1. Assessing Clients
with Endocrine
Disorders

2. Endocrine Glands Pituitary Gland Thyroid Gland Parathyroid Glands
Adrenal Glands
Pancreatic Glands
Reproductive Glands

3. Endocrine Glands
Figure 18–1 Location of the major endocrine glands.

4. Endocrine Glands
Figure 18–2 Location of the pituitary gland.

5. Endocrine Glands
Figure 18–3 Actions of the major hormones of the anterior pituitary.

6. Endocrine Glands
Figure 18–4 The thyroid gland.

7. Endocrine Glands
Figure 18–5 Location of the adrenal glands.

8. Endocrine Glands
Figure 18–6 Negative feedback.

9. Endocrine Glands
Figure 18–7 Examples of three mechanisms of hormone release: A, hormonal; B, humoral; or C, neural.

10. Endocrine Glands
Figure 18–8 Palpating the thyroid gland from behind the client.

11. 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 extension
released messengers diffuse through interstitial fluid

12. Topics Covered in Health History Interview
Health Perception and Management: state of health, endocrine problems, use of drugs, alcohol, smoking
Nutritional: diet, fluid intake, weight changes, change in energy level
Elimination: changes in bowel, bladder habits
Activity/Exercise: describe physical activities, energy level

13. Topics Covered in Health History Interview
Sleep/Rest: how many hours of sleep/night, problems sleeping, night sweats
Cognitive/Perceptual: memory problems, restlessness, confusion, anxiety, vocal changes, visual changes, heart palpitations, abdominal pain, pain, stiffness in joints
Self Perception/Self Concept: feelings about self, medications
Role/Relationships: family history of endocrine disorders? Does this condition affect your relationship with others?

14. Topics Covered in Health History Interview
Sexuality/Reproductive: affects on sexual activities
Coping/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?

15. Disorders of the Thyroid Gland
An enlarged thyroid may indicate Graves disease or a goiter
Exophthalmos (protruding eyes)seen in hyperthyroidism
Brittle nails, dry hair, hair loss indicative of hypothyroidism

16. Disorders of the Thyroid Gland
Restlessness, anxious, disturbed sleep pattern indicative of hyperthyroidism
Age—related endocrine changes
Pituitary: decreased production of ACTH, TSH, FSH
Thyroid: decrease in gland activity
Adrenal medulla: increase secretion and level of norepinephrine
Pancreas: decreased absorption of fat soluble vitamins delayed and decreased insulin production

17. Normal Variation
Normal variation in assessment findings for the older adult
A higher than normal blood glucose levels are not unusual in nondiabetic older adults

18. Endocrine System
Growth Hormone—deficiency indicates dwarfism and excess indicates gigantism, acromegly
MRI—identifies tumors of the pituitary and hypothalamus
Thyroid stimulating hormone (TSH) differentiates between pituitary and thyroid causes of hypothyroidism
Thyroine T4-aid in diagnosis of thyroid function
Triiodothyronine(T3)-compare T3 and T4 to diagnose thyroid disorder

19. Endocrine System indirect measure of free thyroxin
Thyroid Antibodies-identifies thyroid immune disease
Thyroid Scan-evaluates nodules
Parathyroid Hormone-identifies hypoparathyroidism or hyperparathyroidism
Fasting Blood Sugar-confirms diagnosis of diabetes mellitus
CT Scan-identifies pancreatic tumors or cysts

20. Nursing Care of
Clients with Endocrine
Disorders

21. Nursing Care for Clients with Endocrine Disorders
Directed toward meeting physiologic needs
Providing education
Ensuring psychologic support for client and family
Holistic approach is essential

22. Hyperfunction and Hypofunction Disorders
Hyperthyroidism: palpataions, increased sweating, increased appetite, weight loss
Hypothyroidism: lethargy, weight gain, depression, dry skin
Hyperparathyroidism: hypertension, psychosis, muscle weakness, renal calculi
Hypoparathyroidism: tetany, muscle spasms,
Arrhythmia: hyperactive reflexes
Cushing’s Syndrome: weakness, easily bruised, poor wound healing, glycosuria

23. Hyperfunction 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.

24. Hyperfunction 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.

25. Nursing Implications for Selected Endocrine Medications
Hyperthyroidism Medications: assess for hypersensitivity to iodine or shellfish prior to giving medication
Antithyroid Drugs: monitor for side effects such as pruritis rash, elevated temperature, anorexia, loss of taste, menstrual changes, fatigue, and weight gain

26. Nursing Implications for Selected Endocrine Medications
Hypothyroidism Treatments
Administer 1 hour prior to eating or at least 2 hours after eating
Monitor for minor bruising, bleeding gums, and blood in the urine
Monitor for coronary insufficiency, chest pain, dyspnea, and tachycardia
Hyperparathyroidism Therapy
Education to avoid OTC medications with calcium, drink fluids, and remain active

27. Nursing Care
Client teaching to support the neck postoperatively, to increase comfort and to decrease straining of the suture line
Teaching effective coughing and deep breathing exercises
Reassurance concerning the scar
Encourage verbalization of concerns

28. Nursing Care Postoperative care Assess the client for complications
Comfort measures
Assess pain
Client in the semi-Fowler’s position
Assess the client for complications
Use medical and surgical asepsis
Adrenalectomy preoperative care includes a dietary consultation
Adrenalectomoy postoperative care includes vital signs, monitoring intake and output

29. Nursing Process and Frameworks of Care
Thyroid: hyperthyroid or hypothyroid goal is euthyroid function
Parathyroid
Hyperfunction: observe for renal calculi, muscle weakness, and polyuria
Hypofunction: observe for tetany, low serum calcium levels

30. Nursing Process and Frameworks of Care
Adrenal Gland
Cushing’s syndrome: observe for pathologic fractures, hypertension, emotional disturbances
Addison’s disease: observe for postural hypotension, syncope, Addisonian crisis
Anterior Pituitary Gland: observe for hypertension, voice changes, tongue enlargement, indicating acromegaly

31. Nursing Process and Frameworks of Care
Diabetes insipidus is manifested by polydipsia and polyuria
Posterior Pituitary: observe for signs of SIADH, which can occur as a result of water retention