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  1. 1. NURSING MANAGEMENT OF PATIENT WITH ENDOCRINE DISORDER Preparedby: IntanBaiduri Badri 18September2018 HealthCampus,KubangKerian
  2. 2. INTRODUCTION • Effects almost every cell, organ, and function of the body • The endocrine system is closely linked with the nervous system and the immune system • The nervous system and the interconnected network of glands known as the endocrine system control body systems. • Endocrine disorders are the consequences of hypo function and hyper function of each endocrine gland.
  3. 3. ENDOCRINE • Made up of gland in many tissues and organs in difference body areas • Main features of all endocrine gland is the secretion of hormones • Responses to stress injury • Growth and development • Energy metabolism • Reproduction • electrolyte, acid base balance
  5. 5. HORMONES • Secreted by endocrines glands • Endocrine glands are composed of secretory cells arranged in minutes cluster known as acini • Glands are ductless with rich with blood supply, so hormones they produce enter the bloodstream rapidly
  6. 6. HORMONES • Hormone concentration in bloodstream is maintained at a relatively constant level • When the hormone concentration increase, further production of that hormones is inhibited • Are natural chemical substances that initiate or regulate activity and exert their effect on specific tissues known as Target Tissues
  7. 7. TARGET TISSUES • Are usually located some distance from the endocrine gland with no direct physical connection between the endocrine gland and its target tissue • The endocrine gland are called “ductless” gland and must be used the blood to transport secreted hormones to the target tissue.
  8. 8. NEGATIVE FEEDBACK • The level of hormone in the blood is regulated by the homeostasis called Negative Feedback. • Ex : control of insulin secretion • Increase level of blood glucose, the hormone insulin is secreted thus increase glucose uptake by the cells- > causing a decrease in blood glucose
  9. 9. CLASIFFICATION OF HORMONES • Steroid hormones : hydrocortisone • Peptide or protein hormones : insulin • Amine Hormone : epinephrine • Fatty acid derivatives : retinoids
  10. 10. HYPOTHALAMUS • Located between the cerebrum and brainstem • Houses the pituitary gland and hypothalamus • Regulates: – Temperature – Fluid volume – Growth – Pain and pleasure response – Hunger and thirst
  11. 11. HYPOTHALAMUS HORMONES • Releasing and inhibiting hormones • Corticotropin-releasing hormone • Thyrotropin-releasing hormone • Growth hormone (GH)-releasing hormone • Gonadotropin-releasing hormone • Somatostatin-=-inhibits GH and TSH
  12. 12. PITUITARY GLAND • Located beneath the hypothalamus • Also known as the “master gland” • Divided into: – Anterior Pituitary Gland – Posterior Pituitary Gland
  13. 13. ANTERRIOR PITUITARY 1. Thyroid stimulating hormone (TSH) – Stimulates thyroid growth and secretion of the thyroid hormone 2. Andrenocorthropic hormone (ACTH) – Stimulates adrenal cortex growth and secretion of glucocorticoids 3. Growth hormone (GH) – stimulate growth 4. Prolactin / Lactogen – Stimulate breast development during pregnancy and milk secretion after delivery
  14. 14. ANTERRIOR PITUITARY 5. Follicle stimulating hormone (FSH) – Stimulates ovarian follicles to mature and produce oestrogens; in the male stimulates sperm production 6. Luteinizing hormone (LH) – Acts with FSH to stimulate estrogen production; causes ovulation; stimulates progesterone production by corpus luteum; in male stimulate testes to produce testosterone 7. Melanocytes stimulating hormone – Synthesis and spread of melanin in the skin
  15. 15. POSTERIOR PITUITARY • ADH antidiuretic hormone – Stimulate water retention by kidneys to decrease urine secretion • Oxytocin – Stimulate uterine contraction, causes breast to release milk into ducts
  17. 17. ADRENAL GLANDS 17 • Pyramid-shaped organs that located on top of the kidneys • Each has two parts: – Outer Cortex – Inner Medulla
  18. 18. ADRENAL CORTEX 18 • Mineralocorticoid – Regulates electrolyte and fluid homeostasis – Aldosterone.- affects sodium absorption, loss of potassium by kidney • Glucocorticoids—cortisol & hydrocortisone – Affects metabolism, regulates blood sugar levels, – Affects growth, anti-inflammatory action, – Decreases effects of stress • Adrenal androgens (sex hormone) – Stimulates sexual drive in females; in male negligible effect
