Download Lecture 11 Endocrine - Porterville College

Endocrine System
Lecture 11
Medical Surgical Nursing
P10B
Chapter 34-35
Endocrine System
• Primary function
– Regulate internal
environment
– Homeostasis
Endocrine System
• Structure
– Glands
– Hormones
Major Endocrine Glands
•
•
•
•
•
•
•
•
Hypothalamus
Pituitary gland
Thyroid gland
Parathyroid glands
Thymus
Adrenal glands
Pancreas
Gonads
– Ovaries
– Testis
Hormones
• Chemical messengers of
the body
• Act on specific target
cells 
• Increase or decrease in
body function
Hormone Regulation
• “Negative Feedback”
• When target cells release
too much hormone 
send back a message to
reduce the hormone
release.
• When too little hormone
is released  the target
cell sends back a message
to increase the normal
level
Negative feedback
• i temperature 
• Unit (gland) 
• Heating unit turns on
and generates heat
(hormone) 
• h temperature 
• (Heating unit turns off)
Hypothalamus
• Location
– Brain
– Attached to the pituitary
gland
• Function
– Controls the anterior
pituitary
• Temperature
• Fluid volume
• growth
Pituitary Gland
• AKA: hypophysis
• AKA: “Master gland”
• Location
– In the skull
– Below the hypothalamus
Parts of the Pituitary Gland
• Anterior lobe
– 6 hormones
•
•
•
•
•
•
GH
PRL
FSH
LH
TSH
ACTH
• Posterior lobe
– 2 hormones
• Oxytocin
• ADH
Anterior Pituitary Gland
• Growth hormone (GH)

– Bones & muscles
• Function
– Stimulate growth
– h blood glucose levels
Anterior Pituitary Gland
• Prolactin (PRL) 
– Mammary glands
• Function
– Stimulate breast
development during pg
– Milk secretion p\
delivery
Anterior Pituitary Gland
• Follicle-Stim horm. (FSH)
• Luteinizing Horm. (LH) 
– Testes or ovaries
• FSH 
– Sperm production
– Estrogen secretion
• LH 
– Ovulation
– Testosterone secretion
Anterior Pituitary Gland
• Thyroid Stimulating
Hormone (TSH) 
– Thyroid
• Function
– Stim. thyroid growth
– Stim. secretion of
thyroid hormones
Anterior Pituitary Gland
• Adrenocorticotropic
hormone (ACTH) 
– Adrenal Cortex
• Function
– Stim. adrenal cortex
growth
– Stim. secretion of
glucocorticoids
Posterior Pituitary Hormones
• Anti-diuretic Hormone
(ADH)
• Oxytocin
Posterior Pituitary Gland
• Antidiuretic Hormone
(ADH) 
– Kidney
• Function
– Stim. H2O retention 
– i urine output 
– h H2O in serum/body
Posterior Pituitary Gland
• Oxytocin
– Uterus
– Mammary glands
• Function:
– Uterine contractions
during labor
– “let-down” hormone
• Milk secretion
Thyroid Gland
• Shape
– Butterfly
– Two lobes
• Isthmus
• Location
– Straddles the trachea
Thyroid Hormones
• Hormones (3)
– Thyroid Hormone
• Thyroxine (T4)

– Triiodothyronine (T3)
– Necessary ingredient
• Iodine
– Calcitonin 
• i Ca+ levels in the blood.
– h Metabolism
Parathyroid Glands
• Location
– Embedded on the
posterior lobes of the
thyroid gland
• Number
– @4-6
• Hormone
– Parathyroid Hormone
(PTH)
• Necessary ingredient
– Vitamin D
Parathyroid Hormone
• i Serum Ca+ levels 
• PTH released 
– Bone (target cell) 
– Releases Ca+ into plasma

• h Serum Ca+ levels
Adrenal Gland
• Location
– On top of each kidney
• Two parts
– Adrenal Cortex
– Adrenal Medulla
Adrenal Cortex
• Corticosteroids
– Glucocorticoids
• cortisol
– Mineralocorticoids
• Aldosterone
• Androgens
Glucocorticoids
• Cortisol
– Primary Action
• ___ blood glucose levels
– h
– Secondary action
• Anti-inflammatory
– Primary purpose
• Handle stress
Mineralocorticoids
• Aldosterone
– Function:
• Salt & water balance
– Target cells
• Kidney
Mineralocorticoids
• i blood volume / blood
pressure 
• Adrenal Cortex 
• Aldosterone 
• Kidney 
• Retains Na+ and H2O 
• h blood volume / blood
pressure
Adrenal Medulla
• Epinephrine
– Adrenaline
• Norepinephrine
• Action
– h heart rate
– h Force of heart
contraction
– Constrict blood vessels
• Purpose:
– Physical Stress Response
– Fight or Flight!
