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Textbook For Nursing Assistants Chapter 30 The Endocrine System Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 1 Structure of The Endocrine System Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 2 Endocrine and Exocrine Glands Endocrine glands produce hormones and release them directly into the bloodstream Exocrine glands produce substances that are released into a hollow organ or onto a surface Examples of exocrine glands include: The salivary glands in the mouth, which produce saliva The sweat glands in the skin, which produce sweat. Exocrine glands are not part of the endocrine system Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 3 Endocrine Glands Endocrine glands include: Pituitary gland Pineal gland Thyroid gland Parathyroid glands Thymus gland Adrenal glands Pancreas Sex glands (gonads) Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 4 Endocrine Glands Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 5 Location of Endocrine Glands Endocrine glands are found throughout the body The pituitary gland Is about the size of a cherry Lies underneath the brain Is connected by a stalk, called the infundibulum, to the hypothalamus The pineal gland Is located underneath the brain The thyroid gland Is located in the neck Is butterfly-shaped, with two oval lobes located on either side of the larynx; connected by a narrow band of tissue called the isthmus Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 6 Location of Endocrine Glands The parathyroid glands Are four tiny glands that are embedded in the back of the thyroid gland The thymus gland Is located in the upper part of the chest above the heart The adrenal glands Are located on top of the kidneys The pancreas Is located in the abdomen The sex glands (gonads) Are the ovaries in women and the testes in men Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 7 Functions of The Endocrine Glands Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 8 Endocrine System The endocrine system controls many of the body’s processes, such as: Growth and development Reproduction Metabolism Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 9 How an Endocrine System Endocrine glands produce hormones, chemicals that act on cells to produce a response The hormones are released into the bloodstream The hormone travels in the blood until it reaches its target cell Once there, it attaches to a special receptor in the cell wall Attaching a hormone to a receptor causes a specific reaction in the cell Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 10 Negative Feedback System of the Endocrine System The secretion of many hormones is initiated by a negative-feedback system Some change in the internal environment causes the gland to begin producing its hormone The gland continues to produce the hormone until the amount of hormone (or some other related substance) reaches a certain level in the body At that point, the gland stops producing the hormone The negative-feedback system works very much like a central heating unit in a house Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 11 Pituitary Gland Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 12 Pituitary Gland: Posterior Lobe Antidiuretic hormone (ADH) secreted by the posterior lobe; acts on the kidneys ADH limits the amount of water lost from the body in the form of urine ADH causes the kidneys to save body fluid by decreasing the amount of urine produced The lack of ADH causes the kidneys to produce more urine, eliminating excess fluid from the body Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 13 Pituitary Gland: Posterior Lobe Oxytocin is a hormone that: Causes labor to begin Lets down milk in the breasts of a nursing mother Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 14 Pituitary Gland: Anterior Lobe Growth hormone is what causes our bodies to get bigger and taller as we move from infancy into adulthood Growth hormone is usually released in greater amounts during short periods of time, resulting in a child’s “growth spurts” The anterior lobe continues to release growth hormone long after the growing phase of development is finished because cells continue to need to be replaced throughout a person’s lifetime Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 15 Pituitary Gland: Anterior Lobe Thyroid-stimulating hormone (TSH) stimulates the thyroid gland Produces thyroid hormones Affects the rate of metabolism in the body’s tissues Adrenocorticotropic hormone (ACTH) stimulates the adrenal glands Produces hormones Helps the body to cope with stress Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 16 Pituitary Gland: Anterior Lobe Prolactin stimulates the milk glands of the breasts to produce milk when a baby is born Gonadotropins regulate the functioning of the sex glands (gonads) in both males and females Two types of gonadotropins: Follicle-stimulating hormone (FSH) Luteinizing hormone (LH) Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 17 Thyroid Gland The thyroid gland produces the following two hormones: Thyroxine Calcitonin These hormones help to regulate the body’s metabolism rate Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 