9Endocrine GlandsFigure 18–7 Examples of three mechanisms of hormone release: A, hormonal; B, humoral; or C, neural.
10Endocrine GlandsFigure 18–8 Palpating the thyroid gland from behind the client.
11Transportation 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 fluid
12Topics 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 level
13Topics 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?
14Topics 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?
15Disorders of the Thyroid Gland An enlarged thyroid may indicate Graves disease or a goiterExophthalmos (protruding eyes)seen in hyperthyroidismBrittle nails, dry hair, hair loss indicative of hypothyroidism
16Disorders of the Thyroid Gland Restlessness, anxious, disturbed sleep pattern indicative of hyperthyroidismAge—related 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 production
17Normal VariationNormal variation in assessment findings for the older adultA higher than normal blood glucose levels are not unusual in nondiabetic older adults
18Endocrine SystemGrowth Hormone—deficiency indicates dwarfism and excess indicates gigantism, acromeglyMRI—identifies 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 disorder
19Endocrine System indirect measure of free thyroxin Thyroid 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 cysts
23Hyperfunction 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.
24Hyperfunction 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.
25Nursing 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 gain
26Nursing 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 active
27Nursing CareClient 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 concerns
28Nursing Care Postoperative care Assess the client for complications Comfort measuresAssess painClient in the semi-Fowler’s positionAssess the client for complicationsUse medical and surgical asepsisAdrenalectomy preoperative care includes a dietary consultationAdrenalectomoy postoperative care includes vital signs, monitoring intake and output
29Nursing Process and Frameworks of Care Thyroid: hyperthyroid or hypothyroid goal is euthyroid functionParathyroidHyperfunction: observe for renal calculi, muscle weakness, and polyuriaHypofunction: observe for tetany, low serum calcium levels
30Nursing Process and Frameworks of Care Adrenal GlandCushing’s syndrome: observe for pathologic fractures, hypertension, emotional disturbancesAddison’s disease: observe for postural hypotension, syncope, Addisonian crisisAnterior Pituitary Gland: observe for hypertension, voice changes, tongue enlargement, indicating acromegaly
31Nursing 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 retention