Transcript Document
Assessing Clients with Endocrine Disorders Endocrine Glands • • • • • • Pituitary Gland Thyroid Gland Parathyroid Glands Adrenal Glands Pancreatic Glands Reproductive Glands Endocrine Glands Endocrine Glands Endocrine Glands Endocrine Glands Endocrine Glands Endocrine Glands Endocrine Glands Endocrine Glands 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 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 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? 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? 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 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 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 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 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 Nursing Care of Clients with Endocrine Disorders 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 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 Hyperfunction and Hypofunction Disorders Hyperfunction and Hypofunction Disorders 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 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 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 Nursing Care • Postoperative care – 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 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 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 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