ENDOCRINE ASSESSMENT.pptx

ENDOCRINE ASSESSMENT
BY: ROMMEL LUIS C. ISRAEL III
BY: ROMMEL LUIS C. ISRAEL III 1

Purpose
Provide an overview of basic
endocrine assessment including
normal and abnormal findings.
2

Objectives
3

Review of
Endocrine
Glands,
Hormones
&Symptomology

Review of
Endocrine
Glands,
Hormones
&Symptomology
BY:
ROMMEL
LUIS
C.
ISRAEL
III
6

Assessing Common Endocrine
Abnormalities
When conducting assessment on your patient, begin with a thorough history of their
chief complaints.
You will need to elicit information about any experienced signs or symptoms of
endocrine disease or disorders.
Endocrine disorders and diseases usually manifest according to which endocrine
hormone is being overproduced and secreted, or under-produced, at any given age.
The key to discovering the nature of the symptoms lies in your understanding of the
functions of the endocrine hormone

The Problem-Focused Endocrine
Assessment
● Endocrine assessment is necessary after a comprehensive assessment indicates a
potential endocrine abnormality.
●This assessment may also be necessary when an interval or abbreviated assessment
shows a change in status from your last assessment or report you received.
●When a new symptom emerges or the patient develops any distress, consider a
focused endocrine assessment.
●The advantage of this assessment is that it allows you to ask about symptoms and
move quickly to conducting a focused physical exam

Subjective and Objective data
Chief Complaint
• Present health status
• Past health history
• Current lifestyle
• Psychological status
• Family history
• Physical assessment

Communication during the history and physical must be respectful
and performed in a culturally-sensitive manner. Privacy is vital.
Take into consideration that a patient’s ethnicity and culture may
affect the history that the patient provides.

OBJECTIVE DATA

PHYSICAL EXAM TECHNIQUES
BY:
ROMMEL
LUIS
C.
ISRAEL
III
13
INSPECTION AUSCULTATION PERCUSSION PALPATION

During inspection, you are looking for conditions you can
observe with your eyes, ears or nose.
Generalized appearance
• Skin color
• Location of lesions
• Bruises or rashes
• Symmetry
• Size of body parts
• Abnormal sounds or odors

Auscultation is used in your focused
endocrine assessment before percussion
or palpation.
•Murmurs
•Cardiac irregularities
• Adventitious breath sounds
• Alterations in bowel sounds

•During light palpation, compress the skin
about ½ inch to 3/4 inch with the pads of
your fingers.
• When using deep palpation, use your
finger pads and compress the skin about 1½
inches to 2 inches
•Palpation allows you to assess for texture,
tenderness, temperature, moisture,
pulsations, masses, and internal organ

Percussion allow you to elicit tenderness or sounds that point to
underlying problems
● When percussing directly over suspected areas of tenderness,
monitor the patient for signs of discomfort.
● Examples of endocrine abnormalities you may percuss are an
enlarged pancreas, a pleural effusion associated with specific
endocrine abnormalities, or a hormone-secreting tumor.

SUBJECTIVE DATA

BY:
ROMMEL
LUIS
C.
ISRAEL
III
19
Fatigue or lethargy Weight gain or loss Dizziness
Feelings of
depression,
irritability,
oranxiety
Pain Decreased libido
Nausea and
vomiting
Changes in urinary
or bowel habits
Changes in vision
Intolerance to heat
or cold
Change in appetite

PITUITARY
DISORDERS

•The endocrine system is comprised of a
number of different glands, each linked
in a unique manner to
the hypothalamus.
• The pituitary gland, also known as the
hypophysis
• Is a pea-sized gland located at the base
of the brain

Two Glands
The anterior pituitary produces growth hormone
(GR), thyroid stimulating hormone (TSH), and
adrenocorticotropin (ACTH) hormone.
The posterior pituitary produces anti diuretic
hormone (ADH), also known as vasopressin

Syndrome of inappropriate
anti diuretic hormone
secretion (SIADH)

Occurs with above
normal ADH release,
which causes impaired
water excretion.
Possible causes
include: a)ADH
secreting tumor,
b)Chemotherapy , c)
Oat cell carcinoma

Watch this
Video:
https://youtu.
be/0NHT8ER
UBo0?feature
=shared
BY:
ROMMEL
LUIS
C.
ISRAEL
III
25