18 Thyroid Gland: Thyroxine The hormone thyroxine sets the rate of metabolism for the cells of the body If the thyroid gland releases more thyroxine, the metabolic rate of the cells increases If the thyroid gland releases less thyroxine, the metabolic rate of the cells decreases Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 19 Thyroid Gland: Thyroxine The thyroid gland needs iodine to produce thyroxine Iodine is found in: Fish and shellfish Added to salt and other commercial products Goiter can occur when a person is deficient of iodine Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 20 Thyroid Gland: Calcitonin Calcitonin regulates the level of calcium in the bloodstream Calcitonin transports the extra calcium to the bones Tetany (cramping of the skeletal muscles and an irregular heart beat) may result if the calcium level drops too low Too much calcium in the bloodstream causes muscles to become weak and slow to respond Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 21 Parathyroid Glands The parathyroid glands produce parathyroid hormone (PTH) PTH increases the amount of calcium in the blood: Causes calcium to be released from the bones into the bloodstream Helps the kidneys to keep calcium, instead of excrete it in the urine Allows us to draw on stored calcium later in life The actions of calcitonin and PTH balance each other and help to keep the levels of calcium in the bloodstream constant Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 22 Parathyroid Glands If parathyroid glands are surgically removed or become damaged by disease: PTH is not produced in adequate amounts The calcium levels may drop, causing tetany Tumors of the parathyroid gland can cause an overproduction of PTH that results in: Excess calcium being removed from the bones Fragile bones Formation of kidney stones Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 23 Thymus Gland The thymus gland secretes thymosin Thymosin helps infection-fighting T cells to mature An increase in the secretion of thymosin stimulates the body to produce more T cells during an infection or illness Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 24 Adrenal Glands Each adrenal gland has two separate parts: The medulla, or inner portion The cortex, or outer portion Each part secretes distinct hormones Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 25 Adrenal Glands and Hormones Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 26 Adrenal Glands-Medullary Hormones The medulla of the adrenal glands secretes two hormones: Epinephrine Norepinephrine Responsible for the “fight-or-flight” response of the body in emergency situations Help the heart and lungs deliver more oxygen and nutrients to the muscles, preparing the body to “stand up and fight or turn tail and run” Dry mouth Pounding heart Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 27 Adrenal Glands-Cortical Hormones Glucocorticoids: Help to metabolize fats and proteins Help to maintain a reserve of glucose that can be used in times of stress Suppress the body’s inflammatory response Glucocorticoids are given in the form of drugs for severe inflammatory disorders such as: Asthma Rheumatoid arthritis Severe allergic reactions Hydrocortisone is a common medication that is a glucocorticoid Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 28 Adrenal Glands-Cortical Hormones Mineralocorticoids help to regulate the level of certain minerals in the body, particularly sodium and potassium Aldosterone is the primary hormone in this group Aldosterone helps the kidneys to reabsorb sodium and secrete potassium Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 29 Adrenal Glands-Cortical Hormones Androgens are secreted in small amounts by the adrenal cortex Androgens are converted by the body into the sex hormones Testosterone (in men) Estradiol (in women) Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 30 Pancreas The pancreas is both an exocrine gland and an endocrine gland It functions as an exocrine gland by producing and secreting enzymes into the small intestine that help to digest food It functions as an endocrine gland by producing two hormones, insulin and glucagon Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 31 Pancreas: Action of Insulin Special cells within the pancreas, called the islets of Langerhans, produce and secrete the hormone insulin Insulin affects all of the body’s cells Insulin allows glucose (sugar) to be transported from the bloodstream into the individual cells, where it is used for energy Insulin lowers the blood glucose level Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 32 Pancreas: Action of Glucagon Glucagon is responsible for raising the blood glucose level When the glucose levels in the bloodstream drop, when a person has not eaten for some time, the pancreas secretes glucagon Glucagon stimulates the liver to release the glucose that has been stored as glycogen into the bloodstream, to supply the cells of the body with fuel for energy Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 33 Sex Glands The sex glands (or gonads) secrete hormones that: Cause the onset of puberty Regulate reproduction Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 