  19. 19. ADRENAL MEDULLA 19 • Secretion of two hormones – Epinephrine : Prolongs and intensifies sympathetic nervous response to stress – Norepinephrine : Prolongs and intensifies sympathetic nervous response to stress • Serve as neurotransmitters for sympathetic system • Involved with the stress response
  20. 20. THYROID 20 • Follicular cells—excretion of triiodothyronine (T3) and thyroxine (T4) - Increase Basal Metabolic Rate (BMR), increase bone and protien turnover, increase response to catecholamines, need for infant for growth & develop • Thyroid C cells—calcitonin. Lowers blood calcium and phosphate levels
  21. 21. THYROID GLAND 21 • Butterfly shaped • Located on either side of the trachea • Has two lobes connected with an isthmus • Functions in the presence of iodine • Stimulates the secretion of three hormones • Involved with metabolic rate management and serum calcium levels
  22. 22. THYROID GLAND 22
  23. 23. THYROID HORMONE • Thyroxine T4 & Triiodothyronine T3 – Increase metabolic rate • Calcitonin – Decrease blood calcium concentration
  25. 25. PARATHYROID GLANDS 25 • Embedded within the posterior lobes of the thyroid gland • Secretion of one hormone • Maintenance of serum calcium levels • Parathyroid hormone—regulates serum calcium (blood calcium concentration)
  26. 26. PANCREAS 26 • Located behind the stomach between the spleen and duodenum – it influence carbohydrate metabolism; indirectly influence fat and protein metabolism; produces insulin and glucagon * Glucagon – raises blood glucose * Insulin – lower blood glucose • Has two major functions – Digestive enzymes – Releases two hormones: insulin and glucagon
  27. 27. KIDNEY 27 • 1, 25 dihydroxyvitamin D—stimulates calcium absorption from the intestine • Renin—activates the Renin-Angiotensin System (RAS) • Erythropoietin—Increases red blood cell production
  28. 28. OVARIES 28 • Estrogen • Progesterone—important in menstrual cycle, maintains pregnancy,
  29. 29. TESTES 29 • Androgens, testosterone —secondary sexual characteristics, sperm production
  30. 30. THYMUS 30 • Releases thymosin and thymopoietin • Affects maturation of T lymphocetes
  31. 31. PINEAL 31 • Melatonin • Affects sleep, fertility and aging
  32. 32. CLINICAL MANIFESTATION • Widespread effects on the body and wide variety of signs and symptoms • Changes in energy level & fatigue • Tolerance of heat and cold as well as recent changes in weight • Changes in sexual function and secondary sex characteristic • Changes in mood, memory, and ability to concentrate and altered sleep patterns
  33. 33. PHYSISCAL ASESSMENT • General appearance – Vital signs, height, weight • Integumentary – Skin color, temperature, texture, moisture – Bruising, lesions, wound healing – Hair and nail texture, hair growth • Physical appearance – Buffalo bump, thinning of skin, increased size of the feet and hands
  34. 34. PHYSICAL ASSESSMENT 34 • Face – Shape, symmetry – Eyes, visual acuity • Eye changes – exophthalmos – Neck
  35. 35. Palpating the thyroid gland from behind the client. (Source: Lester V. Bergman/Corbis) 35
  36. 36. PHYSICAL ASSESSMENT 36 • Extremities – Hand and feet size – Trunk – Muscle strength, deep tendon reflexes – Sensation to hot and cold, vibration – Extremity edema • Thorax – Lung and heart sounds
  37. 37. OLDER & ENDOCRINE FUNCTION 37 • Relationship unclear • Aging causes fibrosis of thyroid gland • Reduces metabolic rate • Contributes to weight gain • Cortisol level unchanged in aging
  38. 38. ABNORMAL FINDINGS • Ask the client: – Energy level – Fatigue – Maintenance of ADL – Sensitivity to heat or cold – Weight level – Bowel habits – Level of appetite – Urination, thirst, salt craving 38
  39. 39. ABNORMAL FINDINGS (CONT) • Ask the client: – Cardiovascular status: blood pressure, heart rate, palpitations, SOB – Vision: changes, tearing, eye edema – Neurologic: numbness/tingling lips or extremities, nervousness, hand tremors, mood changes, memory changes, sleep patterns – Integumentary: hair changes, skin changes, nails, bruising, wound healing 39
  40. 40. LABAROTORY STUDIES • Test of thyroid – To differentiate primary and secondary hypothyroidism • Serum thyroid stimulating hormone – To measure the basal serum thyroid stimulating hormone • Serum thyroxine and triiodothyronine – To measure concentration of thyroxine T$9T3) in the blood • Test of parathyroid function – To measure the concentration of calcium, phosphorus, alkaline, phosphatase, parathyroid hormone and osteocalcin in the blood.
