1. Chapter 32 Metabolic and Endocrine Conditions

2. Functions of the Endocrine System Body growth and development Reproduction Metabolism of energy Maintenance of homeostasis Response to stress and injury

3. Characteristics of the Endocrine System Consists of glands that synthesize and secrete hormones Two major classes of hormones: –Steroids and thyronines lipid soluble –Polypeptides and catecholamines water soluble.

4. Increased Incidence of Glucose Intolerance A physiologic deterioration of glucose tolerance occurs with increasing age. Improvement of diagnostic techniques enable more persons with the condition to be detected. There is an increase in the incidence of diabetes throughout the general population.

5. Indications of Diabetes in Elders Orthostatic hypotension Periodontal disease Stroke Gastric hypotony Impotence Neuropathy

6. Indications of Diabetes in Elders (cont.) Confusion Gaucoma Dupuytren contracture Infection

7. Criteria for the Diagnosis of Diabetes Random plasma glucose concentrations are greater than or equal to 200 mg/dL. Fasting blood glucose concentrations are greater than or equal to 136 mg/dL on two occasions. Plasma glucose concentrations after oral glucose intake are greater than or equal to 200 mg/dL.

8. Patient Education for Diabetes General overview Nutrition Activity and exercise Medications Monitoring Recognizing hypoglycemia and hyperglycemis Recognition of symptoms Prevention of complications

9. Primary Symptoms of Hypoglycemia Behavioral disorders Convulsions Somnolence Confusion Disorientation Altered sleep Nocturnal headache Slurred speech Cardiac symptoms

10. Effects of Aging on the Thyroid Gland Moderate atrophy Fibrosis Increasing colloid nodules Some lymphocytic infiltration

11. Hypothyroidism Definition –A subnormal concentration of thyroid hormone in the tissues. Types –Primary: results from a disease process that destroys the thyroid gland –Secondary: caused by insufficient pituitary secretion of thyroid-stimulating hormone (TSH).

12. Symptoms of Hypothyroidism Fatigue, weakness, and lethargy Depression and disinterest in activities Anorexia Weight gain Impaired hearing Periorbital or peripheral edema

13. Symptoms of Hypothyroidism (cont.) Constipation Cold intolerance Myalgia, paresthesia, and ataxia Dry skin and coarse hair

14. Symptoms of Hyperthyroidism Diaphoresis Tachycardia Palpitations Hypertension Tremor Diarrhea Stare Lid lag

15. Symptoms of Hyperthyroidism (cont.) Insomnia Nervousness Confusion Heat intolerance Increased hunger Proximal muscle weakness Hyperreflexia

16. Treatment of Hyperthyroidism Graves’ Disease or Single Autonomous Nodule –Treatment typically includes antithyroid medications or radioactive iodine. Toxic Multinodular Goiter –Surgery may be preferred due to the delayed and incomplete response to medications.

17. Factors Contributing to Hyperlipidemia Increase in low-density lipoprotein (LDL) with aging Uncontrolled diabetes Hypothyroidism Uremia Nephrotic syndrome Use of corticosteroids, thiazide diuretics, and other drugs that increase the risk.

18. Treatment for Hyperlipidemia Dietary changes Exercise Weight reduction Limiting alcohol intake Medications Alternative and complementary therapies

19. Source Eliopoulos, C. (2005). Gerontological Nursing, (6 th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).