Transcript Indezine Template

Chapter 64
Assessment of the
Endocrine System
Marion Kreisel MSN, RN
NU230 Adult Health 2
Fall 2011
ENDOCRINE SYSTEM
• Key role to secrete hormones
• Hormones: are natural chemicals that
exert their effects on specific tissues
known as target tissues.
• Endocrine Glands are ductless and
must use the blood system to transport
secreted hormones to target tissues
Hormone-Receptor
Binding
Hormone A fits and
binds to receptor
sites, causing
change in cell
action. Then
hormone B does
not fit or bind an
change in cell
action
Each receptor site
specific for one
hormone
HYPOTHALAMUS
• Secretes Corticotropic Releasing Hormone (CRH)
• When you have low levels of Cortisol from the adrenal
cortex Stimulates secretion CRH which stimulates
anterior pituitary gland to secrete adrenocorticotropic
hormone (ACTH). ACTH triggers release of cortisol
from the adrenal cortex.
• Increase cortisol, decrease CRH and therefore no
ACTH….normal cortisol levels
• Has both endocrine functions: produce regulatory
hormones and control release or inhibit it
Hypothalamus & Pituitary Glands
• They share a closed circulatory system
(anterior pituitary gland)
• System is called hypothalamichypophysial portal system: allows
hormones from the hypothalamus to travel
directly to the anterior pituitary gland
Hypothalamus
Positive and Negative Feedback
System
Pituitary Gland
• Base of brain
• 2 lobes
• Anterior or adenophpophysis large lobe: secreates tropic
hormones that stimulate other endocrine glands;
• prolactin
• Posterior or neurohypophysis: stores hormones
produced in the hypothalamus
• Vasopressin, Anti-diuretic hormone (ADH), oxytocin
Drugs, diet, lifestyle and pathologic conditions can
affect the release of hormones and the pituitary gland.
Anatomy and Physiology Review
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Hypothalamus
Pituitary glands
Gonads
Adrenal glands
Thyroid gland
Parathyroid gland
Pancreas
Gonads
• Male & female reproductive endocrine
glands.
• Male: testes
• Female: Ovaries
Don’t work until puberty
Endocrine
System
Endocrine Glands: Adrenal
Glands
• Vascular, tent shape, on top of each
kidney
• These hormones have effects throughout
the whole body.
• Adrenal cortex (outer portion)—
mineralocorticoids (aldosterone),
Glucocortoids (corticosteroids) (cortisol)
• Adrenal medulla (inner portion)—
catecholamines (norepinephrine and
epinephrine)
Adrenal Cortex
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90% of adrenal gland
3 layers
Control NA+ & K+
Mineralocorticoids: control body fluids and electrolytes. Aldosterone is
the main mineralocorticoid maintains extracellular fluid volume
• Glucocortoids: ESSENTIAL FOR LIFE The main glucocortoid is
Cortisol:
• Carbohydrate, protein & fat metabolism
• Body’s response to stress
• Emotional stability
• Immune Function
Adrenal Medulla
• Sympathetic System
• Release Catecholamines (epi & norepi)
• Works on Stress
Thyroid Gland
• Control of metabolism
• Calcium and phosphorus balance
Parathyroid Gland
• 4 small glands back of the thyroid
• Produce & secrete parathyroid hormone (PTH)
• Regulates calcium & phosphorus
• PTH increase increase bone resorption (bone releaseof
calcium into blood)
Pancreas
• Main job regulate blood sugar
• Islets of Langerhans
• 3 cell types
• Alpha: secreate glucagon: increase
blood glucose levels
• Beta: secrete insulin: lowers glucose
levels
• Delta: secrete somatostatin (growth
hormone)
Assessment Methods
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Patient history
Nutrition history
Family history and genetic risk
Current health problems
Assessment Methods (Cont’d)
• Current health problems including any
changes in:
• Energy levels
• Elimination
• Sexual and reproductive functions:
• Decreased Libido
• Impotence or infertility
• Irregular menstrual cycle
• Physical appearance
• Muscle Wasting & Atrophy
Physical Assessment
• Examine for:
• Prominent forehead or jaw
• Round or puffy face
• Dull or flat expression
• Exophthalmos: protrusion of eyeballs
• Vitiligo: irregular patches of skin and no pigment
• Striae: linear scar develops from rapid tension in skin
(pregnancy)
• Hirsutism: excessive body hair in a masculine
distribution
Palpation
Laboratory Tests
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Stimulation/suppression tests
Assays
Urine tests
Tests for glucose
Imaging assessment
Other diagnostic assessment
Chapter 64
Assessment of the
Endocrine System
NCLEX
TIME
Question 1
A priority nursing intervention for a patient with primary
adrenal cortex dysfunction would be to:
A. Monitor vital signs and patient’s physiologic
response to stress.
B. Closely measure fluid intake and output.
C. Provide emotional support during stressful
situations.
D. Weigh the patient daily.
Question 2
Which diagnostic test is most sensitive in
evaluating a pituitary gland disorder?
A. Computed tomography (CT) scan
B. Laboratory evaluation of serum sodium
levels
C. Magnetic resonance imaging (MRI)
D. Urine specific gravity test
Question 3
An expected outcome for the patient who has
recently experienced the death of her
spouse is changes in the secretion of
which pituitary hormones?
A.
B.
C.
D.
Growth hormone and vasopressin
Oxytocin and prolactin
Vasopressin and prolactin
Growth hormone and oxytocin
Question 4
An expected outcome for the patient being
treated with opioid analgesics as part of
her therapy for cancer is a change in the
secretion of which pituitary hormones?
A. Growth hormone and prolactin
B. Prolactin and oxytocin
C. Growth hormone and vasopressin
D. Vasopressin and oxytocin
Question 5
Which of these is a possible outcome for the
patient
experiencing an age-related decrease in
antidiuretic
hormone?
A.
B.
C.
D.
Constipation, lethargy, and dry skin
Greater-than-ideal body weight
Diluted urine and polyuria
Yeast infection and polydipsia