endocrine

1. NURSING MANAGEMENT
OF PATIENT WITH
ENDOCRINE DISORDER
Preparedby: IntanBaiduri Badri
18September2018
HealthCampus,KubangKerian

2. INTRODUCTION
• Effects almost every cell, organ, and function of
the body
• The endocrine system is closely linked with the
nervous system and the immune system
• The nervous system and the interconnected
network of glands known as the endocrine
system control body systems.
• Endocrine disorders are the consequences of
hypo function and hyper function of each
endocrine gland.

3. ENDOCRINE
• Made up of gland in many tissues and organs in
difference body areas
• Main features of all endocrine gland is the
secretion of hormones
• Responses to stress injury
• Growth and development
• Energy metabolism
• Reproduction
• electrolyte, acid base balance

4. GLANDS OF ENDOCRINE SYSTEM

5. HORMONES
• Secreted by endocrines glands
• Endocrine glands are composed of secretory
cells arranged in minutes cluster known as
acini
• Glands are ductless with rich with blood
supply, so hormones they produce enter the
bloodstream rapidly

6. HORMONES
• Hormone concentration in bloodstream is
maintained at a relatively constant level
• When the hormone concentration increase,
further production of that hormones is
inhibited
• Are natural chemical substances that initiate
or regulate activity and exert their effect on
specific tissues known as Target Tissues

7. TARGET TISSUES
• Are usually located some distance from the
endocrine gland with no direct physical
connection between the endocrine gland and
its target tissue
• The endocrine gland are called “ductless”
gland and must be used the blood to transport
secreted hormones to the target tissue.

8. NEGATIVE FEEDBACK
• The level of hormone in the blood is regulated
by the homeostasis called Negative Feedback.
• Ex : control of insulin secretion
• Increase level of blood glucose, the hormone
insulin is secreted thus increase glucose
uptake by the cells- > causing a decrease in
blood glucose

9. CLASIFFICATION OF HORMONES
• Steroid hormones : hydrocortisone
• Peptide or protein hormones : insulin
• Amine Hormone : epinephrine
• Fatty acid derivatives : retinoids

10. HYPOTHALAMUS
• Located between the cerebrum and brainstem
• Houses the pituitary gland and hypothalamus
• Regulates:
– Temperature
– Fluid volume
– Growth
– Pain and pleasure response
– Hunger and thirst

11. HYPOTHALAMUS HORMONES
• Releasing and inhibiting hormones
• Corticotropin-releasing hormone
• Thyrotropin-releasing hormone
• Growth hormone (GH)-releasing hormone
• Gonadotropin-releasing hormone
• Somatostatin-=-inhibits GH and TSH

12. PITUITARY GLAND
• Located beneath the hypothalamus
• Also known as the “master gland”
• Divided into:
– Anterior Pituitary Gland
– Posterior Pituitary Gland

13. ANTERRIOR PITUITARY
1. Thyroid stimulating hormone (TSH)
– Stimulates thyroid growth and secretion of the thyroid
hormone
2. Andrenocorthropic hormone (ACTH)
– Stimulates adrenal cortex growth and secretion of
glucocorticoids
3. Growth hormone (GH) – stimulate growth
4. Prolactin / Lactogen
– Stimulate breast development during pregnancy and
milk secretion after delivery

14. ANTERRIOR PITUITARY
5. Follicle stimulating hormone (FSH)
– Stimulates ovarian follicles to mature and produce
oestrogens; in the male stimulates sperm production
6. Luteinizing hormone (LH)
– Acts with FSH to stimulate estrogen production;
causes ovulation; stimulates progesterone production
by corpus luteum; in male stimulate testes to produce
testosterone
7. Melanocytes stimulating hormone
– Synthesis and spread of melanin in the skin

15. POSTERIOR PITUITARY
• ADH antidiuretic hormone
– Stimulate water retention by kidneys to decrease
urine secretion
• Oxytocin
– Stimulate uterine contraction, causes breast to
release milk into ducts

16. MAJOR HORMONES OF
PITUITARY GLAND ACTIONS

17. ADRENAL GLANDS
17
• Pyramid-shaped organs that located on top of
the kidneys
• Each has two parts:
– Outer Cortex
– Inner Medulla