•
•
•
•
Stress 
Fight or Flight response 
Adrenal Medulla 
Epi/norepinephrine 
– Heart  h heart rate/contraction
– Blood Vessels  constriction
• Handle Stress
Small Group Questions
1. What is negative feedback?
2. What is the “Master Gland”? Why is it called that?
3. What are the target cells of GH?
4. What hormone targets the mammary glands?
5. What hormones target the gonads?
6. What are the targets cells of ACTH?
7. What is the action of the thyroid hormones?
8. What is the action of PTH
9. What is the purpose and action of Glucocorticoids?
10. What is the action of Epinephrine? What response does
it elicit?
Endocrine System Assessment
• Hormone affect all body
systems
• Health Hx
–
–
–
–
–
Energy
Wt
Cold/ heat
Nervousness
Hydration
Endocrine System Physical Assessment
• General appearance
• Skin
– Color
– Temp
– Moisture
•
•
•
•
Hair& Nails
Exophthalmos
Visual acuity
Palpate thyroid
Diabetes Insipidus
• Hormone imbalance
– ADH insufficiency
What endocrine glad secretes ADH?
A. Thyroid
B. Anterior Pituitary
C. Posterior Pituitary
D. Adrenal Cortex
E. Adrenal Medulla
What is the function / action of ADH?
A. Stimulates H2O retention leading to i urine
output
B. Increased blood glucose levels
C. Decreases blood calcium levels
D. Increases blood calcium levels
E. Increases metabolism, increased heart rate
and blood pressure
What effect would insufficient ADH
have?
A.
B.
C.
D.
E.
Edema
Decreased urinary output
Increased urinary output
Decreased blood calcium levels
Increased blood calcium levels
S&S of DI
• Polyuria (5-15 L/day)
• Thirst
• Urine specific gravity
– i
• Urine color
– Pale
• Dehydration
– Pulse
• Tachy
– Poor skin turgor
– Dry mucous membranes
On your own QUIZ
• What would be the priority nursing
diagnosis for a client with a medical
diagnosis of diabetes Insipidus?
– Fluid Volume Deficit
Nursing Interventions
• Monitor
–
–
–
–
–
I&O
Specific gravity of urine
Vital signs
Skin turgor
Neuro function
• Daily weights
• Provide adequate fluids
• Administer meds per
order
– Monitor for S/E
Syndrome of Inappropriate ADH
secretion
• AKA: SIADH
• Hormone Imbalance:
– Excess production of ADH
What endocrine gland secretes ADH?
A. Adrenal Medulla
B. Thyroid
C. Anterior Pituitary
D. Adrenal Cortex
E. Posterior Pituitary
What is the function / action of ADH?
A. Decreases blood calcium levels
B. Increases blood calcium levels
C. Increased urine output
D. Decrease urine output
E. Increased blood glucose levels
What effect would excess ADH
secretion have?
A.
B.
C.
D.
E.
Decreased urinary output
Increased urinary output
Decreased blood calcium levels
Increased blood calcium levels
Dehydration
S&S of SIADH
• Decreased urine output
• Concentrated urine
– Specific Gravity
• h
• Hyponatremia
– i sodium levels
•
•
•
•
No edema
H/A
Weight gain
Anorexia
On your own QUIZ
• What would be the priority nursing
diagnosis for a client with a medical
diagnosis of SIADH?
– Fluid Volume Excess
Nursing Interventions
• Monitor
–
–
–
–
I&O
V/S
LOC
Serum Na+ levels
• Daily weights
• Auscultate lungs
• Fluid
– Restriction
• Provide mouth care
• Administer meds per
MD order
– Diuretics
• Lasix
– Monitor for S/E
• Hypokalemia
• Seizure precaution
What is a normal Serum Na+ level?
