Chapter 26 Endocrine Function

Introduction Functions of the endocrine system Glands that synthesize and secrete hormones Two major classes of hormones Steroids Thyronines Age-related changes are diverse and interrelated

Effects of Aging on Endocrine Function Thyroid gland atrophies and activity decreases Diminished adrenal function Adrenocorticotropic hormone (ACTH) secretion decreases Volume of pituitary gland decreases Insufficient release of insulin and reduced tissue sensitivity to circulating insulin

Question Which of the following statements best describes the effects of aging changes on thyroid gland activity? Lower basal metabolic rate (BMR) Inability of the thyroid to meet daily needs Improved secretion of thyrotropin Increased radioactive iodine uptake

Answer A. Lower basal metabolic rate (BMR) Rationale: With age, the thyroid gland progressively atrophies and thyroid gland activity decreases, resulting in a lower BMR, reduced radioactive iodine uptake, and less secretion and release of thyrotropin.

Diabetes Mellitus Type 2 diabetes (T2DM) Seventh leading cause of death in older adults Incidence Glucose intolerance Diagnosis of diabetes in the older adult Classic nonspecific symptoms may be absent

Diabetes Mellitus (cont.) Screening Fasting blood sugar recommended every 3 years for persons over 45 years of age. Glucose tolerance test is the most effective test. To avoid false-positive results, more than one test should be performed Lab tests may be misleading.

Diabetes Mellitus (cont.) Criteria for diagnosis (generally established if one of three exists): Symptoms and a random blood glucose concentration ≥200 mg/dL Fasting blood glucose concentration ≥126 mg/dL Blood glucose concentrations 2 hours after oral glucose intake ≥200 mg/dL

Diabetes Mellitus (cont.) Management through patient education Content Overview of disease process Nutrition Activity and exercise Medications Monitoring Recognition of signs/symptoms Presentation of complications

Diabetes Mellitus (cont.) Management Implications of diagnosis Psychological Social Assessment of self-care capacity Reassurance and support

Question The effects of aging on the action of insulin include which of the following? Insufficient release of insulin by the beta cells Increased tissue sensitivity to circulating insulin Improved ability to metabolize glucose Decreased glucagon production

Answer A. Insufficient release of insulin by the beta cells Rationale: Insulin secretion is affected by age as there is insufficient release of insulin by the beta cells in the pancreas and a reduced sensitivity to circulating insulin. Many older adults also have a reduced ability to metabolize glucose.

Diabetes Mellitus (cont.) Drug therapy Types Action Side effects Preferred medications for older adults Management/monitoring Individualized

Diabetes Mellitus (cont.) Patient self-care and monitoring Ability to handle a syringe and vial of insulin Ability to read calibrations on an insulin syringe Hyperglycemic without being glycosuric Instructed in finger-prick technique and demonstrate competency

Diabetes Mellitus (cont.) Monitoring Hemoglobin (Hgb or Hb) A1c test measures the amount of glycosylated Hgb in the blood Used to monitor effectiveness of disease control Triglyceride monitoring Levels below 150 mg/dL (ideal)

Question Glycosylated hemoglobin levels monitor average blood glucose levels over what period of time? 1 to 2 weeks 3 to 4 weeks 6 to 12 weeks 12 to 20 weeks

Answer C. 6 to 12 weeks Rationale: The HgbA1c test measures the amount of glycosylated Hgb in the blood and is used to monitor the effectiveness of disease management. HgbA1c provides an average of the patient’s blood glucose control over a 6- to 12-week period.

Diabetes Mellitus (cont.) Exercise and nutrition Health benefits of regular exercise Effect of exercise on blood glucose and triglyceride levels Need to monitor the level of activity as it relates to blood glucose levels Need for consistent daily intake of food Psychosocial factors impacting

Complications of Diabetes Mellitus At greater risk for developing than younger adults Hypoglycemia Greater threat than ketoacidosis Atypical symptoms Peripheral vascular disease (PVD) Diabetic retinopathy Drug interactions

Complications of Diabetes Mellitus (cont.) Neuropathies Retinopathy leading to blindness Cognitive impairment Coronary artery disease Cerebral arteriosclerosis Urinary tract infections Higher risk of developing problems in every body system

Question Is the following statement true or false? Confusion and abnormal behavior are symptoms that may demonstrate hypoglycemia episodes in an older adult.

Answer True Rationale: Rather than the classic symptoms of hypoglycemia that one would anticipate in younger adults, older individuals may experience confusion, abnormal behavior, altered sleep patterns, nocturnal headache, and slurred speech.

Hypothyroidism Effects of aging on the thyroid gland Subnormal concentration of thyroid hormone Prevalence Primary versus secondary hypothyroidism Signs and symptoms Treatment/management Nursing interventions

Hyperthyroidism Secretion of excess amounts of thyroid hormone Incidence/prevalence Causes Signs and symptoms Diagnosis Treatment/management