Chapter 32 Metabolic and Endocrine Conditions

1. Chapter 32Metabolic and Endocrine Conditions

2. Functions of the Endocrine System • Body growth and development • Reproduction • Metabolism of energy • Maintenance of homeostasis • Response to stress and injury

3. Characteristics of the Endocrine System • Consists of glands that synthesize and secrete hormones • Two major classes of hormones: • Steroids and thyronines • lipid soluble • Polypeptides and catecholamines • water soluble.

4. Increased Incidence of Glucose Intolerance • A physiologic deterioration of glucose tolerance occurs with increasing age. • Improvement of diagnostic techniques enable more persons with the condition to be detected. • There is an increase in the incidence of diabetes throughout the general population.

5. Indications of Diabetes in Elders • Orthostatic hypotension • Periodontal disease • Stroke • Gastric hypotony • Impotence • Neuropathy

6. Indications of Diabetes in Elders (cont.) • Confusion • Gaucoma • Dupuytren contracture • Infection

7. Criteria for the Diagnosis of Diabetes • Random plasma glucose concentrations are greater than or equal to 200 mg/dL. • Fasting blood glucose concentrations are greater than or equal to 136 mg/dL on two occasions. • Plasma glucose concentrations after oral glucose intake are greater than or equal to 200 mg/dL.

8. Patient Education for Diabetes • General overview • Nutrition • Activity and exercise • Medications • Monitoring • Recognizing hypoglycemia and hyperglycemis • Recognition of symptoms • Prevention of complications

9. Primary Symptoms of Hypoglycemia • Behavioral disorders • Convulsions • Somnolence • Confusion • Disorientation • Altered sleep • Nocturnal headache • Slurred speech • Cardiac symptoms

10. Effects of Aging on the Thyroid Gland • Moderate atrophy • Fibrosis • Increasing colloid nodules • Some lymphocytic infiltration

11. Hypothyroidism • Definition • A subnormal concentration of thyroid hormone in the tissues. • Types • Primary: results from a disease process that destroys the thyroid gland • Secondary: caused by insufficient pituitary secretion of thyroid-stimulating hormone (TSH).

12. Symptoms of Hypothyroidism • Fatigue, weakness, and lethargy • Depression and disinterest in activities • Anorexia • Weight gain • Impaired hearing • Periorbital or peripheral edema

13. Symptoms of Hypothyroidism (cont.) • Constipation • Cold intolerance • Myalgia, paresthesia, and ataxia • Dry skin and coarse hair

14. Symptoms of Hyperthyroidism • Diaphoresis • Tachycardia • Palpitations • Hypertension • Tremor • Diarrhea • Stare • Lid lag

15. Symptoms of Hyperthyroidism (cont.) • Insomnia • Nervousness • Confusion • Heat intolerance • Increased hunger • Proximal muscle weakness • Hyperreflexia

16. Treatment of Hyperthyroidism • Graves’ Disease or Single Autonomous Nodule • Treatment typically includes antithyroid medications or radioactive iodine. • Toxic Multinodular Goiter • Surgery may be preferred due to the delayed and incomplete response to medications.

17. Factors Contributing to Hyperlipidemia • Increase in low-density lipoprotein (LDL) with aging • Uncontrolled diabetes • Hypothyroidism • Uremia • Nephrotic syndrome • Use of corticosteroids, thiazide diuretics, and other drugs that increase the risk.

18. Treatment for Hyperlipidemia • Dietary changes • Exercise • Weight reduction • Limiting alcohol intake • Medications • Alternative and complementary therapies

19. Source • Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).