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Too much Epinephrine, Cortisol and Growth Hormone lately? ;)
Ah, that’s better(You on November 26th, 2014)
ENDOCRINE NURSING
PN 142
OBJECTIVES– Be able to define key terms relating to the
system– Be able to identify the anatomy of the system– Be able to explain negative feedback and
understand how hormones are triggered and their affect on organs or tissue
– Begin to become familiar with some common diagnostic tests and their nursing implications
KEY TERMS
• Chvostek’s sign: abnormal spasm of the facial muscles in response to a light tapping of the facial nerve. http://www.youtube.com/watch?v=kvmwsTU0InQ (28 sec)
• Cretinism: congenital lack of thyroid hormones causing defective physical development and mental retardation.
Key Terms
• Dawn phenomenon: abrupt increases in fasting levels of plasma glucose concentrations at 5-9 am morning glucose elevation in patients receiving insulin. http://www.bing.com/videos/search?q=dawn+phenomenon+youtube&FORM=HDRSC3#view=detail&mid=0D8DC1FB8E00C92B78A30D8DC1FB8E00C92B78A3 (3 min 10 sec)
• Endocrine: group of cells secreting substances directly into the blood or lymph circulation and affecting another part of the body. Vs: Exocrine: Pertaining to the secretion of a substance out through a duct. The exocrine glands include the salivary glands, sweat glands and glands within the gastrointestinal tract. Exocrine is as opposed to endocrine which refers to the secretion of a substance (a hormone) into the bloodstream. The exocrine glands are the "glands of external secretion" while the endocrine glands are "glands of internal secretion."
• Exophthalmos: marked protrusion resulting from increased orbital fluid behind the eyeballs.
• Glucagon: hormone secreted by the alpha cells of the pancreas which stimulate the release of glucose from the liver.
KEY TERMS• Glycosuria: excess glucose in the urine.• Goiter: enlargement of the thyroid gland.• Gynecomastia: abnormal enlargement of one or
both breasts in males.
• Hirsutism: excessive body hair in a masculine distribution.
• Hormone: substance that initiates or regulates activity of another organ, system or gland in another part of the body.
KEY TERMS• Hyperglycemia: condition where the blood
glucose level becomes too high as a result of the absence of insulin.
• Hypoglycemia: condition where the blood glucose level is exceedingly low.
• Hypovolemia: abnormally low circulatory blood volume.
• Iatrogenic: caused by treatment or diagnostic procedures. http://www.youtube.com/watch?v=l_o6Tnqst9s(1 min 13 sec)
KEY TERMS• Insulin: pancreatic hormone that aids in the diffusion of glucose into
the liver and muscle cells • Ketonuria: presence of ketones in the urine.
• Myxedema: severe hypothyroidism in adults.A condition that can result from a thyroid gland that produces too little of its hormone. In addition to a decreased metabolic rate, symptoms may include anemia, slow speech, an enlarged tongue, puffiness of the face and hands, loss of hair, coarse and thickened skin, and sensitivity to cold.
• Paroxysmal: descriptor for a symptom that begins and ends abruptly Examples: Pheocromocytoma observation example: The most prominent sign is severe sustained or episodic hypertension. This is accompanied by a classic symptom triad of severe, pounding paroxysmal headache, palpitations, and profuse sweating. In paroxysmal supraventricular tachycardia (PSVT), abnormal conduction of that electricity causes the atrium, and secondarily the ventricles, to beat very rapidly. It is referred to as paroxysmal, because the rapid rate can occur sporadically and without warning and may also stop on its own.
KEY TERMS
• Polydipsia: excessive thirst.• Polyphasia: increased hunger.• Polyuria: increased urination.• Somogyi “ phenomenon” or “ effect “: in
response to hypoglycemia, the release of glucose elevating hormones (epinephrine, cortisol, glucose) produces a hyperglycemic state. Somogyi: http://www.bing.com/videos/search?q=somogyi%20effect%20&qs=n&form=QBVR&pq=somogyi%20effect%20&sc=8-15&sp=-1&sk=#view=detail&mid=1128F9F668580041A2921128F9F668580041A292 (1min 14 sec)
• Somogyi vs Dawn phenomenon: http://www.bing.com/videos/search?q=dawn+phenomenon+youtube&FORM=HDRSC3#view=detail&mid=D28E6761694235FE29C7D28E6761694235FE29C7 (5 minutes)
KEY TERMS
• Tetany: sharp flexion of the wrist and ankle joints, involving muscle twitching or cramps.
• Trousseau’s sign: carpal spasm caused by inflating a blood pressure cuff above the client’s systolic pressure and leaving it in place for three minutes. http://www.youtube.com/watch?v=Ry5Rh3wO8Sw (1 min 30 sec)
ANATOMY AND PHYSIOLOGY• Endocrine system: group of glands that produces
regulatory chemicals called hormones.
