1. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning VOLUME ONE | SECOND EDITION Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Metabolism 12 MODULE

2. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition The Concept of Metabolism Processes of biochemical reactions in body's cells Hormones  Chemical messengers secreted by various glands

3. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Normal Metabolism Pituitary gland  Located in skull beneath hypothalamus  "Master gland"  Its hormones regulate many body functions  Two parts: Anterior pituitary Posterior pituitary

4. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Normal Metabolism, continued Anterior pituitary  Several types of endocrine cells 1.Promotes growth of body tissues by enhancing protein synthesis. 2.Promotes use of fat for energy.

5. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Normal Metabolism, continued Thyroid gland  Location Anterior to upper trachea Inferior to larynx  Glandular tissue with follicles  Secretes hormones T 3, T 4 (thyroid hormone) Calcitonin

6. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Normal Metabolism, continued Parathyroid glands  Four to six glands  Secrete parathyroid hormone (PTH) Maintains calcium levels Phosphate metabolism

7. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Normal Metabolism, continued Adrenal glands  Two pyramid-shaped organs  Sit on top of kidneys  Two organs within each gland Adrenal medulla Epinephrine Norepinephrine Adrenal cortex Mineralocorticoids Glucocorticoids

8. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Normal Metabolism, continued Pancreas  Behind stomach Between spleen and duodenum  Endocrine gland and exocrine gland  Endocrine cells produce hormones that regulate carbohydrate metabolism Clustered in pancreatic islets (islets of Langerhans) Three cell types: alpha, beta, delta

9. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Normal Metabolism, continued Hormones  Chemical messengers secreted by endocrine organs  Transported in four ways Endocrine glands Neurons Hypothalamus Paracrine method

10. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Genetic and Lifespan Considerations Endocrine system responsible for  Sexual differentiation during fetal development  Stimulating growth and development Childhood Adolescence

11. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Concepts Related to Metabolism Acid-Base Balance Metabolic acidosis Perfusion Myxedema Oxygenation Ascites Stress and Coping Powerlessness

12. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Alterations to Metabolism Disorders of structure and function Hormone production increases or decreases

13. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Alterations and Manifestations Endocrine and Metabolic Disorders that alter normal hormone levels  Diabetes mellitus Type 1, 2 Insulin  Obesity  Graves disease  Hypothyroidism  Osteoporosis  Cirrhosis

14. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Prevention Help client identify and modify risk factors Screenings for diabetes and obesity Liver disease  CAGE questionnaire  Some diseases that result in cirrhosis can be genetic in nature

15. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Nursing Assessment Health assessment interview  Genetic influences  Screening  Medical history  Family history  Social, personal history  Changes in normal growth, development  Injuries

16. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Assessment Interview 1. Does anyone in your family have an endocrine disorder? 2. Has your weight changed? 3. Describe your physical activities. 4. Have you noticed any problem with your memory? 5. Have you noticed any change in the color or condition of your skin and hair?

17. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Nursing Assessment, continued Thyroid gland: only palpable organ Skin assessments Texture and moisture Nail and hair assessment Facial assessment Symmetry of face; position of eyes Thyroid gland assessment Palpate gland for size and consistency Motor function assessment Reflexes Sensory function assessment Pain, temperature, vibration sense, stereognosis

18. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Nursing Assessment, continued Musculoskeletal assessment Assessing for hypocalcemic tetany  Trousseau sign Tetany with BP  Chvostek sign Facial grimacing with tapping of facial muscle

19. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Diagnostic Tests Hemoglobin A 1C T 3, T 4, TSH Individual hormone levels Serum electrolytes Liver enzymes Bilirubin Serum albumin Serum calcium

20. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Interventions and Therapies Multidisciplinary care for multiple problems Meet physiological needs Education Ensure psychological support Holistic approach essential

21. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Independent Educate client regarding the diagnostic testing, disease state and therapies Develop a lifestyle that will limit complications from the disorder Community resources

22. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Collaborative Collaboration with a certified exercise physiologist and certified dietitian Behavioral therapy

23. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Collaborative Pharmacologic therapy  Hormone administered as replacement Insulin Antithyroid agents -Tapazole Thyroid agents -Synthroid Hormonal agents -Evista Bisphosphonates -Fosamax