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Nursing:
A Concept-Based Approach to Learning
VOLUME ONE | SECOND EDITION
MODULE
12
Metabolism
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
The Concept of Metabolism
• Processes of biochemical reactions in
body's cells
 Necessary to produce energy, repair cells,
and maintain life
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Normal Metabolism
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Normal Metabolism
• Pituitary gland
 Located in skull beneath hypothalamus
 Two parts:
• Anterior pituitary: secretes
• Adrenocorticotrophic hormone (ACTH): Stimulates the adrenal
glands to produce cortisol.
• Growth hormone (GH)
• Thyroid-stimulating hormone (TSH): TSH stimulates the
thyroid gland to produce its own hormones, triiodothyronine
(T3) and thyroxine (T4).
• Posterior pituitary: secretes
• ADH
• oxytocin
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Normal Metabolism,
continued
• Thyroid gland
 Location
• Anterior to upper trachea
• Inferior to larynx
 Glandular tissue with follicles
 Secretes hormones
• T3, T4 (thyroid hormones): metabolism
• Calcitonin: maintains serum calcium when
plasma calcium levels elevated
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Normal Metabolism,
continued
• Parathyroid glands
 Four glands
 Secrete parathyroid hormone (PTH)
• Maintains serum calcium levels when plasma
calcium levels decreased
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Normal Metabolism,
continued
• Adrenal glands
 Sit on top of kidneys
 Two organs within each gland
• Adrenal medulla
- Epinephrine
- Norepinephrine
• Adrenal cortex
- Mineralocorticoids (aldosterone): sodium
and water reabsorption
- Glucocorticoids (cortisol): lipid release,
glucose formation, anti-inflammatory effects
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Normal Metabolism,
continued
• Endocrine Pancreas
 Behind stomach
• Between spleen and duodenum
 Endocrine cells produce hormones that
regulate carbohydrate metabolism
• Glucagon: glucose synthesis
• Insulin: facilitates uptake of glucose
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Normal Metabolism,
continued
• Other organs involved with metabolism
• Liver
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Genetic and Lifespan
Considerations
• Endocrine system responsible for
 Sexual differentiation during fetal
development
 Stimulating growth and development
 Table 12-2 Age related changes
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Concepts Related to Metabolism
Some examples…
• Acid-Base Balance
• Metabolic acidosis
• Perfusion
• Myxedema (hypothyroidism with fluid
retention)
• Oxygenation
• Ascites
• Stress and Coping
• Powerlessness
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Alterations to Metabolism
• Disorders of structure and function
• Hormone production increases or
decreases
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
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Alterations and Manifestations
• Endocrine and Metabolic Disorders that
alter normal hormone levels
 Diabetes mellitus
• Type 1, 2
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Obesity
Graves disease
Hypothyroidism
Osteoporosis
Cirrhosis
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Prevention
• Help client identify and modify risk factors
• Screenings
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Nursing Assessment
• Health assessment interview
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Genetic influences
Screening
Medical history
Family history
Social, personal history
Changes in normal growth, development
Injuries
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Assessment Interview
• 1. Does anyone in your family have an
endocrine disorder?
• 2. Has your weight changed?
• 3. Describe your physical activities.
• 4. Have you noticed any problem with
your memory?
• 5. Have you noticed any change in the
color or condition of your skin and hair?
