Endocrine System

Lecture 11Medical Surgical Nursing

P10BChapter 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 Questions1. 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 PTH9. 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. ThyroidB. Anterior PituitaryC. Posterior PituitaryD. Adrenal CortexE. Adrenal Medulla

What is the function / action of ADH?

A. Stimulates H2O retention leading to i urine output

B. Increased blood glucose levelsC. Decreases blood calcium levelsD. Increases blood calcium levelsE. Increases metabolism, increased heart rate

and blood pressure

What effect would insufficient ADH have?

A. EdemaB. Decreased urinary outputC. Increased urinary outputD. Decreased blood calcium levelsE. 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 MedullaB. ThyroidC. Anterior PituitaryD. Adrenal CortexE. Posterior Pituitary

What is the function / action of ADH?

A. Decreases blood calcium levelsB. Increases blood calcium levelsC. Increased urine outputD. Decrease urine outputE. Increased blood glucose levels

What effect would excess ADH secretion have?

A. Decreased urinary outputB. Increased urinary outputC. Decreased blood calcium levelsD. Increased blood calcium levelsE. 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. 3.5 – 5.3 mEq/LB. 135-140 mEq/LC. 12-18 g/dLD. 4,500 – 10,000 /mm3E. 36 – 54%

Which of the following is a S&S of hyponatremia?

A. ThirstB. Postural hypotensionC. Positive Chvostek’s signD. ConvulsionsE. Dysrhythmias

What is a normal Serum K+ level?

A. 3.5 – 5.3 mEq/LB. 135-140 mEq/LC. 12-18 g/dLD. 4,500 – 10,000 /mm3E. 36 – 54%

Which of the following is a S&S of hypokalemia?

A. ThirstB. Postural hypotensionC. Positive Chvostek’s signD. ConvulsionsE. Dysrhythmias

Small Group Questions

1. What hormonal imbalance is assoc. with DI?2. What are the characteristic S&S of DI?3. What is the primary nursing diagnosis for DI?4. Identify 5 nursing interventions for a client with DI (give

rationales for those nursing interventions)5. What hormonal imbalance is assoc. with SIADH?6. What are the characteristic S&S of SIADH?7. What is the primary nursing diagnosis for SIADH?8. 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. Decreases blood calcium levelsB. Increases blood calcium levelsC. Increased urine outputD. Increase metabolic functionE. 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. More CalciumB. Less CalciumC. More THD. Less THE. 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. Increased heart contractilityB. AnalgesicC. Decrease blood pressureD. Diuretic, increase urine outputE. 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. Increased urine outputB. Increase metabolic functionC. Increased blood glucose levelsD. Decreases blood calcium levelsE. Increases blood calcium levels

What would be the effect of decreased TH?

A. Fluid retentionB. Fluid lossC. Calcium imbalanceD. Decreased metabolism rateE. 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. More CalciumB. Less CalciumC. More THD. Less THE. 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. ½ tabletB. 1 tabletC. 1 ½ tabletD. 2 tabletsE. 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 toleratedRest periodsAssist 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 Questions1. What hormonal imbalance is assoc. with hyper & hypo thyroidism?2. What are the distinguishing characteristic of hyperthyroidism?3. What is the medical treatment for hyperthyroidism4. What are the primary nursing diagnosis for hyperthyroidism?5. What are 5 nursing interventions for a client with hyperthyroidism (give

rationales)?6. What are the distinguishing characteristic of hypothyroidism?7. What is the medical treatment for hypothyroidism8. What are the primary nursing diagnosis for hypothyroidism?9. What are 5 nursing interventions for a client with hypothyroidism (give

rationales)?

Cushing’s syndrome• Hormonal imbalance:– Excess Cortisol

What gland secretes Cortisol?

A. ThyroidB. Anterior PituitaryC. Posterior PituitaryD. Adrenal CortexE. Adrenal Medulla

What is the primary function of Cortisol

A. Increase blood pressureB. Increase urine outputC. Stress managementD. Increase metabolismE. Increase Calcium levels

What are the two main actions of Cortisol?

A. Increase blood glucose levels & anti-inflammation

B. Increase blood glucose levels & fluid retention

C. Increase blood glucose levels & diuresisD. Decrease blood glucose levels & anti-

inflammationE. Decrease blood glucose levels and diuresis

What would be the effect of increased Cortisol

A. Increased blood pressureB. Decreased blood pressureC. Increase blood sugar levelsD. Decreased blood sugar levelsE. 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. Decrease CortisolB. Increase CortisolC. Decrease THD. Increase THE. Increase ADHF. 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 excessB. 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. ThyroidB. PituitaryC. Adrenal CortexD. Adrenal MedullaE. Parathyroid

What is the primary function of Glucocorticoids & Mineralocorticoids?

A. Increase blood pressureB. Increase urine outputC. Stress managementD. Increase metabolismE. Increase Calcium levels

What are the two main actions of Cortisol?

A. Decrease blood glucose levels & anti-inflammation

B. Decrease blood glucose levels and diuresisC. Increase blood glucose levels & fluid

retentionD. Increase blood glucose levels & diuresisE. Increase blood glucose levels & anti-

inflammation

What would be the effect of decreased Cortisol

A. Increased blood pressureB. Decreased blood pressureC. Increase blood sugar levelsD. Decreased blood sugar levelsE. Fluid retention

What is the main action of mineralocorticoids?

A. Increase blood glucose levels B. Decrease blood glucose levelsC. Anti-inflammationD. Calcium balanceE. 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. Decrease CortisolB. Increase CortisolC. Decrease THD. Increase THE. Increase ADHF. 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 excessB. 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. PituitaryB. HypothalamusC. ThymusD. ThyroidE. Adrenal gland

Pop Quiz: Which of the following is a gonad?

A. ThyroidB. OvaryC. PituitaryD. AdrenalE. Pancreas

Pop Quiz: What term is used to describe hormone regulation?

A. Negative feedbackB. Auto-immuneC. Balancing actD. Show stopperE. Break through

Pop Quiz: What is the most important hormone for the regulation of metabolism?

A. EpinephrineB. CortisolC. Thyroxine D. TestosteroneE. Anti-diuretic hormone

Pop Quiz: Which hormone requires Vitamin D to function?

A. Thyroid HormoneB. FHSC. ACTHD. CortisolE. Parathyroid Hormone