Nursing Assessment_ Endocrine System - Amazon S3 by malj

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

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




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




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   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.

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      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.

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




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




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      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.

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Structures and Functions of Endocrine
               System




  Fig. 48-5. Feedback mechanism between parathyroid hormone (PTH) and calcium.




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




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    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).

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




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Structures and Functions of Endocrine
               System




       Fig. 48-7. Circadian rhythm of cortisol secretion.

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Structures and Functions of Endocrine
               System
• Hypothalamus




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               Test your knowledge
•   Two hormones produced by the posterior pituitary gland
    (neurohypophysis) are:
    a.   Antidiuretic hormone (ADH) and oxytocin.
    b.   Growth hormone (GH) and adrenocorticotropic hormone
         (ACTH).
    c.   Thyroid-stimulating hormone (TSH) and growth hormone (GH).
    d.   Follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
                  Answer
• A antidiuretic hormone (ADH) and oxytocin.
Structures and Functions of Endocrine
               System




  Table 48-2. Hormones of the Hypothalamus.

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             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
      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.

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




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Structures and Functions of Endocrine
               System




 Table 48-3. Factors Affecting ADH Release.

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Structures and Functions of Endocrine
               System




 Fig. 48-9. Relationship of plasma osmolality to antidiuretic hormone (ADH) release and action.

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




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Structures and Functions of Endocrine
               System




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Structures and Functions of Endocrine
               System




    Fig. 48-10. Thyroid and parathyroid glands. Note the surrounding structures.

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




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Structures and Functions of Endocrine
               System
• Adrenal Glands




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Structures and Functions of Endocrine
               System




  Fig. 48-11. The adrenal gland is composed of the adrenal cortex and the adrenal medulla.

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

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Structures and Functions of Endocrine
               System




 Table 48-4. Factors Influencing Insulin Secretion.
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        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
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 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



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 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


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 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




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


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Assessment of Endocrine System




   Fig. 48-12. Posterior palpation of the thyroid gland.

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




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     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

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