A.
B.
C.
D.
E.
3.5 – 5.3 mEq/L
135-140 mEq/L
12-18 g/dL
4,500 – 10,000 /mm3
36 – 54%
Which of the following is a S&S of
hyponatremia?
A.
B.
C.
D.
E.
Thirst
Postural hypotension
Positive Chvostek’s sign
Convulsions
Dysrhythmias
What is a normal Serum K+ level?
A.
B.
C.
D.
E.
3.5 – 5.3 mEq/L
135-140 mEq/L
12-18 g/dL
4,500 – 10,000 /mm3
36 – 54%
Which of the following is a S&S of
hypokalemia?
A.
B.
C.
D.
E.
Thirst
Postural hypotension
Positive Chvostek’s sign
Convulsions
Dysrhythmias
Small Group Questions
1.
2.
3.
4.
5.
6.
7.
8.
What hormonal imbalance is assoc. with DI?
What are the characteristic S&S of DI?
What is the primary nursing diagnosis for DI?
Identify 5 nursing interventions for a client with DI
(give rationales for those nursing interventions)
What hormonal imbalance is assoc. with SIADH?
What are the characteristic S&S of SIADH?
What is the primary nursing diagnosis for SIADH?
Identify 5 nursing interventions for a client with
SIADH (give rationales for those nursing interventions)
Hyperthyroidism
• Hormonal imbalance
– Excess TH
What is the function/ action of TH?
A.
B.
C.
D.
E.
Decreases blood calcium levels
Increases blood calcium levels
Increased urine output
Increase metabolic function
Increased blood glucose levels
S&S of Hyperthyroidism
• Think FAST & HOT
• Neuro
– Hand tremors
– Nervousness
• C/V
– HTN
– Tachycardia
• G/I
– Diarrhea
– Weight loss
S&S of Hyperthyroidism
• Integumentary
– Warm
– Thin hair
• Endocrine
– Goiter
• Sensory
– Exophthalmos
What is the priority medical need for a
person diagnosed with
hyperthyroidism?
A.
B.
C.
D.
E.
More Calcium
Less Calcium
More TH
Less TH
More fluids
Medical Management
• Goal: reduce production of
TH
– Meds
• Anti-thyroid drugs
– Action
• Inhibit thyroid hormone
production
– Surgery
• Goal: Prevent complications
– Beta-Adrenergic Blockers
What is the action of Beta-blockers?
A.
B.
C.
D.
E.
Increased heart contractility
Analgesic
Decrease blood pressure
Diuretic, increase urine output
Decreases inflammation
Priority Nursing Diagnosis
• Alt. Cardiovascular
function
• Imbalanced nutrition
• Fatigue
• Visual deficits
• Body image disturbance
Nursing Interventions
• Monitor
–
–
–
–
V/S
Breath sounds
Weight
Food intake
• Diet
–
–
–
–
High calorie
High protein
High fiber
6 small meals
Nursing Interventions
•
•
•
•
Teach relaxation
Provide rest periods
Cool showers
Protect eyes
– Tinted glasses
– Artificial tears
• Enc. To express feelings
• Enc to ask questions
Hypothyroidism
• Hormonal imbalance:
– Insufficient TH
production
What is the function/ action of TH?
A.
B.
C.
D.
E.
Increased urine output
Increase metabolic function
Increased blood glucose levels
Decreases blood calcium levels
Increases blood calcium levels
What would be the effect of decreased
TH?
A.
B.
C.
D.
E.
Fluid retention
Fluid loss
Calcium imbalance
Decreased metabolism rate
Increased metabolism rate
S&S of hypothyroidism
• Think SLOW & COLD
• Neuro
– Slow movement
– Lethargy
• C/V
– Hypotension
– Bradycardia
• G/I
– Constipation
– Weight gain
• Integumentary
– Cold
– Hair loss
• Endocrine
– Goiter
• Sensory
– Edema around eyes
What is the priority need for a person
diagnosed with hypothyroidism?
A.
B.
C.
D.
E.