  41. 41. LABAROTORY STUDIES • Test of adrenal function – To measure concentration of adrenocortical hormones and adrenal medullary hormones through urine and blood specimen • Aldosterone level – Aids in the diagnosis of hyperaldosteronism • Urine catecholamines – To assess function of the adrenal medulla • Test of thyroid structure & function – To assess the size, shape, position and fucntion of the thryroid through ulstrasound, MRI, CT scan, & radionuclide imaging
  42. 42. LABAROTORY STUDIES • Radioactive iodine uptake – To measure the amount of radioactive iodine in the thyroid 24H after administration of a radioiodine isotope through scintillation scanner • Achilles tendon reflexes – To diagnose thyroid disorders by measuring the amplitude and duration of ankle jerk using an instrument that will help to elicit the reflex
  43. 43. MOST COMMONENDOCRINE DISORDERS • Thyroid abnormalities • Diabetes mellitus 43
  44. 44. HYPERPITUITARISM • Over secretion of hormone due to tumour or hyperplasia > compresses brain tissue . Neurologic sign & symptom (ICP, Visual impairment & headache • Hormone affected : growth hormone & ADH • Resulting to Gigantism if the secretion occurs in childhood, Acromegaly in adult
  45. 45. ACROMEGALY • Pathology:-GH hypersecretion during adulthood • Risk: Pituitary adenoma • Cardinal Signs: large hands and feet; protrusion of lower jaw(Prognathism). Coarse facial feature • Nurse Concern: Psychosocial adjustment to Altered body image; monitor Diabetes Insipidus
  46. 46. DWARFISM • due to hyposecretion of growth hormone • Nursing Intervention: – Assess patient – Monitor height and weight – Assess other neurologic functions – Focus on the family client’s feeling • Medical Management : – Biosynthetic growth hormone -Somatrem
  47. 47. GIGANTISM • Results from excessive secretion of growth hormone • Clinical manifestation: – Height more than 8 feet – Acromegaly • Medical Management: – Radiation therapy – Parlodel – Transphenoidal hypophysectomy
  48. 48. PANHYPOPITUITARISM (SIMMOND’SDISEASE) • complete absence of pituitary secretion resulting to: – Dwarfism – Hypoglycemia – Extreme weight loss – Hair loss – Emaciation – Impotence – hypometabolism – absence of gonadal & adrenal function – Atrophy of all endocrine gland and organs
  49. 49. HYPOPITUITARISM • Result from destruction of the anterior pituitary gland, hypothalamic dysfunction, trauma, tumour, vascular lesion, and complication of radiation therapy to the head and neck area • S&S: – -Extreme weight loss – Emaciation- – Hypoglycaemia – Impotence – Amenorrhea – Hypometabolism
  50. 50. HYPERPROLACTINEMIA • Results from oversecretion of prolactin associated with pituitary tumors • Management and Nursing Management same as hyperpituitarism
  51. 51. PITUITARY TUMOR Types: 1.Eosinophilic - result to gigantism if developed early in life and acromegaly if developed during adult life 2.Basophilic - results to Cushing's syndrome; clinical manifestation: amenorrhea & masculinization in females, truncal obesity, osteoporosis &polycytemia 3.Chromophobic - produces no hormone but destroys the whole pituitary glands resulting to hypopituitarism. S&S: obesity, somnolence, scanty hair, dry, soft skin, loss of libido, headache, blindness, polyphagia, polyuria, and lowered BMR
  52. 52. GONADAL DISORDER • Result from hypothalamic-pituitary dysfunction resulting to hypo secretion of gonadotropins may lead to infertility and hypo-androgenism- • Collaborative Management : – Removal of the underlying cause of pituitary dysfunction
