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Assessing Clients
with Endocrine
Disorders
Endocrine Glands
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Pituitary Gland
Thyroid Gland
Parathyroid Glands
Adrenal Glands
Pancreatic Glands
Reproductive Glands
Endocrine Glands
Endocrine Glands
Endocrine Glands
Endocrine Glands
Endocrine Glands
Endocrine Glands
Endocrine Glands
Endocrine Glands
Transportation
of Hormones
• Endocrine glands release most hormones into the
bloodstream (some require a protein carrier)
• Neurons release some hormones (epinephrine) into
bloodstream (neuroendocrine route)
• Hypothalamus releases hormones directly to target
cells in posterior pituitary by nerve cell extension
• released messengers diffuse through interstitial fluid
Topics Covered in Health
History Interview
• Health Perception and Management: state of
health, endocrine problems, use of drugs,
alcohol, smoking
• Nutritional: diet, fluid intake, weight changes,
change in energy level
• Elimination: changes in bowel, bladder habits
• Activity/Exercise: describe physical activities,
energy level
Topics Covered in Health
History Interview
• Sleep/Rest: how many hours of sleep/night, problems
sleeping, night sweats
• Cognitive/Perceptual: memory problems, restlessness,
confusion, anxiety, vocal changes, visual changes, heart
palpitations, abdominal pain, pain, stiffness in joints
• Self Perception/Self Concept: feelings about self, medications
• Role/Relationships: family history of endocrine disorders?
Does this condition affect your relationship with others?
Topics Covered in Health
History Interview
• Sexuality/Reproductive: affects on sexual activities
• Coping/Stress Tolerance: does stress make condition
worse? Has condition made stress worse?
• Value/Belief: how do relationships or activities help
you cope? How do cultural beliefs or practices affect
how you care for yourself? Are there any specific
treatments you would not use to treat this
condition?
Disorders of the
Thyroid Gland
• An enlarged thyroid may indicate Graves
disease or a goiter
• Exophthalmos (protruding eyes)seen in
hyperthyroidism
• Brittle nails, dry hair, hair loss indicative of
hypothyroidism
Disorders of the
Thyroid Gland
• Restlessness, anxious, disturbed sleep pattern
indicative of hyperthyroidism
• Age—related endocrine changes
– Pituitary: decreased production of ACTH, TSH, FSH
– Thyroid: decrease in gland activity
– Adrenal medulla: increase secretion and level of
norepinephrine
– Pancreas: decreased absorption of fat soluble vitamins
delayed and decreased insulin production
Normal Variation
• Normal variation in assessment findings for
the older adult
• A higher than normal blood glucose levels are
not unusual in nondiabetic older adults
Endocrine System
• Growth Hormone—deficiency indicates dwarfism
and excess indicates gigantism, acromegly
• MRI—identifies tumors of the pituitary and
hypothalamus
• Thyroid stimulating hormone (TSH) differentiates
between pituitary and thyroid causes of
hypothyroidism
• Thyroine T4-aid in diagnosis of thyroid function
• Triiodothyronine(T3)-compare T3 and T4 to diagnose
thyroid disorder
Endocrine System
• indirect measure of free thyroxin
• Thyroid Antibodies-identifies thyroid immune
disease
• Thyroid Scan-evaluates nodules
• Parathyroid Hormone-identifies hypoparathyroidism
or hyperparathyroidism
• Fasting Blood Sugar-confirms diagnosis of diabetes
mellitus
• CT Scan-identifies pancreatic tumors or cysts
Nursing Care of
Clients with Endocrine
Disorders
Nursing Care for Clients
with Endocrine Disorders
• Directed toward meeting physiologic needs
• Providing education
• Ensuring psychologic support for client and
family
• Holistic approach is essential
Hyperfunction and
Hypofunction Disorders
• Hyperthyroidism: palpataions, increased sweating,
increased appetite, weight loss
• Hypothyroidism: lethargy, weight gain, depression,
dry skin
• Hyperparathyroidism: hypertension, psychosis,
muscle weakness, renal calculi
• Hypoparathyroidism: tetany, muscle spasms,
• Arrhythmia: hyperactive reflexes
• Cushing’s Syndrome: weakness, easily bruised, poor
wound healing, glycosuria
Hyperfunction and
Hypofunction Disorders
Hyperfunction and
Hypofunction Disorders
Nursing Implications for
Selected Endocrine Medications
• Hyperthyroidism Medications: assess for
hypersensitivity to iodine or shellfish prior to
giving medication
• Antithyroid Drugs: monitor for side effects
such as pruritis rash, elevated temperature,
anorexia, loss of taste, menstrual changes,
fatigue, and weight gain
Nursing Implications for
Selected Endocrine Medications
• Hypothyroidism Treatments
– Administer 1 hour prior to eating or at least 2
hours after eating
– Monitor for minor bruising, bleeding gums, and
blood in the urine
– Monitor for coronary insufficiency, chest pain,
dyspnea, and tachycardia
• Hyperparathyroidism Therapy
– Education to avoid OTC medications with calcium,
drink fluids, and remain active
Nursing Care
• Client teaching to support the neck
postoperatively, to increase comfort and to
decrease straining of the suture line
• Teaching effective coughing and deep
breathing exercises
• Reassurance concerning the scar
• Encourage verbalization of concerns
Nursing Care
• Postoperative care
– Comfort measures
– Assess pain
– Client in the semi-Fowler’s position
• Assess the client for complications
• Use medical and surgical asepsis
• Adrenalectomy preoperative care includes a dietary
consultation
• Adrenalectomoy postoperative care includes vital
signs, monitoring intake and output
Nursing Process and
Frameworks of Care
• Thyroid: hyperthyroid or hypothyroid goal is
euthyroid function
• Parathyroid
– Hyperfunction: observe for renal calculi, muscle
weakness, and polyuria
– Hypofunction: observe for tetany, low serum
calcium levels
Nursing Process and
Frameworks of Care
• Adrenal Gland
– Cushing’s syndrome: observe for pathologic
fractures, hypertension, emotional disturbances
– Addison’s disease: observe for postural
hypotension, syncope, Addisonian crisis
• Anterior Pituitary Gland: observe for
hypertension, voice changes, tongue
enlargement, indicating acromegaly
Nursing Process and
Frameworks of Care
• Diabetes insipidus is manifested by polydipsia
and polyuria
• Posterior Pituitary: observe for signs of SIADH,
which can occur as a result of water retention