SUBJECTIVE ASSESSMENT OBJECTIVE ASSESSMENT
Anorexia Weight Gain
Nausea Vomiting
Headache Muscle Weakness
Fatigue Muscle Spasms or Cramps
Irritability Hallucinations
Decrease Level of Consciousness (LOC)
Confusion
Low Serum Sodium
Low Serum Osmolarity
High Urine Osmolarity
Normal Sodium Urine Excretion
Low Edema
Possible Coma

Therapeutic
Interventions
•Fluid Restrictions
• Hypertonic parenteral Fluids
• Hypertonic solutions, used to help re-
establish equilibrium in electrolyte and acid-
base imbalances, include electrolyte
replacement solutions and parenteral
nutrition solutions

Nursing
Interventions
• Monitor Vital signs, Intake and Output and Daily weight
• Monitor Fluid and electrolyte status
• Restrict fluid intake: administer hypertonic intravenous
solution as ordered
• Institute seizure precautions and protect from injury
• Diuretics may be given as ordered if along with fluid
restriction if severe hyponatremia is present
• Close monitoring of urine and blood chemistries and
neurologic status

Diabetes Insipidus (DI)
29
BY:
ROMMEL
LUIS
C.
ISRAEL
III

Watch this
Video:
https://youtu.be
/75JrAx4hBC0?fe
ature=shared

Possible causes
Cerebral
vascular
accident (CVA)
Hypothalamic-
pituitary
tumors
Cranial trauma
or surgeries
Hereditary
Drugs (lithium
and phenytoin
[Dilantin])
Alcohol
(transient DI)

Abrupt onset of polydipsia and polyuria Fluid intake 5-20 L/day
Nocturia Urine output of 2-20 L/day of dilute
urine
Sleep disturbances related to nocturia Urine specific gravity < 1.006
Fatigue Changes in LOC
Headache Fever
Visual Disturbances Hypotension
Tachycardia

Pharmacologic Therapy

Desmopressin (
DDAVP)
• use to treat the
disease
• Administered
intranasally, one to
two administration
every 12 to 24
hours
• Decrease in urine
output

Vasopressin
tannate in oil
•Administered
intramuscularly at
night, 24 to 96
hours
•abdominal
cramping is the
side effect

Clofibrate
Hypolipidemic
agent
has
antidiuretic
effect

Thiazide diuretics
• For mild forms of
the disease
• Potentiate the action of
vasopressin
• Rotation of injection sites is
necessary to prevent from
lipodytrophy (Lipodystrophy
is a condition in which the
amount and/or distribution
of adipose tissue (fat
tissue) in the body is
abnormal)

Nursing Management
•Monitor Fluid and Electrolytes status, Intake and
output, daily weight and skin turgor
•Replace fluids
•Monitor response to ADH replacement
• Advise to avoid alcohol (Alcohol- suppress ADH
secretion)
•Vasopressin: Watch for acute coronary disease
because it can cause vasoconstriction

Hypopituitarism

•Hypopituitarism is the deficiency of one or
more anterior pituitary hormones
•Total absence of pituitary hormones(
Panhypopituitarism)- Simmond’s disease
•Occurs when there is a destruction of the
anterior lobe of the gland by trauma, tumor
or hemorrhage
•Clinical findings vary with target organs
affected

Watch this
Video:
https://youtu.b
e/hbIsel20bHM
?feature=share
d
BY:
ROMMEL
LUIS
C.
ISRAEL
III
42

CLINICAL FINDINGS
Lethargy Decreased Temperature
Loss of strength and Libido Postural Hypotension
Decreased levels in GH, ACTH, TSH, FSH and LH
Hypoglycemia

•Hyperpituitarism results from overactivity of
the gland or adenoma
•Caused by excessive secretion
concentration of pituitary hormone
(GH, ACTH, Prolactin) in the blood
•Overactivity
•Changes in the anterior lobe of the pituitary
gland
•GH overproduction: Gigantism, acromegaly

Watch this
Video:
https://youtu.b
e/OQQjsorl_sA
?feature=share
d
BY:
ROMMEL
LUIS
C.
ISRAEL
III
46

CLINICAL FINDINGS
Headache Increased soft tissue and
bone thickness
Depression Change in facial features
Weakness Enlarge hand and feet
Increased in GH, ACTH and Prolacti
Amenorrhea
Increased in Intracranial pressure
Diabetes and hyperthyroidism may
occur

An adenoma is a benign tumor of
epithelial tissue with glandular origin,
glandular characteristics, or both.
Adenomas can grow from many
glandular organs, including the
adrenal glands, pituitary gland,
thyroid, prostate, and others.

