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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. All Rights Reserved Alterations and Manifestations • Endocrine and Metabolic Disorders that alter normal hormone levels Diabetes mellitus • Type 1, 2 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 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. All Rights Reserved Pathophysiology and Etiology • Nutrients in food provide energy • Etiology 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 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 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 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