Assessment of the Endocrine System

Endocrine system  Endocrine system (ES) – the nervous system and the interconnected network of glands  A key feature of all endocrine glands (EG) is the secretion of hormones  Hormones are biochemicals that exert their effect on target tissues  Target tissues (TT) – usually located some distance from the endocrine gland, with no direct physical connection between EG and TT

Endocrine system  For this reason EG are called “ductless” glands and must use circulatory system to transport secreted hormones to the TT  EG include the following: Pituitary gland Adrenal glands Thyroid gland Islet cells of the pancreas Parathyroid glands Gonads

Endocrine system  The endocrine system works with the nervous system to regulate overall physiologic function – neuroendocrine regulation  The ES keeps the constant normal balance (homeostasis) of the organs and systems in response to environmental changes

Endocrine system  Hormones: steroid - hydrocortisone peptide (protein) - insulin amine – epinephrine  Negative feedback control mechanisms In the healthy physiologic state, hormone concentration in the bloodstream is maintained at a relatively constant level When the hormone concentration rises, further production of that hormone is inhibited When the hormone concentration falls, the rate of production of that hormone increases

Assessment. History  Demographic data age and gender (some disorders are age related: hyperosmolar states, loss of ovarian function, decreased thyroid and parathyroid function; and gender related – sexual effects of hyperpituitarism and hypopituitarism)

Assessment. History  Personal and family history family history of obesity, grows or development difficulties, diabetes mellitus, infertility, or thyroid disorders assess the client of the following: endocrine dysfunction; signs or symptoms that could indicate an endocrine disorder; hospitalisations past and current medications (hydrocortisone, levothyroxine, oral contraceptives, antihypertensive drugs)

Assessment. History  Diet history Nutritional changes and GI tract disturbances may reflect a variety of endocrine problems (nausea, vomiting, abdominal pain) Changes in food and fluid intake (diabetes insipidus, diabetes mellitus) Rapid changes in weight without accompanying changes in diet (diabetes mellitus, thyroid disfunction)

Assessment. History  Socioeconomic status are the clients resources adequate to maintain the healthy diet, purchase needed medications  Current health problems did the client’s symptoms occur gradually, or was the onset sudden? has the client been treated for this problem in the past? How have the current symptoms interfered with activities of daily living?

Assessment. History energy levels (changes in energy levels are associated with a number of endocrine problems: thyroid, adrenal glands) elimination  urine amount and frequency. Does he or she urinate frequently in large amounts? Does the client wake during the night to urinate (nocturia), or does he or she experience pain on urinaton (dysuria)?  information about the frequency of bowel movements and their consistency and color

Assessment. History sex and reproduction. Women are asked about any changes in the menstrual cycle (increased flow, duration, frequency of menses; pain or excessive cramping; or a recent change in the regularity of menses). Men are asked whether they have experienced impotence. Both have to be asked about changes in libido or any fertility problems

Assessment. History Physical appearance. The client is asked about changes in the following:  hair texture and distribution  facial contours  voice quality  body proportions  secondary sexual characteristics

Physical Assessment  Inspection use a head-to-toe approach observe a general client’s appearance, height, weight, fat distribution, muscle mass in relation to age head: prominent forehead, jaw; round or puffy face; dull or flat face expression; exophtalmos (protrunding eyeballs and retracting upper lids)

Physical Assessment  Inspection lower half of the neck – visible enlargement of the thyroid gland (N – isthmus can be observed during the swallowing) jugular vein dilation – can indicate fluid overload skin – color, areas of hypo- or hyperpigmentation; fungal skin infections, slow wound healing, petechiae (adrenocortical hyperfunction); skin infections, foot ulcers, slow wound healing (diabetes mellitus)

Physical Assessment  Vitiligo (patchy areas of depigmentation with increased pigmentation at the edges) – primary hypofunction of the adrenal glands. Most often occur on the face, neck and extremities. Mucous membranes can exhibit a large areas of pigmentation  Necessary to document the location, distribution, color, size of all skin discolorations and lesion fingernails – malformation, thickness, or brittleness (thyroid gland difficulties)

Physical Assessment the extremities and the base of the spine are assessed for edema (disturbance in fluid and electrolyte balance) trunk  abnormalities in chest size and simmetry  truncal obesity, supraclavicular fat pads and a “buffalo hump” – adrenocortical excess  secondary sexual characteristics – breasts of both men and women for size, symmetry, pigmentation and discharge

Physical Assessment  Striae (usually reddish purple “stretch marks”) on the breasts or abdomen are often seen with adrenocortical excess hair distribution – hirsutism (abnormal grows of body hair, especially on the face, chest, and the linea alba of the abdomen of women), excessive hair loss, or change in hair texture genitalia (hypogonadism)

Physical Assessment  Palpation Thyroid gland (size, symmetry, general shape, presence of nodules or other irregularities)  the nurse palpates the thyroid gland standing either behind (may be easier) or in front of the client  offering the client sips of water to promote swallowing during the examination helps palpate the thyroid gland

Physical Assessment  the client is asked to sit and to lower the chin  using the posterior approach, the thumbs of both hands are placed on the back of the clients neck, with the fingers curved around to the front of the neck on either side of the trachea  the client is asked to swallow, and the nurse locates the isthmus of the thyroid and feels it rising. The anterior surface of the thyroid lobe is also identified

Physical Assessment  to examine the right lobe, the nurse: turns the client’s head to the right displaces the thyroid cartilage to the right with the fingers of the left hand palpates the right lobe with the right hand  this procedure is reversed for examination of the left lobe

Physical Assessment  Auscultation the nurse auscultates the client’s chest to establish baseline vital signs and to determine irregularities in cardiac rate and rhythm the nurse documents any difference in client’s blood pressure and pulse in the lying, standing, or sitting positions (orthostatic vital signs) – many endocrine disorders can cause dehydration and volume depletion

Physical Assessment  Auscultation if an enlarged thyroid gland is palpated, the area of enlargement is auscultaded for bruits (hypertrophy causes an increase in vascular flow)

Diagnostic Assessment  Laboratory tests Best practice for endocrine testing  explain the procedure to the client  emphasize the importance of taking a medication prescribed for the test on time. Tell the client to set an alarm if the medication is to be taken during the night  instruct the client to begin the urine collection (whether for 2, 4, 8, 12 or 24 hours) by emptying his or her bladder. Tell the client NOT to save the urine specimen that begins the collection. The timing for the urine collection begins after this specimen. To end the collection, the client empties his or her bladder at the end of the timed period and adds that urine to the collection

Diagnostic Assessment  make sure that the preservative has been added to the collection container at the beginning of the collection, if necessary. Tell the client of its presence in the container

Diagnostic Assessment  check your laboratory’s method of handling hormone test samples. Blood samples drawn for certain hormones (e.g., catecholamines) must be placed on ice and taken to the laboratory immediately  if you are drawing blood samples from a line, clear the IV line thoroughly. Do not use a double- or triple-lumen line to obtain samples; contamination or dilution from another port is possible

Diagnostic Assessment Stimulation/suppression tests Radioimmunoassay Urine tests Tests for glucose  Radiographic examinations  Other diagnostic tests (needle biopsy)