Watch this Video:
https://youtu.be/4uM39kImUxc?feature=shared

Acromegaly is a disorder
marked by progressive
enlargement of the head,
face, hands, feet, and chest
due to excessive secretion of
growth hormone by the
anterior lobe of the pituitary
gland. BY: ROMMEL LUIS C. ISRAEL III 50

Watch this Video: https://youtu.be/rHTzuWKAH-
k?feature=shared

Gigantism is a
generalized increase in
size, especially in
children involving the
long bones

Watch this Video:
https://youtu.be/Ze5ag7DdNpw?feature=shared

Therapeutic Interventions
Replace hormones
Intervene surgically if tumor is present
Medications: sandostatin, dopamine agonist bromocriptine (Parlodel) and other medications that
can relieve clinical findings of other endocrine imbalances resulting from pituitary hyperfunctioning
Surgical Interventions: Hypophesectomy-irradiation of the pituitary
A hypophysectomy is a brain surgery to remove all or part of the pituitary gland

Nursing
managemen
t
• Monitor effects of hormone
replacement therapy
• Discuss the importance of
adhering to medical regimen
to a long-term basis
• Provide rest period
• Encourage to express
feelings
• Help understand the change
in sexual functioning
55

Care after hypohesectomy
Let your patient know that a decreased sense of smell is expected
for about the first month after the procedure,
do not brush teeth but use dental floss
need lifelong hormone replacement therapy

After a hypophysectomy
procedure, the patient’s nose will
drain. It’s important to monitor
that drainage for signs and
symptoms of a cerebrospinal fluid
(CSF) leak.

•One sign of CSF leak is a halo sign
in the drainage. This means there is
clear or bloody fluid in the center of
the drainage, but a yellow ring
outside that drainage. If you see
this halo sign, it can mean the
patient has a CSF leak.

Another sign of CSF leak is if the patient
complains of a headache and also
indicates that their drainage tastes sweet.
If you test the drainage and it’s positive
for glucose, that is another sign of CSF
leak and will need to be further
investigated

THYROID DISORDERS

The Thyroid gland lies in the anterior portion of the neck and
straddles the trachea.
It secretes two hormones that play a major role in the body’s
metabolism: a) Thyroxine (T4) and b) Triiodothyronine (T3)
Absence of these hormones may decrease the body’s basal
metabolic rate by 60% and
an excess of these hormones may increase the body’s basal
metabolic rate by 100%

Hypothyroidis
m - Chronic
deficiency of
T4& T3
Possible causes include:
• Thyroid gland dysfunction
• Inadequate release of TRH or TSH from the
hypothalamic-pituitary
axis (hypophysectomy or pituitary radiation)
• Surgical removal or radio-iodine ablation
with hyperthyroidism
• Hashimoto's thyroiditis (chronic
inflammation of the thyroid)
TRH - Thyrotropin-releasing hormone
TSH - thyroid-stimulating hormone.

Watch this Video:
https://youtu.be/wyanDtvx8K0?feature=shared

SUBJECTIVE ASSESSMENTNNN OBJECTIVE ASSESSMENT
Diminished hearing Bradycardia
Cold intolerance Decreased LOC
Fatigue Hypothermia
Lethargy Hypoventilation
Complaints of constipation Hypoactive bowel sounds
Weight gain
Elevated TSH
Decreased T3, T4, free T4
Elevated CK-MB
Increased pCO2
Decreased P02, Ph
Hypoglycemia

triiodothyronine (T3)
Tyroxine-T4
Creatine kinase-MB (CK-MB)
Hypoventilation - The state in which are duced amount of air enters the alveoli in the lungs
Reduced (hypoactive) bowel sounds include a reduction in the loudness, tone, or regularity of the
sounds.

