1. Chapter 26 Endocrine Function

2. 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

3. 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

4. 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

5. 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.

6. 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

7. 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.

8. 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

9. 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

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

11. 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

12. 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.

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

14. 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

15. 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)

16. 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

17. 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.

18. 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

19. 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

20. 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

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

22. 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.

23. 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

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