More Calcium
Less Calcium
More TH
Less TH
More fluids
Medical Management:
Hypothyroidism
• Goal:
• Replace TH
• Thyroid preparations
– Levothyroxine sodium
(Synthroid, Levothroid)
– Action
• h blood TH levels
Nursing Implications: Thyroid
preparations
• Give in AM a\breakfast
• Check pulse a\ admin
– If >100/min hold and call
MD
• Monitor S/E
– Nervousness
– Weight loss
• Rx for life
Dimensional Analysis Time
• The doctor orders 0.2
mg of Synthroid, PO q
AM.
• How much would you
give?
A.
B.
C.
D.
E.
½ tablet
1 tablet
1 ½ tablet
2 tablets
Unable to give with this
label/medication
Priority Nursing Diagnosis:
Hypothyroidism
• Decreased Cardiac output
• Imbalances nutrition: more than body
requirements
• Constipation
• Activity intolerance
Nursing interventions: Hypothyroidism
• Monitor
– B/P
– Apical pulse
– Peripheral pulses
• Provide blankets
• Increase room temp
• Monitor resp status
– Rate
– Depth
– Auscultate
Nursing Interventions: Hypothyroidism
• Monitor weight
• Diet
– Decreased calorie
– High fiber
• Increase fluid
– >2,000 mL/day
 Enc exercise at tolerated
 Rest periods
 Assist with ADL’s
Nursing Interventions: Hypothyroidism
 Administer stool softener
per MD order
• Administer meds per
MD order
– Monitor for S/E
• Tachycardia
• Nervousness
• Weight loss
Small Group Questions
1.
2.
3.
4.
5.
6.
7.
8.
9.
What hormonal imbalance is assoc. with hyper & hypo thyroidism?
What are the distinguishing characteristic of hyperthyroidism?
What is the medical treatment for hyperthyroidism
What are the primary nursing diagnosis for hyperthyroidism?
What are 5 nursing interventions for a client with hyperthyroidism (give
rationales)?
What are the distinguishing characteristic of hypothyroidism?
What is the medical treatment for hypothyroidism
What are the primary nursing diagnosis for hypothyroidism?
What are 5 nursing interventions for a client with hypothyroidism (give
rationales)?
Cushing’s syndrome
• Hormonal imbalance:
– Excess Cortisol
What gland secretes Cortisol?
A.
B.
C.
D.
E.
Thyroid
Anterior Pituitary
Posterior Pituitary
Adrenal Cortex
Adrenal Medulla
What is the primary function of
Cortisol
A.
B.
C.
D.
E.
Increase blood pressure
Increase urine output
Stress management
Increase metabolism
Increase Calcium levels
What are the two main actions of
Cortisol?
A. Increase blood glucose levels & antiinflammation
B. Increase blood glucose levels & fluid
retention
C. Increase blood glucose levels & diuresis
D. Decrease blood glucose levels & antiinflammation
E. Decrease blood glucose levels and diuresis
What would be the effect of increased
Cortisol
A.
B.
C.
D.
E.
Increased blood pressure
Decreased blood pressure
Increase blood sugar levels
Decreased blood sugar levels
Fluid retention
S&S of Cushing’s syndrome
•
•
•
•
•
Moon face
Buffalo hump
Easy bruising
Slow wound healing
Hirsutism
– Excessive facial hair
What would be the priority medical
need of a client with Cushing’s
syndrome?
A.
B.
C.
D.
E.
F.
Decrease Cortisol
Increase Cortisol
Decrease TH
Increase TH
Increase ADH
Decreased ADH
Medical Management: Cushing’s
syndrome
• Goal: Decrease Cortisol
levels
– Medication
– Surgery
Which of the following Nrs Dx would
you expect with a client diagnosed with
Cushings disease?
A. Fluid volume excess
B. Fluid volume deficit
Priority Nursing Diagnosis: Cushing
Syndrome
•
•
•
•
Fluid volume excess
Risk for injury
Risk for infection
Disturbed body image
Nursing Interventions
• Monitor
–
–
–
–
•
•
•
•
•
•
Weight
I&O
B/P
V/S
Safe environment
Assistive devices
Provide rest periods
Private room/limit visitors
Assess wounds
Sterile tech with procedures
Addison’s Disease
• Hormonal imbalance:
• Insufficient Glucocorticoids
& Mineralocorticoids
What gland secretes Glucocorticoids
and Mineralocorticoids?