Nursing
Interventions
• Assess and monitor vital signs; watch for bradycardia, and decreased
respirations
• Encourage self-care; schedule activities for times when the patient has
the most energy
• Administer Medication: Levothyroxine
• Monitor food intake and appetite; encourage healthy food choices, avoid
comfort foods
• Assess skin integrity; dry skin and brittle hair; apply moisturizers
and encourage adequate hydration
• Provide a comfortable environment and limit exposure to cold
• Monitor weight regularly

The decreased thyroid hormone levels slow all the body processes, including
respiration and cardiac output
Fatigue is one of the biggest complaints among patients with
hypothyroidism. Encourage patients to engage in self-care and activities
during the period of high erenergy and allow for rest periods as needed.
BY: ROMMEL LUIS C. ISRAEL III . 67

Give medication in the morning on an empty stomach approximately 1
hour before meal for most effective treatment.
Patients often have a decreased appetite but continue to gain weight.
Take note of a patient’s eating habits and provide nutrition
recommendations

•- As the metabolism slows, skin
and hair begin to dry out and become
thin and brittle. Encourage
moisturizers applied to the skin after
bathing and conditioner for
hair. Note: any excoriations or
wounds as healing may also be
impaired. BY: ROMMEL LUIS C. ISRAEL III 69

Patients are more sensitive to colder temperatures
and often complain of being cold, even in hot
weather. Provide blankets as needed.
Patients tend to gain weight but should begin to
lose weight as the medication takes effect

Myxedema Coma - Acute deficiency of
T4& T3
•Insufficient thyroid hormone or
supplementation, together with an acute
stressor, can lead to a myxedema coma, or
acute deficiency of T4 and T3.
stressor, can lead to a myxedema coma, oracute deficiency or T4 and
T3. 71

Watch this Video:
https://youtu.be/JSt9jgmpsQo?feature=shared

Insufficient thyroid supplementation
Increased stressors in patients with
hypothyroidism (e.g. trauma, cold, anesthesia,
infection)

Diminished hearing Anasarca
Cold intolerance Horseness
Complaints of constipation Pericardial & pleural effusions
Fatigue Diminished hearing
Lethargy Paralytic ileus
Unresponsiveness
Decreased breathing
Hypotension
Hypoglycemia
Hypothermia
Objective assessment findings are similar to signs & symptoms of hypothyroidism
but even more pronounced

Anasarca
- An accumulation of serous fluid in various tissues and cavities of
the body.
Paralytic ileus
- is the occurrence of intestinal blockage in the absence of an actual
physical obstruction

Nursing Interventions
Monitor vital signs, including heart rate and rhythm.
Administer thyroid replacement, levothyroxine sodium (Synthroid) is most commonly prescribed.
Instruct the client about thyroid replacement therapy.
Instruct the client in low-calorie, low-cholesterol, low-saturated-fate diet.
Assess the client for constipation; provide roughage and fluids to prevent constipation

• Provide a warm environment for the client.
• Avoid sedatives and narcotics because of increase sensitivity
to these medications.
• Monitor for overdose of thyroid medications, characterized by
tachycardia, restlessness, nervousness, and insomnia.
• Instruct the client to report episodes of chest pain immediately

Hyperthyroidis
m
Hyperthyroidism is
a chronic increase in
T4and T3 levels.

Watch this Video:
https://youtu.be/Urwbo61a6Po?feature=shared

• Adenoma
• Thyroiditis
• Over treatment of hypothyroidism
• Discontinuation of thyroid supplements
• Stress
• Iodine load with pre-existing hyperthyroid state
• Pituitary tumor

Irritability Tachycardia
Restlessness Atrial arrhythmias
Heat intolerance Premature atrial contractions (PACs)
Complaints of diarrhea Premature ventricular contractions
(PVCs)
Complaints of diarrhea Dyspnea
Palpitations
Weight loss
Hyperthermia
Elevated T4 and T3

OBJECTIVE ASSESSMENT
Decreased TSH
Increased TSH if from a TSH secreting
tumor (in pituitary)
Positive test for thyroid antibodies(Grave's
Disease)
Hyperglycemia
Diaphoresis

Nursing
Interventio
ns
Provide adequate rest.
Administer sedatives as
prescribed.
Provide a cool and quiet
environment.
Obtain weight daily.
Provide a high-calorie
diet.
Avoid the administration
of stimulants.
Administer antithyroid
medications(propylthiour
acil [PTU]) that block
thyroid synthesis, as
prescribed

Nursing
Intervention
s
• Administer iodine preparations that
inhibit the release of thyroid hormone as
prescribed.
• Administer propranolol (Inderal) for
tachycardia as prescribed.
• Prepare the client for radioactive iodine
therapy, as prescribed, to destroy thyroid
cells.
• Prepare the client for thyroidectomy if
prescribed
84

