1. Medical-Surgical Nursing: Concepts & Practice
3rd edition
Chapter 35
The Endocrine System
Copyright © 2017, Elsevier Inc. All rights reserved.

2. Functions of the Endocrine System
Alter chemical reactions and control the rates at which chemical activities take place within cells
Change the permeability of cell membranes and select the substances that can be transported across cell membranes
Activate a particular mechanism in the cell, such as the system that controls cellular growth and reproduction

3. Effects of Hormones from the Pituitary Gland
See Figure 35-2 on p. 823.

4. Endocrine System Structure and function Effects of aging
Pituitary hormones
Thyroid hormones
Parathyroid gland
Adrenal glands
Endocrine pancreas
Effects of aging

5. Effects of Epinephrine and Control of Its Secretion
See Figure 35-4 on p. 825
From Applegate E: The anatomy and physiology learning system,
ed 4, Philadelphia, 2011, Saunders.

6. Regulation of Aldosterone and Cortisol Secretion
See Figure 35-5 on p. 825.
From Applegate E: The anatomy and physiology learning system, ed 2, Philadelphia, 2000, Saunders.

7. Blood Glucose Regulation
See Figure 35-6 on p. 826
Adapted from Applegate E: The anatomy and physiology learning system, ed 2, Philadelphia, 2000, Saunders.

8. Major Endocrine Glands
See Figure 35-1 on p. 822

9. Basic Concepts Hormones and target tissues Negative feedback
Hypothalamus and the pituitary gland

11. Causes of Endocrine Disorders
Primary dysfunction
Hypersecretion and hyposecretion
Tumors and inflammation
Infection, mechanical damage, or autoimmune response
Secondary dysfunction
Medications, trauma, hormone therapy
Temporary or permanent

12. Endocrine Disorders Preventing goiter Diagnosis Thyroid panel
Parathyroid function—serum calcium and phosphate levels
Adrenal gland function—electrolyte panels, glucose levels, hormone levels, and 12-lead electrocardiogram (ECG)

13. Effects of Aging on the Endocrine System
Pituitary gland smaller
Thyroid lumpy or nodular
Hormones decrease or increase
Blood glucose levels rise
Thyroid hormone levels decrease

14. Diagnosis of Diabetes Mellitus
Presence of symptoms and
Random blood glucose level greater than or equal to 200 mg/dL, OR
Fasting glucose level greater than or equal to 126 mg/dL, OR
Glucose tolerance test revealing postprandial glucose greater than or equal to 200 mg/dL 2 hours after 75 g of glucose is administered

16. Diagnosis of Diabetes Mellitus (Cont.)
Glucose tolerance test
Hemoglobin A1c (A1C) test
Healthy People 2020: Increase the proportion of adults with diabetes who have an A1C test at least twice a year
Fructosamine assay
In a glucose tolerance test, the patient is given a set amount of glucose to evaluate insulin secretion and ability to metabolize glucose.
A1C test (formerly called the glycosylated hemoglobin test) measures blood glucose over a period of many weeks. Glucose in the bloodstream attaches itself to the hemoglobin A (red blood cell) molecule and remains there for the life span of the red blood cell. Physicians use A1C test results to prescribe adjustments to a patient’s treatment program for managing diabetes.
Fructosamine assay monitors blood glucose over a shorter time frame than the A1C test because the assay measures sugar attached to the protein albumin, which has a shorter life than hemoglobin.

19. Degrees of Control of Blood Glucose Based on HbA1C Levels
See Table 35-4 on p. 832.

20. Nursing Management of Endocrine Disorders
Thorough focused assessments
Nursing diagnosis
Goals of care
Evaluation
Community care

21. General Nursing Goals Prevention of injury
Maintenance of fluid and electrolyte balance
Maintenance of hormone balance
Reduction of stress
Use of effective coping mechanisms

22. General Nursing Goals (Cont.)
Knowledge of self-care
Tolerance of physical activity
Promotion of normal bowel function
Improvement of mental-emotional status
Integration of body image