18. ADRENAL CORTEX
18
• Mineralocorticoid
– Regulates electrolyte and fluid homeostasis
– Aldosterone.- affects sodium absorption, loss of
potassium by kidney
• Glucocorticoids—cortisol & hydrocortisone
– Affects metabolism, regulates blood sugar levels,
– Affects growth, anti-inflammatory action,
– Decreases effects of stress
• Adrenal androgens (sex hormone)
– Stimulates sexual drive in females; in male negligible
effect

19. ADRENAL MEDULLA
19
• Secretion of two hormones
– Epinephrine : Prolongs and intensifies sympathetic
nervous response to stress
– Norepinephrine : Prolongs and intensifies
sympathetic nervous response to stress
• Serve as neurotransmitters for sympathetic
system
• Involved with the stress response

20. THYROID
20
• Follicular cells—excretion of triiodothyronine (T3)
and thyroxine (T4) - Increase Basal Metabolic
Rate (BMR), increase bone and protien turnover,
increase response to catecholamines, need for
infant for growth & develop
• Thyroid C cells—calcitonin. Lowers blood calcium
and phosphate levels

21. THYROID GLAND
21
• Butterfly shaped
• Located 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

22. THYROID GLAND
22

23. THYROID HORMONE
• Thyroxine T4 & Triiodothyronine T3
– Increase metabolic rate
• Calcitonin
– Decrease blood calcium concentration

24. HYPOTHALAMIC-PITUITARY-THYROID AXIS
24

25. PARATHYROID GLANDS
25
• Embedded within the posterior lobes of the
thyroid gland
• Secretion of one hormone
• Maintenance of serum calcium levels
• Parathyroid hormone—regulates serum calcium
(blood calcium concentration)

26. PANCREAS
26
• Located behind the stomach between the spleen and
duodenum – it influence carbohydrate metabolism;
indirectly influence fat and protein metabolism;
produces insulin and glucagon
* Glucagon – raises blood glucose
* Insulin – lower blood glucose
• Has two major functions
– Digestive enzymes
– Releases two hormones: insulin and glucagon

27. KIDNEY
27
• 1, 25 dihydroxyvitamin D—stimulates calcium
absorption from the intestine
• Renin—activates the Renin-Angiotensin
System (RAS)
• Erythropoietin—Increases red blood cell
production

28. OVARIES
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• Estrogen
• Progesterone—important in menstrual cycle,
maintains pregnancy,

29. TESTES
29
• Androgens, testosterone —secondary sexual
characteristics, sperm production

30. THYMUS
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• Releases thymosin and thymopoietin
• Affects maturation of T lymphocetes

31. PINEAL
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• Melatonin
• Affects sleep, fertility and aging

32. CLINICAL MANIFESTATION
• Widespread effects on the body and wide
variety of signs and symptoms
• Changes in energy level & fatigue
• Tolerance of heat and cold as well as recent
changes in weight
• Changes in sexual function and secondary sex
characteristic
• Changes in mood, memory, and ability to
concentrate and altered sleep patterns

33. PHYSISCAL ASESSMENT
• General appearance
– Vital signs, height, weight
• Integumentary
– Skin color, temperature, texture, moisture
– Bruising, lesions, wound healing
– Hair and nail texture, hair growth
• Physical appearance
– Buffalo bump, thinning of skin, increased size of
the feet and hands

34. PHYSICAL ASSESSMENT
34
• Face
– Shape, symmetry
– Eyes, visual acuity
• Eye changes – exophthalmos
– Neck

35. Palpating the thyroid gland from behind the client. (Source: Lester V. Bergman/Corbis)
35

36. PHYSICAL ASSESSMENT
36
• Extremities
– Hand and feet size
– Trunk
– Muscle strength, deep tendon reflexes
– Sensation to hot and cold, vibration
– Extremity edema
• Thorax
– Lung and heart sounds

37. OLDER & ENDOCRINE FUNCTION
37
• Relationship unclear
• Aging causes fibrosis of thyroid gland
• Reduces metabolic rate
• Contributes to weight gain
• Cortisol level unchanged in aging

38. ABNORMAL FINDINGS
• Ask the client:
– Energy level
– Fatigue
– Maintenance of ADL
– Sensitivity to heat or cold
– Weight level
– Bowel habits
– Level of appetite
– Urination, thirst, salt craving 38