Thyrotoxicosi
s or Thyroid
Storm
An acute increase in T4 and T3 can
cause thyrotoxicosis or an acute
thyroid storm.
The possible cause
is Decompensating of a pre-existing
hyperthyroid state after stressor
(e.g. surgery, anesthesia, infection,
trauma)

Watch this Video: https://youtu.be/-
naOgnjJlz0?feature=shared

Restlessness Tachycardia
Agitation Diaphoresis
Changes in LOC Fever
Diarrhea
Confusion
Signs and symptoms
associated with CHF and
pulmonary edema

Nursing
Manageme
nt
Observe patients carefully and
provide aggressive and supportive
nursing care during and after the
acute stage of illness
Care provided for the patient with
hyperthyroidism is the basis for
management of patients with
thyroid storm

Thyroiditis
Inflammation, abrosis
or lymphocytic
infiltration of the
thyroid gland-cause
by staphylococcus
aureus

• Chronic ( Hashimoto ) -
Occurs most in women (30-
50 years old)- Most
common cause of
hypothyroidism in adults-
autoimmune thyroiditis- Not
accompanied by pain,
pressure symptoms, fever
and thyroid activity are
usually normal or low-
If untreated-hypothyroidism
• autoimmune thyroiditis -
the immune system the
thyroid gland
• Acute- Can occur in
postpartum period-
autoimmune reaction

WATCH THIS VIDEO:
https://youtu.be/jJ5Ukmcr4bc?feature=shared

WATCH THIS VIDEO:
https://youtu.be/dr2cO46WTMI?feature=shared

Clinical Manifestations
• Anterior neck pain and swelling, fever dysphagia, dysphonia
• Pharyngitis or pharyngeal pain
• Warmth, erythema and tenderness of the thyroid gland
• Multiple nodules, mild tenderness, diffuse goiter with irregular
surface, rubbery or firm, tender pyramidal lobe, hard fibrous variant
• Fatigue, sluggish, pale skin, constipation and increased sensitivity to
col
Dysphonia - refers to having an abnormalvoice. It is also known as
hoarseness.

Medical Management
Antimicrobial agents and
fluid replacement
Surgical incision and drainage
if abscess is present
Thyroid hormone therapy
Surgery is performed when
pressure symptom persist

Thyroid hormone therapy - to reduce
the size of the thyroid gland and prevent
hypothyroidism and if hypothyroid
symptom is present

The adrenal glands are two organs located at the top of each
kidney, which are responsible for the secretion of:
• Mineralocorticoids
• Glucocorticoids
• Corticosteroids:
- Epinephrine and Norepinephrine. Aldosterone accounts for
95%
of all mineralocorticoids produced and is secreted by the
adrenal
cortex.
- Cortisol is the primary glucocorticoid secreted by the adrenal
cortex.
- Epinephrine and norepinephrine are hormones secreted
from
the adrenal medulla

• Addison's
disease is the
chronic deficiency
or secretion of
cortisol from
the adrenal
cortex. Aldosteron
e is usually
unaffected

WATCH THIS VIDEO:
https://youtu.be/V6XcBp8EV7Q?feature=shared

•Secondary
adrenal
insufficiency is
the chronic
deficiency of
ACTH from the
anterior pituitary,
which stimulates
cortisol release
from the adrenal
cortex.

WATCH THIS VIDEO:
https://youtu.be/W6RLUeOjUrw?feature=shared

Possible causes of adrenal
insufficiency include:
• Autoimmune destruction of the adrenal gland
• Adrenal destruction from surgery, trauma, sepsis,
infection, tuberculosis, hemorrhage, or bilateral
adrenelectomy
• Suppression of gland related to medications
• Pituitary hypofunction (surgery, trauma, ischemia)

Did you Know?
The most common reason for ACTH suppression is the use of glucocorticoid medications.
These include cortisone, hydrocortisone, prednisone, prednisolone, and dexamethasone.
Other medications which can suppress the anterior pituitary include ketoconazole(Nizoral), rifampin (Rifadin),
and phenytoin (Dilantin)
(National Adrenal Diseases)

Nausea Hyperpigmentation (only in primary adrenal
insufficiency)
Abdominal Pain Orthostatic hypotension
Fatigue Decreased cardiac size and output
Malaise Weak & irregular pulse
Weakness X-rays may show adrenal calcification(only in
primary adrenal insufficiency)
Decreased cortisol levels
Elevated plasma ACTH levels (in primary
adrenal insufficiency due to disorder of the
adrenal gland)
Decreased plasma ACTH (when dysfunction is
a result of the hypothalamic-pituitary axis)
Other endocrine abnormalities (in
secondary adrenal insufficiency due to
pituitary abnormality)