34 The Effects of Aging on the Endocrine System Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 35 The Effects of Aging The normal processes of aging: decrease the amount of hormones produced slow the secretion by the endocrine glands Decrease in thyroid hormone levels slows the body’s metabolism In women, menopause occurs as a result of decreased hormone production by the ovaries In men, secretion of hormones by the testes decreases, affecting sexual drive and function Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 36 Disorders of the Endocrine Glands Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 37 Disorders of the Endocrine System Disorders of the endocrine system can be caused: when the body produces too much or too little of a certain hormone by disorders of the hypothalamus, the pituitary gland, or the specific endocrine gland responsible for the hormone as a result of poor nutrition Corrective measures may be needed to restore the body’s homeostasis and prevent the imbalances from causing health problems Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 38 Pituitary Dwarfism A deficiency in the amount of growth hormone secreted during the growing years results in a condition known as pituitary dwarfism A person with pituitary dwarfism is much smaller than average, but still well proportioned If the condition is diagnosed while the person is still a child, growth hormone may be given to help stimulate growth Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 39 Pituitary Gigantism An excess in the amount of growth hormone secreted during the growing years results in a condition known as pituitary gigantism A person with pituitary gigantism is much larger than average, but still well proportioned Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 40 Acromegaly The secretion of too much growth hormone after a person has reached adulthood causing excessive growth of the bones of the hands, feet, and face Causes disproportioned appearance, especially in the face and hands Person does not grow taller Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 41 Thyroid Disorders Secretion of thyroid hormones is controlled by the pituitary gland Thyroid disorders can be caused by: Pituitary gland abnormalities Thyroid gland abnormalities Nutrient deficiencies, such as a lack of iodine A simple blood test can be used to detect imbalances in thyroid hormones Once detected, these imbalances can usually be treated Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 42 Hyperthyroidism Hyperthyroidism or Graves’ disease is caused by the excessive secretion of thyroxine In a person with hyperthyroidism, the metabolic rate of the body’s cells is increased Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 43 Hyperthyroidism: Sign and Symptoms Signs and symptoms of hyperthyroidism: Increased hunger accompanied by weight loss Irregular heartbeat Inability to sleep Irritability Confusion Increased perspiration, and intolerance to heat Hyperthyroidism may be treated by: Surgically removing part of the thyroid gland Destroying part of the gland with radiation Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 44 Hypothyroidism and Cretinism Hypothyroidism results when thyroxine secretion is too low Congenital hypothyroidism, if left untreated, can result in a condition known as cretinism Cretinism is characterized by a lack of physical growth and mental development Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 45 Causes of Hypothyroidism Most cases of hypothyroidism develop later in life, as a result of a disorder of the: Hypothalamus Pituitary gland, or Thyroid gland Hypothyroidism is more common among women and the elderly Hypothyroidism is treated by administering thyroxine in the form of a pill Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 46 Hypothyroidism: Sign and Symptoms Signs and symptoms of hypothyroidism: Fatigue Weakness Depression Anorexia Weight gain Constipation Intolerance to cold The administration of oral thyroxine helps to restore the body’s metabolism to a normal rate and relieve the signs and symptoms of hypothyroidism Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 47 Adrenal Gland Disorders Two of the most common adrenal gland disorders are: Addison’s disease Cushing’s syndrome Result from imbalances of the adrenal cortical hormones Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 48 Addison’s Disease In Addison’s disease, the adrenal cortex is destroyed, resulting in low levels of the adrenal cortical hormones A person with Addison’s disease experiences: Muscle weakness and atrophy Dark discoloration of the skin Disturbances in the body’s salt and water balance Hypertension A person with Addison’s disease may need assistance with walking and range-of-motion exercises Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 49 Cushing’s Syndrome Cushing’s syndrome results from: Excessive secretion of glucocorticoids Disorders of the pituitary gland that affect ACTH secretion Disorders of the adrenal gland itself Administering high doses of steroid medications, such as hydrocortisone, for a long period of time Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 50 Cushing’s