39. ABNORMAL FINDINGS (CONT)
• Ask the client:
– 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
39

40. LABAROTORY STUDIES
• Test of thyroid
– To differentiate primary and secondary hypothyroidism
• Serum thyroid stimulating hormone
– To measure the basal serum thyroid stimulating hormone
• Serum thyroxine and triiodothyronine
– To measure concentration of thyroxine T$9T3) in the blood
• Test of parathyroid function
– To measure the concentration of calcium, phosphorus,
alkaline, phosphatase, parathyroid hormone and
osteocalcin in the blood.

41. LABAROTORY STUDIES
• Test of adrenal function
– To measure concentration of adrenocortical hormones
and adrenal medullary hormones through urine and
blood specimen
• Aldosterone level
– Aids in the diagnosis of hyperaldosteronism
• Urine catecholamines
– To assess function of the adrenal medulla
• Test of thyroid structure & function
– To assess the size, shape, position and fucntion of the
thryroid through ulstrasound, MRI, CT scan, &
radionuclide imaging

42. LABAROTORY STUDIES
• Radioactive iodine uptake
– To measure the amount of radioactive iodine in
the thyroid 24H after administration of a
radioiodine isotope through scintillation scanner
• Achilles tendon reflexes
– To diagnose thyroid disorders by measuring the
amplitude and duration of ankle jerk using an
instrument that will help to elicit the reflex

43. MOST COMMONENDOCRINE
DISORDERS
• Thyroid abnormalities
• Diabetes mellitus
43

45. HYPERPITUITARISM
• Over secretion of hormone due to tumour or
hyperplasia > compresses brain tissue .
Neurologic sign & symptom (ICP, Visual
impairment & headache
• Hormone affected : growth hormone & ADH
• Resulting to Gigantism if the secretion occurs
in childhood, Acromegaly in adult

46. ACROMEGALY
• Pathology:-GH hypersecretion during adulthood
• Risk: Pituitary adenoma
• Cardinal Signs: large hands and feet; protrusion
of lower jaw(Prognathism). Coarse facial feature
• Nurse Concern: Psychosocial adjustment
to Altered body image; monitor Diabetes
Insipidus

47. DWARFISM
• due to hyposecretion of growth hormone
• Nursing Intervention:
– Assess patient
– Monitor height and weight
– Assess other neurologic functions
– Focus on the family client’s feeling
• Medical Management :
– Biosynthetic growth hormone -Somatrem

48. GIGANTISM
• Results from excessive secretion of growth
hormone
• Clinical manifestation:
– Height more than 8 feet
– Acromegaly
• Medical Management:
– Radiation therapy
– Parlodel
– Transphenoidal hypophysectomy

49. PANHYPOPITUITARISM
(SIMMOND’SDISEASE)
• complete absence of pituitary secretion resulting
to:
– Dwarfism
– Hypoglycemia
– Extreme weight loss
– Hair loss
– Emaciation
– Impotence
– hypometabolism
– absence of gonadal & adrenal function
– Atrophy of all endocrine gland and organs

50. HYPOPITUITARISM
• Result from destruction of the anterior pituitary
gland, hypothalamic dysfunction, trauma, tumour,
vascular lesion, and complication of radiation
therapy to the head and neck area
• S&S:
– -Extreme weight loss
– Emaciation-
– Hypoglycaemia
– Impotence
– Amenorrhea
– Hypometabolism

51. HYPERPROLACTINEMIA
• Results from oversecretion of prolactin
associated with pituitary tumors
• Management and Nursing Management same
as hyperpituitarism

52. PITUITARY TUMOR
Types:
1.Eosinophilic - result to gigantism if developed
early in life and acromegaly if developed during adult
life
2.Basophilic - results to Cushing's syndrome; clinical
manifestation: amenorrhea & masculinization in
females, truncal obesity, osteoporosis &polycytemia
3.Chromophobic -
produces no hormone but destroys the whole
pituitary glands resulting to hypopituitarism.
S&S: obesity, somnolence, scanty hair, dry, soft skin,
loss of libido, headache, blindness, polyphagia,
polyuria, and lowered BMR