A.
B.
C.
D.
E.
Thyroid
Pituitary
Adrenal Cortex
Adrenal Medulla
Parathyroid
What is the primary function of
Glucocorticoids & Mineralocorticoids?
A.
B.
C.
D.
E.
Increase blood pressure
Increase urine output
Stress management
Increase metabolism
Increase Calcium levels
What are the two main actions of
Cortisol?
A. Decrease blood glucose levels & antiinflammation
B. Decrease blood glucose levels and diuresis
C. Increase blood glucose levels & fluid
retention
D. Increase blood glucose levels & diuresis
E. Increase blood glucose levels & antiinflammation
What would be the effect of
decreased Cortisol
A.
B.
C.
D.
E.
Increased blood pressure
Decreased blood pressure
Increase blood sugar levels
Decreased blood sugar levels
Fluid retention
What is the main action of
mineralocorticoids?
A.
B.
C.
D.
E.
Increase blood glucose levels
Decrease blood glucose levels
Anti-inflammation
Calcium balance
Sodium and water balance
Addison’s disease
• “The show stopper
disease”
S&S of Addison’s disease
• Skin
– Bronze color
• C/V
– Postural hypotension
– Weak pulse
• CNS
– Dizzy
– Lethargy
• G/I
– Anorexia
– N/V
What is the primary medical need of a
client with Addison’s disease?
A.
B.
C.
D.
E.
F.
Decrease Cortisol
Increase Cortisol
Decrease TH
Increase TH
Increase ADH
Decreased ADH
Medical Management: Addison’s
• Goal: replace
corticosteroids and
Mineralocorticoids
– Cortisone (Cortone)
Nursing Implications
• Cortisone
– Give with food
– S/E
•
•
•
•
•
h B/P
Edema
Weight gain
Bruising
Poor wound healing
Which of the following would be the priority Nursing
diagnosis for a client with Addison’s disease?
A. Fluid volume excess
B. Fluid volume deficit
Priority Nursing Diagnosis
• Fluid volume deficit
• Activity intolerance
• Imbalanced nutrition: Less than body
requirements
Nursing interventions
• Monitor
– I&O
– S&S of dehydration
– Orthostatic B/P
• Enc fluids
– 3,000 L/day
• Rest  slowly increase
activities
• Diet
– High calorie
– 6 small meals
Small Group Questions
1. What is the hormonal imbalance assoc. with
Cushing’s disease?
2. What are the distinguishing and important S&S
of Cushing’s disease?
3. What is the medical management for a client
with Cushing's disease?
4. What are the primary nursing diagnosis of a
client with Cushing’s disease?
5. What are 5 nursing interventions for a client
with Cushing’s disease? Prioritize you
interventions and give a rational
Small Group Questions
1. What is the hormonal imbalance assoc. with
Addison’s disease?
2. What are the distinguishing and important S&S
of Addison’s disease?
3. What is the medical management for a client
with Addison’s disease?
4. What are the primary nursing diagnosis of a
client with Addison’s disease? Prioritize your dx.
5. What are 5 nursing interventions for a client
with Addison’s disease - give a rational?
Pop Quiz: Which gland if it swells us can
cause asphyxiation?
A.
B.
C.
D.
E.
Pituitary
Hypothalamus
Thymus
Thyroid
Adrenal gland
Pop Quiz: Which of the following is a
gonad?
A.
B.
C.
D.
E.
Thyroid
Ovary
Pituitary
Adrenal
Pancreas
Pop Quiz: What term is used to
describe hormone regulation?
A.
B.
C.
D.
E.
Negative feedback
Auto-immune
Balancing act
Show stopper
Break through
Pop Quiz: What is the most important
hormone for the regulation of
metabolism?
A.
B.
C.
D.
E.
Epinephrine
Cortisol
Thyroxine
Testosterone
Anti-diuretic hormone
Pop Quiz: Which hormone requires
Vitamin D to function?
A.
B.
C.
D.
E.
Thyroid Hormone
FHS
ACTH
Cortisol
Parathyroid Hormone