowler’s position Assess the client for complications Use medical and surgical asepsis Adrenalectomy preoperative care includes a dietary consultation Adrenalectomoy postoperative care includes vital signs, monitoring intake and output

Nursing Process and Frameworks of Care Thyroid: hyperthyroid or hypothyroid goal is euthyroid function Parathyroid Hyperfunction: observe for renal calculi, muscle weakness, and polyuria Hypofunction: observe for tetany, low serum calcium levels

Nursing Process and Frameworks of Care Adrenal Gland Cushing’s syndrome: observe for pathologic fractures, hypertension, emotional disturbances Addison’s disease: observe for postural hypotension, syncope, Addisonian crisis Anterior Pituitary Gland: observe for hypertension, voice changes, tongue enlargement, indicating acromegaly

Nursing Process and Frameworks of Care Diabetes insipidus is manifested by polydipsia and polyuria Posterior Pituitary: observe for signs of SIADH, which can occur as a result of water retention