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Chapter 64

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.

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Chapter 64

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  1. Chapter 64 Assessment of the Endocrine System Marion Kreisel MSN, RN NU230 Adult Health 2 Fall 2011

  2. 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

  3. 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

  4. 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

  5. Hypothalamus & Pituitary Glands • They share a closed circulatory system (anterior pituitary gland) • System is called hypothalamic-hypophysial portal system: allows hormones from the hypothalamus to travel directly to the anterior pituitary gland

  6. Hypothalamus

  7. Positive and Negative Feedback System

  8. 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.

  9. Anatomy and Physiology Review • Hypothalamus • Pituitary glands • Gonads • Adrenal glands • Thyroid gland • Parathyroid gland • Pancreas

  10. Gonads • Male & female reproductive endocrine glands. • Male: testes • Female: Ovaries Don’t work until puberty

  11. Endocrine System

  12. 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)

  13. Adrenal Cortex • 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

  14. Adrenal Medulla • Sympathetic System • Release Catecholamines (epi & norepi) • Works on Stress

  15. Thyroid Gland • Control of metabolism • Calcium and phosphorus balance

  16. 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)

  17. 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)

  18. Assessment Methods • Patient history • Nutrition history • Family history and genetic risk • Current health problems

  19. 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

  20. 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

  21. Palpation

  22. Laboratory Tests • Stimulation/suppression tests • Assays • Urine tests • Tests for glucose • Imaging assessment • Other diagnostic assessment

  23. Chapter 64 NCLEX TIME Assessment of the Endocrine System

  24. Question 1 A priority nursing intervention for a patient with primary adrenal cortex dysfunction would be to: • Monitor vital signs and patient’s physiologic response to stress. • Closely measure fluid intake and output. • Provide emotional support during stressful situations. • Weigh the patient daily.

  25. Question 2 Which diagnostic test is most sensitive in evaluating a pituitary gland disorder? • Computed tomography (CT) scan • Laboratory evaluation of serum sodium levels • Magnetic resonance imaging (MRI) • Urine specific gravity test

  26. 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? • Growth hormone and vasopressin • Oxytocin and prolactin • Vasopressin and prolactin • Growth hormone and oxytocin

  27. 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? • Growth hormone and prolactin • Prolactin and oxytocin • Growth hormone and vasopressin • Vasopressin and oxytocin

  28. Question 5 Which of these is a possible outcome for the patient experiencing an age-related decrease in antidiuretic hormone? • Constipation, lethargy, and dry skin • Greater-than-ideal body weight • Diluted urine and polyuria • Yeast infection and polydipsia

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