• Endocrine system and Nervous system work together to control and coordinate all other systems of the body.
• Nervous system controls rapid actions like muscle movement and intestinal activity by means of chemical and electrical stimuli.
+ = movement
Anatomy & Physiology
• Endocrine Glands– Ductless– Release secretions directly into bloodstream– Secretions have a regulatory function• HORMONES – chemical messengers that travel though
the bloodstream target organ metabolic change occurs
Anatomy & Physiology
• HORMONES • Function of: (What do they do?)– Maintenance and regulation of vital functions– Response to stress and injury– Growth and development– Energy metabolism– Reproduction– Fluid and electrolyte balance; acid-base balance
Anatomy & Physiology
• Negative Feedback system:– Information is constantly being exchanged
between the target organ and pituitary gland via the bloodstream regarding the effect of the hormone on the target organ
– Controls the amount of hormone released decrease in function of the target organ in response to stimuli
Anatomy & Physiology
• Negative Feedback System cont.– The glands within the endocrine system that
stimulate the release of a hormone (eg. pituitary gland) from another gland (eg. thyroid gland) are eventually “shut off”, in a sense, so that too much hormone is not produced and a hormone imbalance is avoided.
Positive verses negative Feedback
An Example
• Negative Feedback System cont.– The hypothalamus secretes TRH (thyrotropin-releasing
hormone) causes the pituitary to release TSH causes the thyroid gland to secrete T4 (thyroid hormone).
– When the body has enough thyroid hormone in the blood, T4 “feeds back” to the hypothalamus and pituitary, and causes decrease in secretion of TRH and TSH.
– This pattern is true of ovaries, testes, and adrenal glands
Anatomy & Physiology
• PITUITARY GLAND (HYPOPHYSIS)• “Master Gland”• Through negative feedback system, it controls
the other endocrine glands– Works closely with hypothalamus– Located in sphenoid bone– Divided into 2 segments: • Anterior• Posterior
Hypothalamus Anterior and Posterior Pituitary Gland
http://www.bing.com/videos/search?q=hypothalamus&FORM=HDRSC3#view=detail&mid=8367DAD87A5958B5DAC28367DAD87A5958B5DAC2
Hypothalamus and Pituitary Gland Found Here!
Hypothalamus and Pituitary Gland
Anatomy & Physiology
• PITUITARY GLAND (cont.)– The hypothalamus produces the hormones of the
posterior pituitary gland and stores them in the posterior lobe of the pituitary gland
– ANTERIOR PITUITARY LOBE: • 6 major hormones secreted (includes MSH)
• 5 “tropic” hormones – responsible for the stimulation of other endocrine glands• The 6th – Prolactin – acts on the mammary glands to
produce milk
Hypothalamus Anterior and Posterior Pituitary Gland
Anatomy & Physiology
• PITUITARY GLAND (cont.)– POSTERIOR PITUITARY LOBE • 2 hormones: Oxytocin and Antidiurectic Hormone• Oxytocin – promotes release of milk and stimulates
uterine contractions during labor • AntiDiurectic Hormone (ADH) – “vasopressin” – causes
kidneys to conserve water decreased urine production– Also, can increase BP d/t increased arterial constriction
Hold Water NOT salt
An AFFECT of too much ADH
Pictograph
Add: Melanocyte Stimulating Hormone (MSH) to Anterior Pituitary Gland (see page 501 in textbook)
Introducing the Adrenal GLAND!!
---MGS
---Adrenaline
Anatomy & Physiology
• ADRENAL GLANDS• Adrenal Cortex– 3 layers; each secretes a particular hormone called
a “steroid”• Mineralocorticoids:
– Affects water and electrolyte balance– Indirectly manages BP – eg. Aldosterone regulates Na+, K+
(holds on to salt and water)
Anatomy & Physiology
• ADRENAL GLANDS (cont.)– Adrenal Cortex, 3 layers (cont.)• Glucocorticoids – Cortisol– Glucose metabolism– Reserve energy in times of stress– Antiinflammatory
• Sex Hormones –Male: Androgen– Female: Estrogen
Anatomy & Physiology
• ADRENAL GLANDS (cont.)– Adrenal Medulla• During times of stress releases epinephrine
(adrenaline) and norepinephrine ↑HR, ↑BP, ↑ vasocontriction; liver releases reserve glucose• System prepares for flight/fight
Thyroid Gland
Anatomy and Physiology
• Thyroid gland: – located in anterior part of the neck; “butterfly”
shape – Adequate oral intake of iodine is needed for the
formation of thyroid hormones– Thyroid hormones: 3 main functions:• Growth and development• Metabolism• Activation of the Nervous System
Thyroid and parathyroid glands
Anatomy and Physiology
• Thyroid Gland (cont.)– Thyroid Hormones (cont.)– Their function is controlled by the release of
Thyroid Stimulating Hormone (TSH) from the pituitary gland
– Hormones:• Thyroxine• Triiodothryronine• (thyro)calcitonin
Anatomy and Physiology
• Thyroid Gland (cont.)– Thyroid Hormones (cont.)• Calcitonin : reduces blood Ca++ by storing Ca++ in
bones
Anatomy and Physiology
• PARATHYROID GLANDS: • Located on the posterior surface of the thyroid
gland• Controls Ca++ and phosphate metabolism• Indirectly influences fat and protein metabolism• Produces parathyroid hormone ( PTH )
Parathyroid Gland
Anatomy and Physiology
– Parathyroid Hormone (PTH)• Antagonist to calcium from the thyroid
hormone• Increases the concentration of calcium in the
blood• Regulates the amount of phosphorus in the
blood (Fun Fact: There is over 1 lb (454 grams) of phosphorus in the human body.)
