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

Nursing Assessment:

Endocrine System

J. Brinley, MSN, RN, CNE

Structures and Functions of Endocrine System

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Fig. 48-1. Location of the major endocrine glands. The parathyroid glands lie on the posterior surface of the thyroid.


• 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


• Hormones– Targets and receptors, continued • Steroid hormone receptors

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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 thelock-and-key model of biochemical reactions.


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Fig. 48-3. A, Protein hormones bind to receptors located in the cell membrane. The hormone-receptor interactionstimulates the formation of cAMP, thereby activating various cell processes. B, Steroid hormones penetrate thecell membrane and interact with intracellular receptors. The hormone-receptor complex activates the cell bystimulating protein synthesis.


• Hormones– Targets and receptors, continued • Protein hormone receptors

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• Hormones, continued – Regulation of hormonal secretion• Simple feedback

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Fig. 48-4. Feedback mechanism between blood glucose and insulin. A, Increased blood glucose stimulatesincreased insulin secretion from the pancreas. B, As blood glucose levels decline, insulin secretion decreases.


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


• Hormones– Regulation of hormonal secretion, continued• Complex feedback

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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).


• Hormones– Regulation of hormonal secretion, continued• Nervous system control• Rhythms

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


• 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.


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Table 48-2. Hormones of the Hypothalamus.

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


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Fig. 48-8. Relationship between the hypothalamus, pituitary, and target organs. The hypothalamus communicateswith the anterior pituitary via a capillary system and with the posterior pituitary via nerve tracts. The anterior andposterior pituitary hormones are shown with their target tissues.


• Pituitary– Anterior pituitary, continued • Tropic hormones• Growth hormone• Prolactin

– Posterior pituitary• Antidiuretic hormone

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Table 48-3. Factors Affecting ADH Release.


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


• Pituitary– Posterior pituitary, continued • Oxytocin

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


• Thyroid Gland, continued – Thyroxine and triiodothyronine– Calcitonin

• Parathyroid Glands– Parathyroid hormone

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• Adrenal Glands

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


• Adrenal Glands, continued– Adrenal medulla– Adrenal cortex• Cortisol• Aldosterone• Adrenal androgens

• Pancreas– Glucagon– Insulin

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Table 48-4. Factors Influencing Insulin Secretion.

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

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


• 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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Documents

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