  53. 53. POSTERIOR PITUITARY DISORDERS • Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - resulting from abnormal increase of ADH secretion & excessive water retention leads to include urinary sodium • Etiology: Bronchogenic carcinoma, head injury, tumor, infection, and brain surgery • Cardinal signs: water intoxication, neurologic signs • Medical Mgt: – Diuretics & Demecclocycline (declomycin) – Eliminate underlying cause
  54. 54. DIABETES INSIPIDUS • A condition characterized by a deficiency in antidiuretic hormone resulting to excessive fluid excretion: neurogenic and nephrogenic • Risk: head trauma, irradiation, removal of pituitary gland, renal disease • Manifestation: diluted urine, polydipsia, excessive urination • Diagnostic: vasopressin and H20 deprivation test; serum Na include &Uric Acid • Cardinal signs: Polyuria, Polydipsia
  55. 55. HYPERTHYROIDISM/GRAVES’ DISEASE • Hyperthyroidism is the second most prevalent endocrine disorder, after diabetes mellitus. • Graves' disease: the most common type of hyperthyroidism, results from an excessive output of thyroid hormones. • May appear after an emotional shock, stress, or an infection • Other causes: thyroiditis and excessive ingestion of thyroid hormone • Affects women 8X more frequently than men (appears between second and fourth decade)
  56. 56. THYROIDITIS • Inflammation of the thyroid gland. • Can be acute, subacute, or chronic (Hashimoto's Disease) • Each type of thyroiditis is characterized by inflammation, fibrosis, or lymphocytic infiltration of the thyroid gland. • Characterized by autoimmune damage to the thyroid. • May cause thyrotoxicosis, hypothyroidism, or both
  57. 57. • Can be being benign or malignant. • If the enlargement is sufficient to cause a visible swelling in the neck, referred to as a goiter. • Some goiters are accompanied by hyperthyroidism, in which case they are described as toxic; others are associated with a euthyroid state and are called nontoxic goiters. 58 THYROID TUMORS
  58. 58. THYROID CANCER • Much less prevalent than other forms of cancer; however, it accounts for 90% of endocrine malignancies. • Diagnosis: thyroid hormone, biopsy • Management – The treatment of choice surgical removal. Total or near-total thyroidectomy is performed if possible. Modified neck dissection or more extensive radical neck dissection is performed if there is lymph node involvement. – After surgery, radioactive iodine. – Thyroid hormone supplement to replace the hormone. 59
  60. 60. PANCREAS • Lies horizontally behind the stomach at the level of the 1st and 2nd lumbar vertebrae • The head attached to the duodenum, tail reaching to the spleen • With exocrine and endocrine function • Produced two Importance hormones: 1. Insulin: beta cells of islets of Lagerhans - Decrease glucose levels: - transcellular membrane transport of glucose; - inhibits/breakdown of fats and protein; - requires sodium for transport protein - requires potassium for production
  61. 61. GLUCAGON • Alpha cells of Islets of Lagerhans • Stimulates release of glucose by the liver • Increases glucose levels(gluconeogenesis)
  62. 62. DIABETES MELLITUS • A chronic systemic disease • Classifications: 1.Type 1: IDDM; Juvenile onset; Brittle; labile 2.Type 2: NIDDM; Adult onset 3.Other Specific Types: beta cell genetic defect; endocrinopathies, drug/chemical induced 4.Gestational Diabetes mellitus
  63. 63. HYPOGLYCEMIA • Pathology: blood glucose levels<60mg/100ml • SIGNS & SYMPTOMS: – Tachycardia, headache, weakness, irritability – Lack of muscular coordination – Night hypoglycemia, Bizarre nightmares, restlessness, diaphoresis – Sleeplessness, confusion