1/3/2008. Karen Burke Priscilla LeMone Elaine Mohn-Brown. Medical-Surgical Nursing Care, 2e Karen Burke, Priscilla LeMone, and Elaine Mohn-Brown

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1 Medical-Surgical Nursing Care Second Edition Karen Burke Priscilla LeMone Elaine Mohn-Brown Chapter 15 The Endocrine System and Assessment Major Endocrine Organs Hypothalamus Sits between the cerebrum and brainstem Houses the pituitary gland and hypothalamus Regulates: Temperature Fluid volume Growth Pain and pleasure response Hunger and thirst 1

2 Pituitary Gland Sits beneath the hypothalamus Termed the master gland Divided into: Anterior Pituitary Gland Posterior Pituitary Gland Anterior Pituitary Gland Promotes growth Stimulates the secretion of six hormones Controls pigmentation of the skin Posterior Pituitary Gland Stimulates the secretion of two hormones Promotes water retention 2

3 Thyroid Gland Butterfly shaped Sits on either side of the trachea Has two lobes connected with an isthmus Functions in the presence of iodine Stimulates the secretion of three hormones Involved with metabolic rate management and serum calcium levels Parathyroid Glands Embedded within the posterior lobes of the thyroid gland Secretion of one hormone Maintenance of serum calcium levels Adrenal Glands Pyramid-shaped organs that sit on top of the kidneys Each has two parts: Outer Cortex Inner Medulla 3

4 Adrenal Cortex Secretion of two hormones Involved with blood glucose level, anti-inflammatory inflammatory response, blood volume, and electrolyte maintenance Adrenal Medulla Secretion of two hormones Involved with the stress response Pancreas Located behind the stomach between the spleen and duodenum Has two major functions Digestive enzymes Release insulin and glucagon 4

5 Definition of Hormones Chemical messengers of the body Act on specific target cells Regulated by negative feedback Too much hormone, then hormone release reduced Too little hormone, then hormone release increased Pituitary Gland Anterior Pituitary Gland Hormones GH: growth hormone TSH: thyroid-stimulating hormone ACTH: adrenocorticotropic hormone Melanocyte-stimulating hormone FSH: follicle-stimulating hormone LH: Luteinizing hormone Prolactin 5

6 Posterior Pituitary Gland Hormones ADH: antidiuretic hormone Oxytocin Thyroid Gland Hormones TH: thyroid hormone Calcitonin Parathyroid Gland Hormone PTH: parathyroid hormone 6

7 Adrenal Cortex Hormones Glucocorticoids: cortisol Mineralocortocoids: aldosterone Adrenal Medulla Hormones Epinephrine Norepinephrine Insulin Produced by beta cells in the islets of Langerhans Increases with rising blood glucose levels Decreases when blood glucose levels fall 7

8 Glucagon Produced by the alpha cells in the islets of Langerhans Glucagon Release when blood glucose falls below 70 mg/dl Action of Insulin and Glucagon Insulin Regulates blood glucose levels Mechanisms Eases the active transport of glucose into muscle and fat cells Facilitates fat formation Inhibits the breakdown and movement of stored fat Helps with protein synthesis 8

9 Glucagon Prevents blood glucose from decreasing below a certain level Functions: Makes new glucose Converts glycogen into glucose in the liver and muscles Prevents excess glucose breakdown Decreases glucose oxidation and increases blood glucose During the Health Interview Ask the Client: Energy level Fatigue Maintenance of ADLs Sensitivity to heat or cold Weight level Bowel habits Level of appetite During the Health Interview Ask the Client: Urination, thirst, salt craving Cardiovascular status: blood pressure, heart rate, palpitations, SOB Vision: changes, tearing, eye edema Neurologic: numbness/tingling lips or extremities, nervousness, hand tremors, mood changes, memory changes, sleep patterns Integumentary: hair changes, skin changes, nails, bruising, wound healing 9

10 Past Medical History Hormone replacement therapy Surgeries, chemotherapy, radiation Family history: diabetes mellitus, diabetes insipidus, goiter, obesity, Addison s s disease, infertility Sexual history: changes, characteristics, menstruation, menopause Physical Assessment General appearance Vital signs, height, weight Integumentary Skin color, temperature, texture, moisture Bruising, lesions, wound healing Hair and nail texture, hair growth Face Shape, symmetry Eyes, visual acuity Neck Figure Palpating the thyroid gland from behind the client. (Courtesy of Lester V. Bergman/Corbis.) 10

11 Physical Assessment Extremities Hand and feet size Trunk Muscle strength, deep tendon reflexes Sensation to hot and cold, vibration Thorax Lung and heart sounds Extremity edema Aging and Endocrine Function Relationship unclear Aging causes fibrosis of thyroid gland Reduces metabolic rate Contributes to weight gain Cortisol level unchanged in aging Most Common Endocrine Disorders Thyroid abnormalities Risk for diabetes mellitus 11

12 Diagnostic Tests GH: fasting, well rested, not physically stressed Water deprivation: fasting for 12 hours, no fluids/smoking after midnight T3/T4: no specific preparation Serum calcium/phosphate: fasting may or may not be required Cortisol/aldosterone level: two blood samples, client to be up for at least 2 hours before test is drawn Urine 17-ketosteroids: 24-hour urine collection that needs to be iced or refrigerated Diagnostic Tests FBS: fast before the test HbA1c: No fasting required OGTT: drink 75 g of glucose and do not eat anything until blood is drawn Urine glucose/ketones: fresh urine specimen Urine microalbumin: fresh urine specimen Imaging Studies MRI: metallic implants, lie motionless during test; remove all metal objects CT Scan: assess for allergies to iodine and seafood; lie immobile during the test Thyroid scan: allergies to iodine and seafood; hold thyroid drugs containing iodine for weeks before the study RAI: fast for 8 hours before; can eat 1 hour after radioiodine capsule/liquid taken; hold thyroid drugs with iodine for weeks before the study 12