53. GONADAL DISORDER
• Result from hypothalamic-pituitary
dysfunction resulting to hypo secretion
of gonadotropins may lead to infertility and
hypo-androgenism-
• Collaborative Management :
– Removal of the underlying cause of pituitary
dysfunction

54. POSTERIOR PITUITARY DISORDERS
• Syndrome of Inappropriate Antidiuretic Hormone
(SIADH) - resulting from abnormal increase
of ADH secretion & excessive water retention
leads to include urinary sodium
• Etiology: Bronchogenic carcinoma, head injury,
tumor, infection, and brain surgery
• Cardinal signs: water intoxication, neurologic
signs
• Medical Mgt:
– Diuretics & Demecclocycline (declomycin)
– Eliminate underlying cause

55. DIABETES INSIPIDUS
• A condition characterized by a deficiency in
antidiuretic hormone resulting to excessive fluid
excretion: neurogenic and nephrogenic
• Risk: head trauma, irradiation, removal
of pituitary gland, renal disease
• Manifestation: diluted urine, polydipsia, excessive
urination
• Diagnostic: vasopressin and H20 deprivation test;
serum Na include &Uric Acid
• Cardinal signs: Polyuria, Polydipsia

56. HYPERTHYROIDISM/GRAVES’ DISEASE
• Hyperthyroidism is the second most prevalent
endocrine disorder, after diabetes mellitus.
• Graves' disease: the most common type of
hyperthyroidism, results from an excessive
output of thyroid hormones.
• May appear after an emotional shock, stress, or
an infection
• Other causes: thyroiditis and excessive ingestion
of thyroid hormone
• Affects women 8X more frequently than men
(appears between second and fourth decade)

57. THYROIDITIS
• Inflammation of the thyroid gland.
• Can be acute, subacute, or chronic (Hashimoto's
Disease)
• Each type of thyroiditis is characterized by
inflammation, fibrosis, or lymphocytic infiltration
of the thyroid gland.
• Characterized by autoimmune damage to the
thyroid.
• May cause thyrotoxicosis, hypothyroidism, or
both

58. • Can be being benign or malignant.
• If the enlargement is sufficient to cause a visible
swelling in the neck, referred to as a goiter.
• Some goiters are accompanied by
hyperthyroidism, in which case they are
described as toxic; others are associated with a
euthyroid state and are called nontoxic goiters.
58
THYROID TUMORS

59. THYROID CANCER
• Much less prevalent than other forms of cancer;
however, it accounts for 90% of endocrine
malignancies.
• Diagnosis: thyroid hormone, biopsy
• Management
– The treatment of choice surgical removal. Total or
near-total thyroidectomy is performed if possible.
Modified neck dissection or more extensive radical
neck dissection is performed if there is lymph node
involvement.
– After surgery, radioactive iodine.
– Thyroid hormone supplement to replace the
hormone. 59

60. ADRENOCORTICOL
HYPERFUNCTION

61. PANCREAS
• Lies horizontally behind the stomach at the level of the 1st and 2nd
lumbar vertebrae
• The head attached to the duodenum, tail reaching to the spleen
• With exocrine and endocrine function
• Produced two Importance hormones:
1. Insulin: beta cells of islets of Lagerhans - Decrease
glucose levels:
- transcellular membrane transport of glucose;
- inhibits/breakdown of fats and protein;
- requires sodium for transport protein
- requires potassium for production

62. GLUCAGON
• Alpha cells of Islets of Lagerhans
• Stimulates release of glucose by the liver
• Increases glucose levels(gluconeogenesis)

63. DIABETES MELLITUS
• A chronic systemic disease
• Classifications:
1.Type 1: IDDM; Juvenile onset; Brittle; labile
2.Type 2: NIDDM; Adult onset
3.Other Specific Types: beta cell genetic defect;
endocrinopathies, drug/chemical induced
4.Gestational Diabetes mellitus

64. HYPOGLYCEMIA
• Pathology: blood glucose levels<60mg/100ml
• SIGNS & SYMPTOMS:
– Tachycardia, headache, weakness, irritability
– Lack of muscular coordination
– Night hypoglycemia, Bizarre nightmares,
restlessness, diaphoresis
– Sleeplessness, confusion

67. ADDISON DISEASE S&S