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Nursing Assessment, continued
• Thyroid gland: only palpable organ
• Skin assessments
• Texture and moisture
• Nail and hair assessment
• Facial assessment
• Symmetry of face; position of eyes
• Thyroid gland assessment
• Palpate gland for size and consistency
• Motor function assessment
• Reflexes
• Sensory function assessment
• Pain, temperature, vibration sense, stereognosis
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Nursing Assessment, continued
• Musculoskeletal assessment
• Assessing for hypocalcemic tetany
 Trousseau sign
• Tetany with BP
 Chvostek sign
• Facial grimacing with tapping of facial muscle
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Diagnostic Tests
•
•
•
•
•
•
•
•
Hemoglobin A1C
T3, T4, TSH
Individual hormone levels
Serum electrolytes
Liver enzymes
Bilirubin
Serum albumin
Serum calcium
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Interventions and Therapies
• Multidisciplinary care for multiple
problems
• Meet physiological needs
• Education
• Ensure psychological support
• Holistic approach essential
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Independent
• Educate client regarding the diagnostic
testing, disease state and therapies
• Develop a lifestyle that will limit
complications from the disorder
• Community resources
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Collaborative
• Collaboration with a certified exercise
physiologist and certified dietitian
• Behavioral therapy
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Collaborative
• Pharmacologic therapy
 Hormone administered as replacement
• Insulin
• Antithyroid agents
- Tapazole
• Thyroid agents
- Synthroid
• Hormonal agents
- Evista
• Bisphosphonates
- Fosamax
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Exemplar 12.4
Obesity
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
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Pathophysiology and Etiology
• Nutrients in food provide energy
• Etiology
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Excess calories stored as fat, triglycerides
Basal metabolic rate (BMR)
Appetite regulated by CNS, emotions
Hormones involved in regulating obesity
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Pathophysiology and Etiology,
continued
• Risk factors
 Genetic
 Psychological
• Self-esteem
 Physiological
 Physical inactivity
• Probably most
important factor
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Clinical Manifestations
• Defined by body mass index (BMI)
 BMI 25–29.9 kg/m2 overweight
 BMI ≥ 30 kg/m2  obese
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Complications of Obesity
• Morbid obesity
 >200% of ideal body weight
 Risk of dying 12 times greater
• Significant risk factor for cardiovascular
disease
• 60% have metabolic syndrome
• Affects reproductive function
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Complications of Obesity, continued
• Increased weight increases risk for
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Gallstones
Several types of cancer
Osteoarthritis
Cardiovascular disease
Type 2 DM
Depression
Postoperative complications
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Assessment
• Health history
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Risk factors, family history
Recent weight gain or loss
Perceptions of weight, health
Diet, food intake
• Physical examination
 Vital signs, height, weight
 Skinfold measurements
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Diagnostic Tests
 BMI  divide weight (in kg) by height (in
m2)
 Thyroid profile
 Serum glucose
 Serum cholesterol
 Lipid profile
 ECG
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Diagnosis
• Imbalanced Nutrition: More Than Body
Requirements
• Chronic Low Self-Esteem
• Noncompliance
• Activity Intolerance
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Planning
• Client makes sensible dietary choices
• Client follows exercise routine
• Client demonstrates appropriate weight
loss
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Implementation
• Caring interventions
 Encourage client to identify contributing
factors
 Establish realistic goals, objectives
 Assess knowledge of balanced diet plans
 Discuss behavior modification strategies
 Monitor weight loss, BP, lab data
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Implementation, continued
• Activity Intolerance
 Assess current
activity level,
tolerance
 With medical
clearance, plan
program
• Aerobic exercise 30–
40 minutes 5 days
each week
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
• Imbalanced
Nutrition
 Collaborate with
nutritionist
 Create diet plan
 Discuss ability,
willingness to
incorporate changes
 Help identify behavior
modification strategies
 Have client establish
strategies for "stress"
eating
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Implementation, continued
• Chronic Low Self-Esteem
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Encourage client to verbalize experience
Set small goals
Offer positive feedback, encouragement
Refer for counseling as appropriate
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Behavior Modification
• Food records
• Eliminating cues that precipitate eating
• Examine factors that affect eating
behaviors
• Social support, group programs successful
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Surgery
• Bariatric surgery  BMI > 40 kg/m2
• Restrictive/malabsorptive procedures
 Bypass portion of small intestine
 Rapid weight loss
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Pharmacologic Therapy
• Prescription and OTC
 Amphetamine, nonamphetamine appetite
suppressants
 OTC
• Bulk-forming agents
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
Evaluation
• Identification, understanding of factors
contributing to weight loss
• Understanding, application of behavioral
modification techniques to lose weight
• Accomplishment of desired weight loss
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved