Download Assessment of the Endocrine System

Assessment of the Endocrine
System
Endocrine system
 Endocrine system (ES) – the nervous
system and the interconnected network of
glands
 A key feature of all endocrine glands (EG)
is the secretion of hormones
 Hormones are biochemicals that exert
their effect on target tissues
 Target tissues (TT) – usually located some
distance from the endocrine gland, with no
direct physical connection between EG and
TT
Endocrine system
 For this reason EG are called “ductless”
glands and must use circulatory system to
transport secreted hormones to the TT
 EG include the following:






Pituitary gland
Adrenal glands
Thyroid gland
Islet cells of the pancreas
Parathyroid glands
Gonads
Endocrine system
 The endocrine system works with the
nervous system to regulate overall
physiologic function –
neuroendocrine regulation
 The ES keeps the constant normal
balance (homeostasis) of the organs
and systems in response to
environmental changes
Endocrine system
 Hormones:
 steroid - hydrocortisone
 peptide (protein) - insulin
 amine – epinephrine
 Negative feedback control mechanisms
 In the healthy physiologic state, hormone
concentration in the bloodstream is maintained
at a relatively constant level
 When the hormone concentration rises, further
production of that hormone is inhibited
 When the hormone concentration falls, the rate
of production of that hormone increases
Assessment. History
 Demographic data
 age and gender (some disorders are age
related: hyperosmolar states, loss of
ovarian function, decreased thyroid and
parathyroid function; and gender related
– sexual effects of hyperpituitarism and
hypopituitarism)
Assessment. History
 Personal and family history
 family history of obesity, grows or development
difficulties, diabetes mellitus, infertility, or
thyroid disorders
 assess the client of the following: endocrine
dysfunction; signs or symptoms that could
indicate an endocrine disorder; hospitalisations
 past and current medications (hydrocortisone,
levothyroxine, oral contraceptives,
antihypertensive drugs)
Assessment. History
 Diet history
 Nutritional changes and GI tract
disturbances may reflect a variety of
endocrine problems (nausea, vomiting,
abdominal pain)
 Changes in food and fluid intake
(diabetes insipidus, diabetes mellitus)
 Rapid changes in weight without
accompanying changes in diet (diabetes
mellitus, thyroid disfunction)
Assessment. History
 Socioeconomic status
 are the clients resources adequate to maintain
the healthy diet, purchase needed medications
 Current health problems
 did the client’s symptoms occur gradually, or
was the onset sudden?
 has the client been treated for this problem in
the past?
 How have the current symptoms interfered with
activities of daily living?
Assessment. History
 energy levels (changes in energy levels are
associated with a number of endocrine
problems: thyroid, adrenal glands)
 elimination
 urine amount and frequency. Does he or she
urinate frequently in large amounts? Does the
client wake during the night to urinate
(nocturia), or does he or she experience pain on
urinaton (dysuria)?
 information about the frequency of bowel
movements and their consistency and color
Assessment. History
 sex and reproduction. Women are asked
about any changes in the menstrual
cycle (increased flow, duration,
frequency of menses; pain or excessive
cramping; or a recent change in the
regularity of menses). Men are asked
whether they have experienced
impotence. Both have to be asked about
changes in libido or any fertility problems
Assessment. History
 Physical appearance. The client is asked
about changes in the following:





hair texture and distribution
facial contours
voice quality
body proportions
secondary sexual characteristics
Physical Assessment
 Inspection
 use a head-to-toe approach
 observe a general client’s appearance,
height, weight, fat distribution, muscle
mass in relation to age
 head: prominent forehead, jaw; round or
puffy face; dull or flat face expression;
exophtalmos (protrunding eyeballs and
retracting upper lids)
Physical Assessment
 Inspection
 lower half of the neck – visible enlargement of
the thyroid gland (N – isthmus can be observed
during the swallowing)
 jugular vein dilation – can indicate fluid overload
 skin – color, areas of hypo- or
hyperpigmentation; fungal skin infections, slow
wound healing, petechiae (adrenocortical
hyperfunction); skin infections, foot ulcers, slow
wound healing (diabetes mellitus)
Physical Assessment
 Vitiligo (patchy areas of depigmentation
with increased pigmentation at the edges)
– primary hypofunction of the adrenal
glands. Most often occur on the face, neck
and extremities. Mucous membranes can
exhibit a large areas of pigmentation
 Necessary to document the location,
distribution, color, size of all skin
discolorations and lesion
 fingernails – malformation, thickness, or
brittleness (thyroid gland difficulties)
Physical Assessment
 the extremities and the base of the spine
are assessed for edema (disturbance in
fluid and electrolyte balance)
 trunk
 abnormalities in chest size and simmetry
 truncal obesity, supraclavicular fat pads and
a “buffalo hump” – adrenocortical excess
 secondary sexual characteristics – breasts
of both men and women for size,
symmetry, pigmentation and discharge
Physical Assessment
 Striae (usually reddish purple “stretch
marks”) on the breasts or abdomen are
often seen with adrenocortical excess
 hair distribution – hirsutism (abnormal
grows of body hair, especially on the
face, chest, and the linea alba of the
abdomen of women), excessive hair loss,
or change in hair texture
 genitalia (hypogonadism)
Physical Assessment
 Palpation
 Thyroid gland (size, symmetry, general
shape, presence of nodules or other
irregularities)
 the nurse palpates the thyroid gland
standing either behind (may be easier) or
in front of the client
 offering the client sips of water to promote
swallowing during the examination helps
palpate the thyroid gland
Physical Assessment
 the client is asked to sit and to lower the
chin
 using the posterior approach, the thumbs of
both hands are placed on the back of the
clients neck, with the fingers curved around
to the front of the neck on either side of the
trachea
 the client is asked to swallow, and the
nurse locates the isthmus of the thyroid
and feels it rising. The anterior surface of
the thyroid lobe is also identified
Physical Assessment
 to examine the right lobe, the nurse:
 turns the client’s head to the right
 displaces the thyroid cartilage to the right with
the fingers of the left hand
 palpates the right lobe with the right hand
 this procedure is reversed for examination
of the left lobe
Physical Assessment
 Auscultation
 the nurse auscultates the client’s chest
to establish baseline vital signs and to
determine irregularities in cardiac rate
and rhythm
 the nurse documents any difference in
client’s blood pressure and pulse in the
lying, standing, or sitting positions
(orthostatic vital signs) – many
endocrine disorders can cause
dehydration and volume depletion
Physical Assessment
 Auscultation
 if an enlarged thyroid gland is palpated,
the area of enlargement is auscultaded
for bruits (hypertrophy causes an
increase in vascular flow)
Diagnostic Assessment
 Laboratory tests
 Best practice for endocrine testing
 explain the procedure to the client
 emphasize the importance of taking a medication
prescribed for the test on time. Tell the client to
set an alarm if the medication is to be taken
during the night
 instruct the client to begin the urine collection
(whether for 2, 4, 8, 12 or 24 hours) by emptying
his or her bladder. Tell the client NOT to save the
urine specimen that begins the collection. The
timing for the urine collection begins after this
specimen. To end the collection, the client empties
his or her bladder at the end of the timed period
and adds that urine to the collection
Diagnostic Assessment
 make sure that the preservative has
been added to the collection
container at the beginning of the
collection, if necessary. Tell the
client of its presence in the
container
Diagnostic Assessment
 check your laboratory’s method of
handling hormone test samples. Blood
samples drawn for certain hormones
(e.g., catecholamines) must be placed
on ice and taken to the laboratory
immediately
 if you are drawing blood samples from
a line, clear the IV line thoroughly. Do
not use a double- or triple-lumen line
to obtain samples; contamination or
dilution from another port is possible
Diagnostic Assessment




Stimulation/suppression tests
Radioimmunoassay
Urine tests
Tests for glucose
 Radiographic examinations
 Other diagnostic tests (needle
biopsy)