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Nursing Assessment: Endocrine System

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  1. Nursing Assessment:Endocrine System J. Brinley, MSN, RN, CNE

  2. Structures and Functions of Endocrine System Fig. 48-1. Location of the major endocrine glands. The parathyroid glands lie on the posterior surface of the thyroid. 2

  3. Structures and Functions of Endocrine System • Glands • Hormones • Classifications and functions • Hormone transport • Targets and receptors 3

  4. Hormone Functions and Regulation Released in response to body’s needs Responsible for reproduction, fluid and electrolyte balance, host defenses, responses to stress and injury, energy metabolism, and growth and development Endocrine system: maintain homeostasis Maintenance of physiologic stability despite constant changes in the environment

  5. Structures and Functions of Endocrine System • Hormones • Targets and receptors, continued • Steroid hormone receptors 5

  6. Structures and Functions of Endocrine System Fig. 48-2. The target cell concept. Hormones act only on cells that have receptors specific to that hormone, because the shape of the receptor determines which hormone can react with it. This is an example of the lock-and-key model of biochemical reactions. 6

  7. Structures and Functions of Endocrine System Fig. 48-3. A, Protein hormones bind to receptors located in the cell membrane. The hormone-receptor interaction stimulates the formation of cAMP, thereby activating various cell processes. B, Steroid hormones penetrate the cell membrane and interact with intracellular receptors. The hormone-receptor complex activates the cell by stimulating protein synthesis. 7

  8. Structures and Functions of Endocrine System • Hormones • Targets and receptors, continued • Protein hormone receptors 8

  9. Structures and Functions of Endocrine System • Hormones, continued • Regulation of hormonal secretion • Simple feedback 9

  10. Structures and Functions of Endocrine System Fig. 48-4. Feedback mechanism between blood glucose and insulin. A, Increased blood glucose stimulates increased insulin secretion from the pancreas. B, As blood glucose levels decline, insulin secretion decreases. 10

  11. Structures and Functions of Endocrine System Fig. 48-5. Feedback mechanism between parathyroid hormone (PTH) and calcium. 11

  12. Structures and Functions of Endocrine System • Hormones • Regulation of hormonal secretion, continued • Complex feedback 12

  13. Structures and Functions of Endocrine System Fig. 48-6. General model for control and negative feedback to hypothalamus-pituitary target organ systems. Negative feedback regulation is possible at three levels: target organ (ultrashort feedback), anterior pituitary (short feedback), and hypothalamus (long feedback). 13

  14. Structures and Functions of Endocrine System • Hormones • Regulation of hormonal secretion, continued • Nervous system control • Rhythms 14

  15. Structures and Functions of Endocrine System Fig. 48-7. Circadian rhythm of cortisol secretion. 15

  16. Structures and Functions of Endocrine System • Hypothalamus 16

  17. Test your knowledge • Two hormones produced by the posterior pituitary gland (neurohypophysis) are: • Antidiuretic hormone (ADH) and oxytocin. • Growth hormone (GH) and adrenocorticotropic hormone (ACTH). • Thyroid-stimulating hormone (TSH) and growth hormone (GH). • Follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

  18. Answer • A antidiuretic hormone (ADH) and oxytocin.

  19. Structures and Functions of Endocrine System Table 48-2. Hormones of the Hypothalamus. 19

  20. Anatomy and Physiology Anterior lobe Larger of the two lobes: accounts for 70% to 80% of the gland’s weight Called the adenohypophysis Secretes Growth hormone (GH), or somatotropic hormone Adrenocorticotropic hormone (ACTH) Thyroid-stimulating hormone or thyrotropic hormone Follicle-stimulating hormone Luteinizing hormone Prolactin, or lactogenic hormone Melanocyte-stimulating hormone

  21. Structures and Functions of Endocrine System Fig. 48-8. Relationship between the hypothalamus, pituitary, and target organs. The hypothalamus communicates with the anterior pituitary via a capillary system and with the posterior pituitary via nerve tracts. The anterior and posterior pituitary hormones are shown with their target tissues. 21

  22. Structures and Functions of Endocrine System • Pituitary • Anterior pituitary, continued • Tropic hormones • Growth hormone • Prolactin • Posterior pituitary • Antidiuretic hormone 22

  23. Structures and Functions of Endocrine System Table 48-3. Factors Affecting ADH Release. 23

  24. Structures and Functions of Endocrine System Fig. 48-9. Relationship of plasma osmolality to antidiuretic hormone (ADH) release and action. 24

  25. Structures and Functions of Endocrine System • Pituitary • Posterior pituitary, continued • Oxytocin 25

  26. Structures and Functions of Endocrine System 26

  27. Structures and Functions of Endocrine System Fig. 48-10. Thyroid and parathyroid glands. Note the surrounding structures. 27

  28. Structures and Functions of Endocrine System • Thyroid Gland, continued • Thyroxine and triiodothyronine • Calcitonin • Parathyroid Glands • Parathyroid hormone 28

  29. Structures and Functions of Endocrine System • Adrenal Glands 29

  30. Structures and Functions of Endocrine System Fig. 48-11. The adrenal gland is composed of the adrenal cortex and the adrenal medulla. 30

  31. Structures and Functions of Endocrine System • Adrenal Glands, continued • Adrenal medulla • Adrenal cortex • Cortisol • Aldosterone • Adrenal androgens • Pancreas • Glucagon • Insulin 31

  32. Structures and Functions of Endocrine System Table 48-4. Factors Influencing Insulin Secretion. 32

  33. Gerontologic Considerations:Effects of Aging on Endocrine System • Some subtle and come obvious changes • Decreased hormone production and secretion • Altered hormone metabolism and biologic activity • Decreased responsiveness of target tissues to hormones • Alterations in circadian rhythms • Review table 48-5 on page 1207 33

  34. Assessment of Endocrine System • Subjective Data • Important health information • Past health history including growth and development • Medications • OTC, herbs, and dietary supplements • HRT • Insulin, thyroid hormones, corticosteroids • Surgery or other treatments • Chemotherapy, radiation, brain surgery or head injury 34

  35. Assessment of Endocrine System • Subjective Data, continued • Functional health patterns • Health perception–health management pattern • Nutritional-metabolic pattern • Elimination pattern • Activity-exercise pattern • Sleep-rest pattern • Cognitive-perceptual pattern 35

  36. Assessment of Endocrine System • Subjective Data • Functional health patterns, continued • Self perception–self-concept pattern • Role-relationship pattern • Sexuality-reproductive pattern • Coping–stress tolerance pattern • Value-belief pattern 36

  37. Assessment of Endocrine System • Objective Data • Physical examination • Vital signs • Height and weight • Mental-emotional status • Integument • Head • Neck 37

  38. Assessment of Endocrine System Fig. 48-12. Posterior palpation of the thyroid gland. 38

  39. Assessment of Endocrine System • Objective Data • Physical examination, continued • Thorax • Abdomen • Extremities • Genitalia 39

  40. Diagnostic Studies of Endocrine System • Laboratory Studies • Pituitary studies • GH • Water deprivation (ADH stimulating) • Thyroid studies • TSH, T3 and T4, Thyroid antibodies • Parathyroid studies • PTH, Calcium, Phosphate • Adrenal studies • Cortisol, Aldosterone, ACTH, dexamethasone suppression • 24hour urine 17ketosteroids • CT and MRI • Pancreatic studies • OGTT, HbA1C 40