UNIT 5 BUILDING CLINICAL COMPETENCEResponses to Altered Endocrine FunctionFUNCTIONAL HEALTH PATTERN: Nutritional-Metabolic

Think about clients with altered nutritional or metabolic function for whom you have cared inyour clinical experiences.

■ What were the clients’ major medical diagnoses (e.g., Graves’ disease, myxedema, thyroidcancer, Cushing’s syndrome, Addison’s disease, pheochromocytoma, syndrome ofinappropriate antidiuretic hormone secretion, or diabetes mellitus)?

■ What manifestations did each of these clients have? Were these manifestations similar ordifferent?

■ How did the clients’ endocrine problems interfere with their nutritional and metabolicstatus? Were they on a prescribed diet? What was their daily intake of foods and fluids?Did they have an increased appetite with loss of weight? Did they notice their hands andfeet getting larger? Did they have difficulty swallowing or notice swelling in the front oftheir neck? Did they note an increase or decrease in urination? Did they note a change inenergy levels? Did they notice any visual changes? Did they complain of sleepdisturbances? Did they have any changes in hair distribution, such as facial hair orchanges in skin texture? Was there a change in memory or the ability to concentrate? Didthe clients use hormones or steroids? Was there a family history of diabetes mellitus,thyroid problems, hypertension, or obesity?

The Nutritional-Metabolic Pattern includes metabolism, which is the biochemical processes that takeplace in the body in response to hormones produced and released by the endocrine glands. Theseprocesses include the distribution of nutrients after digestion of carbohydrates, proteins, and fats.The endocrine system regulates growth, reproduction, metabolism, fluid and electrolyte balance,and gender differentiation. Endocrine disorders affect metabolic status in two primary ways:

■ A deficit of hormones may result in disorders of the thyroid gland (e.g., hypothyroidism),disorders of the parathyroid gland (e.g., hypoparathyroidism), disorders of the adrenalgland (e.g., chronic adrenocortical insufficiency), disorders of the pituitary gland (e.g.,hypopituitarism, diabetes insipidus), or disorders of the pancreas (e.g., hypoglycemia).

■ Excess hormones may result in disorders of the thyroid gland (e.g., hyperthyroidism),disorders of the parathyroid gland (e.g., hyperparathyroidism), disorders of the adrenalgland (e.g., hypercortisolism), disorders of the pituitary gland (e.g., hyperpituitarism,SIADH), or disorders of the pancreas (e.g., hyperglycemia).

Hormones are chemical substances, secreted by the endocrine glands, which initiate or regulate func-tioning of a target organ by binding to a receptor site located on the surface of the target organ. Theyare regulated by a negative or positive feedback system in which decreased or increased hormonelevels signal the release of hormones to maintain homeostasis of the body’s internal environment.Imbalance of hormones can result in endocrine disorders, leading to manifestations such as:

■ Weight loss (associated with varying disorders, including increased thyroid hormoneswhich cause increased metabolism of carbohydrates, proteins, and lipids � resulting incaloric and nutritional deficiencies)

■ Blurred vision (for example, a lack of insulin production by the beta cells of the islets ofLangerhans of the pancreas � causes osmotic effects in the eye tissue � resulting inswelling of the lenses of the eyes)

■ Increased urination (common to several endocrine disorders, including a deficit ofantidiuretic hormones � which results in the excretion of large amounts of urine �resulting in dehydration).

Priority nursing diagnoses within the Nutritional-Metabolic Pattern that may be appropriate forclients with endocrine disorders include:

■ Imbalanced Nutrition: Less than Body Requirements as evidenced by increased foodintake with weight loss

■ Deficient Fluid Volume as evidenced by dry mucous membranes, thirst, and decreasedurine output

■ Hyperthermia as evidenced by body temperatures ranging from 102°F (39°C) to 106°F(41°C)

■ Impaired Skin Integrity as evidenced by dry, rough, reddened, and edematous skin.

Two nursing diagnoses from other functional health patterns often are of high priority for theclient with endocrine disorders because the physiologic responses to these problems interferewith proper metabolism:

■ Disturbed Body Image (Self-Perception-Self-Concept)■ Ineffective Therapeutic Regimen Management (Health Perception, Health Management)

lem13086_ch20.qxd 12/29/06 3:30 PM Page 600