Syndrome: Sign and Symptoms Pockets of fat in the abdomen, on the back, and in the face Increased facial hair High blood glucose levels, since one of the effects of glucocorticoids is to decrease the use of glucose by the tissues Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 51 Diabetes Mellitus Diabetes mellitus results when the pancreas is unable to produce enough insulin Diabetes mellitus can occur in people of all ages and races People between the ages of 65 and 74 years and people of African descent are affected most often Diabetes mellitus is the most common of all endocrine gland disorders and is the seventh leading cause of death among the elderly There are two types of diabetes mellitus, type I and type II Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 52 Juvenile Diabetes (Type I) Caused by destruction of the insulinproducing cells of the pancreas Form of diabetes that most often affects children Most people who have type I diabetes are diagnosed while they are children or young adults Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 53 Insulin A person with Type I diabetes mellitus must receive daily injections of insulin The insulin is injected into the subcutaneous layer of the skin, where it is absorbed by the bloodstream Several types of insulin are available The types of insulin differ in the speed at which they start working and how long they last in the body Some patients or residents receive only one injection of insulin each day, while others may receive two or three Insulin can also be delivered continuously by a pump device Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 54 Hypoglycemia and Hyperglycemia People who are receiving insulin injections need to have their blood glucose levels monitored closely Too much insulin causes hypoglycemia, a dangerous drop in blood glucose Hypoglycemia robs the brain of the glucose that is essential for it to function Too little insulin results in hyperglycemia, or too much glucose in the bloodstream If a person’s blood glucose level increases too much, he can enter a state called diabetic coma If not treated, diabetic coma can lead to death Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 55 Diet for a Person with Diabetes People who are receiving insulin injections must eat an adequate amount of nutritious food at regular intervals Meals Snacks A person with type I diabetes must eat a diet with specific amounts of: Carbohydrates Sugars Fats Proteins to react with the amount of injected insulin Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 56 Diet of a Diabetic Person If a person does not eat at the recommended time after receiving her insulin, her blood glucose level can drop too low, resulting in a condition known as insulin shock If one of your patients or residents with diabetes refuses to eat or only partially finishes his meal or snack, report this to the nurse immediately Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 57 Type II Diabetes Mellitus Type II diabetes mellitus: most common in overweight adults In people with type II diabetes mellitus: The pancreas still produces some insulin but the cells of the body are unable to respond to the insulin The body is unable to transport the glucose into the cells This results in higher blood glucose levels Symptoms of type II diabetes mellitus may occur gradually and go undetected for a long time Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 58 Type II Diabetes Mellitus Type II diabetes is treated through: Diet Exercise Use of oral medications to increase the effectiveness of insulin People with severe type II diabetes may need to be treated with insulin injections, especially during times of illness or stress When caring for a person with type II diabetes, be sure to watch closely the amounts and types of food the person eats Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 59 Hypoglycemia and Hyperglycemia: Symptoms Signs and symptoms of hyperglycemia and hypoglycemia are often very similar and should be reported to the nurse immediately. These signs include: Excessive hunger Excessive thirst Weakness, dizziness, or both Drowsiness and confusion Shaking and increased perspiration Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 60 Complications of Diabetes Many organ systems can be affected by uncontrolled diabetes mellitus of either type Low insulin levels increase the release of lipids (fats) into the bloodstream The lipids then build up in the linings of the arteries, damaging the blood vessels and possibly leading to: Atherosclerosis High blood pressure Heart disease Kidney disease Blindness (diabetic retinopathy) Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 61 Preventing Complications of Diabetes Early detection of diabetes mellitus is essential for preventing complications Once diabetes mellitus is diagnosed, measures can be taken to keep the disease under control and minimize the risk of developing complications: Weight loss (if applicable) Regular exercise Close attention to recommended diet Proper use of prescribed medications Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 62 End of Presentation Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Slide 63