Parathyroid and Blood Ca Regulation
Anatomy and Physiology
• PARATHYROID GLANDS (cont.)• Parathyroid Hormone (cont.)– Note: when serum Ca++ is too low, nerve cells
become excited muscles receive too many impulses spasms (tetany).
– Note: when serum Ca++ is too high impaired heart function deathhttp://www.bing.com/videos/search?q=signs+and+symptoms+of+hypercalcemia&FORM=HDRSC3#view=detail&mid=0B8D5EAD0374D46809EB0B8D5EAD0374D46809EB
Pancreas
Anatomy and Physiology
• PANCREAS:– Located posterior to the stomach – Influences carbohydrate metabolism– Produces insulin and glucagon
Composed of: endocrine and exocrine tissueEndocrine: > 1 mil. tiny clusters of cells (Islets of Langerhans)
Secrete 2 major hormones: Insulin and glucagon
Anatomy and Physiology
• PANCREAS (cont.)– Insulin: secreted in response to ↑ levels of serum
glucose– Glucagon: secreted in response to ↓ levels of
serum glucose
Anatomy and Physiology
• OVARIES• Located in the pelvic cavity• At puberty, produce estrogen and
progesterone– Estrogen: responsible for development of
secondary sex characteristics and maturation of reproductive organs
– Progesterone: continues the preparation of the reproductive organs
Anatomy & Physiology
• OVARIES (cont.)– Placenta: a “temporary” endocrine gland that
forms and functions during pregnancy (HCG)TESTES– located in the scrotum– Produces testosterone• Testosterone is responsible for the development of
secondary sexual characteristics, maturation of reproductive organs, deepening of voice, development of bone and muscle mass; and sperm formation
Anatomy & Physiology
• THYMUS GLAND• Located in the upper thorax, posterior to the
sternum• Produces Thymosin which plays an active role
in immune system• Programs information into T-lymphocytes in
utero and infancy carrying out immune reactions to certain antigens
Anatomy & Physiology
• PINEAL GLAND/PINEAL BODY– Small, cone-shaped– Located on the roof of the 3rd ventricle in the brain– Secrete Melatonin:• Inhibits gonadotrophic hormones inhibit reproductive
activity• Also, induces sleep, affects mood, and has an impact on
mentrual cycle
Making the Connections
Anatomy & Physiology• Endocrine system changes occur more slowly and
over a longer period; involve chemical stimuli, and these chemical messengers have widespread effects over the body.
• Activity of pituitary controlled by the brain’s hypothalamus.
• This connection helps the endocrine function to adjust to the body’s changing environment
• Homeostasis: a relative constancy in the internal environment of the body, naturally maintained by adaptive responses that promote healthy survival.
HORMONES AND STRESS• The body’s response to stress involves nervous and
endocrine systems, and hormones• Fight or flight response mediated by brain:
hypothalamus, sympathetic nervous system• Hormones help body meet stressful situations; can
be harmful if unchecked• Unmanaged stress can be harmful; many diseases
can be caused by immunosuppressed disorder; stress management techniques help maintain overall health. Stress relieving methods include– Meditation, prayer, self-talk, exercise, yoga, pilates,
therapy, play, vacation.
Aging
AGING AND THE ENDOCRINE SYSTEM
• Aging-associated changes linked with endocrine changes include:– loss of muscle and bone tissue; decreased bone mass-
osteoporosis– continue with exercise in any form
• Main clinical conditions associated with endocrine system involve pancreas, thyroid– Adult-onset diabetes– Decline in sex hormones in males and females – Hypothyroidism increases with age, esp. women at peri-
menopause or menopause
