Assessing Clients with Endocrine Disorders. Endocrine Glands Pituitary Gland Thyroid Gland...

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Assessing Clients with EndocrineDisorders1 Endocrine Glands Pituitary GlandThyroid GlandParathyroid GlandsAdrenal GlandsPancreatic GlandsReproductive Glands2 Endocrine Glands

3Figure 181 Location of the major endocrine glands. Endocrine Glands

4Figure 182 Location of the pituitary gland. Endocrine Glands

5Figure 183 Actions of the major hormones of the anterior pituitary. Endocrine Glands

6Figure 184 The thyroid gland. Endocrine Glands

7Figure 185 Location of the adrenal glands. Endocrine Glands

8Figure 186 Negative feedback. Endocrine Glands

9Figure 187 Examples of three mechanisms of hormone release: A, hormonal; B, humoral; or C, neural. Endocrine Glands

10Figure 188 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 extensionreleased messengers diffuse through interstitial fluid11 Topics Covered in Health History Interview Health Perception and Management: state of health, endocrine problems, use of drugs, alcohol, smokingNutritional: diet, fluid intake, weight changes, change in energy levelElimination: changes in bowel, bladder habitsActivity/Exercise: describe physical activities, energy level12 Topics Covered in Health History Interview Sleep/Rest: how many hours of sleep/night, problems sleeping, night sweatsCognitive/Perceptual: memory problems, restlessness, confusion, anxiety, vocal changes, visual changes, heart palpitations, abdominal pain, pain, stiffness in jointsSelf Perception/Self Concept: feelings about self, medicationsRole/Relationships: family history of endocrine disorders? Does this condition affect your relationship with others?13 Topics Covered in Health History Interview Sexuality/Reproductive: affects on sexual activitiesCoping/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?14 Disorders of the Thyroid GlandAn enlarged thyroid may indicate Graves disease or a goiterExophthalmos (protruding eyes)seen in hyperthyroidismBrittle nails, dry hair, hair loss indicative of hypothyroidism15 Disorders of the Thyroid GlandRestlessness, anxious, disturbed sleep pattern indicative of hyperthyroidismAgerelated endocrine changesPituitary: decreased production of ACTH, TSH, FSHThyroid: decrease in gland activityAdrenal medulla: increase secretion and level of norepinephrinePancreas: decreased absorption of fat soluble vitamins delayed and decreased insulin production16 Normal Variation Normal variation in assessment findings for the older adultA higher than normal blood glucose levels are not unusual in nondiabetic older adults17 Endocrine System Growth Hormonedeficiency indicates dwarfism and excess indicates gigantism, acromeglyMRIidentifies tumors of the pituitary and hypothalamusThyroid stimulating hormone (TSH) differentiates between pituitary and thyroid causes of hypothyroidismThyroine T4-aid in diagnosis of thyroid functionTriiodothyronine(T3)-compare T3 and T4 to diagnose thyroid disorder18 Endocrine System indirect measure of free thyroxinThyroid Antibodies-identifies thyroid immune diseaseThyroid Scan-evaluates nodulesParathyroid Hormone-identifies hypoparathyroidism or hyperparathyroidismFasting Blood Sugar-confirms diagnosis of diabetes mellitusCT Scan-identifies pancreatic tumors or cysts19Nursing Care of Clients with EndocrineDisorders20 Nursing Care for Clients with Endocrine Disorders Directed toward meeting physiologic needsProviding educationEnsuring psychologic support for client and familyHolistic approach is essential21 Hyperfunction and Hypofunction Disorders Hyperthyroidism: palpataions, increased sweating, increased appetite, weight lossHypothyroidism: lethargy, weight gain, depression, dry skinHyperparathyroidism: hypertension, psychosis, muscle weakness, renal calculiHypoparathyroidism: tetany, muscle spasms,Arrhythmia: hyperactive reflexesCushings Syndrome: weakness, easily bruised, poor wound healing, glycosuria22 Hyperfunction and Hypofunction Disorders

23Figure 191 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

24Figure 192 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 medicationAntithyroid Drugs: monitor for side effects such as pruritis rash, elevated temperature, anorexia, loss of taste, menstrual changes, fatigue, and weight gain25 Nursing Implications for Selected Endocrine Medications Hypothyroidism TreatmentsAdminister 1 hour prior to eating or at least 2 hours after eatingMonitor for minor bruising, bleeding gums, and blood in the urineMonitor for coronary insufficiency, chest pain, dyspnea, and tachycardiaHyperparathyroidism TherapyEducation to avoid OTC medications with calcium, drink fluids, and remain active26 Nursing Care Client teaching to support the neck postoperatively, to increase comfort and to decrease straining of the suture lineTeaching effective coughing and deep breathing exercisesReassurance concerning the scarEncourage verbalization of concerns27 Nursing Care Postoperative care Comfort measuresAssess painClient in the semi-Fowlers position Assess the client for complicationsUse medical and surgical asepsisAdrenalectomy preoperative care includes a dietary consultationAdrenalectomoy postoperative care includes vital signs, monitoring intake and output28 Nursing Process and Frameworks of Care Thyroid: hyperthyroid or hypothyroid goal is euthyroid functionParathyroid Hyperfunction: observe for renal calculi, muscle weakness, and polyuriaHypofunction: observe for tetany, low serum calcium levels29 Nursing Process and Frameworks of CareAdrenal GlandCushings syndrome: observe for pathologic fractures, hypertension, emotional disturbancesAddisons disease: observe for postural hypotension, syncope, Addisonian crisisAnterior Pituitary Gland: observe for hypertension, voice changes, tongue enlargement, indicating acromegaly 30 Nursing Process and Frameworks of Care Diabetes insipidus is manifested by polydipsia and polyuriaPosterior Pituitary: observe for signs of SIADH, which can occur as a result of water retention31