Hyperpigmentation - is a
condition that causes skin
to darken-excess
production of melanin
Orthostatic hypotension -
is a sudden drop in blood
pressure when you stand
from a seated or prone
(lying down) position

• Assess the patient
• Monitor and mange
addisonian crisis
• Restore fluid
balance
• Improve activity
intolerance
• Promote home,
community-based
and transitional
care

Adrenal crisis - is
an acute decrease
in aldosterone and
cortisol from the
adrenal cortex or an
acute deficiency of
ACTH from the
anterior pituitary
which stimulates
cortisol release
from the adrenal
cortex.

WATCH THIS VIDEO:
https://youtu.be/v3BsSishg0g?feature=shared

Decompensation
in a patient with
chronic adrenal
insufficiency
Abrupt cessation
of chronic steroid
administration

Nausea Hypoglycemia
Abdominal Pain Hyponatremia
Fatigue Hypovolemia
Malaise Hypotension
Weakness Tachycardia

OBJECTIVE ASSESSMENT
Hyperkalemia
Hypercalcemia
Vomiting
Decreased cortisol levels
Increased BUN
Elevated plasma ACTH levels
Metabolic acidosis (in primary adrenalinsufficiency due to
disorder of the adrenalgland)
Decreased plasma ACTH (whendysfunction is a result of
thehypothalamic-pituitary axis)
X-Rays may show adrenal calcification

• Providing and monitoring response to fluid and cortisol
replacement therapies
• Providing a safe environment
• Evaluating and maintaining nutritional needs
• Preventing complications of immobility
• Supporting the patient and family in crisis
• Beginning the educational process to avoid future adrenal crisis
situations.

•Cushing's
Syndrome - is
the over-
production or
over-secretion of
cortisol from
the adrenal
cortex

Cushing’s Disease
•Cushing's disease - is the over-
production or secretion of ACTH from
the anterior pituitary, which stimulates
cortisol release from the adrenal cortex

WATCH THIS VIDEO:
https://youtu.be/YPMA_0wjVag?feature=shared

Cortisol secreting tumor (20% of cases),such as oat cell
carcinoma of the lung with destruction of the adrenal gland
Adrenal carcinoma
Pituitary cortisol-secreting adrenal tumor(usually benign)

Weakness Pathologic Structures
Increase Appetite Purple Striae
Irritability Facial Edema
Emotional Ability Acne
Headache Buffalo Hump
Complaints of Easy bruising Poor Wound Healing
Reports symptoms associated
withdecreased stress and
immunologicresponse
Peptic Ulcer
Hypertension
Left Ventricular Hypertrophy

Decrease risk
for injury
Decrease risk
for infection
Preparing
Patient for
surgery
Encouraging
Rest and
activity
Promote Skin
Integrity
Improve body
image
Improve
coping
Monitor and
manage
complications
Educate about
self care

• Pheochromocyto
ma - is an
adrenal neoplasm
resulted by the
increase
epinephrine and
norepinephrine from
the adrenal medulla.
The possible cause
of this disorder is
a tumor of the
adrenal medulla

Watch This Video:
https://youtu.be/xrrSdRkU1cg?feature=shared

Headache Hypertension
Palpitation Hyperglycemia
Dizziness Dyslipidemia
Complaints of
Constipation
Irregular Heart Rate
Anxiety Diaphoresis
Syncope

Syncope - is a temporary loss of consciousness usually related
to insufficient blood flow to the brain.
Dyslipidemia - is an abnormal amount of lipids(e.g.
triglycerides, cholesterol and/or fat phospholipids) in the
blood.
Diaphoresis - sweating, especially to an unusual degree as a
symptom of disease or aside effect of a drug.

Nursing
Interventions
• Monitor vital signs, especially blood pressure
changes
• Administer antihypertensive medications as
ordered
• Promote rest and decrease stressful stimuli
• Monitor urine tests for glucose and acetone
• For clients on 24-hour VMA testing

Nursing
Interventions
• Provide high-calorie, well-balanced diet
• Instruct patient to avoid smoking and stimulants
like coffee and tea
• For clients with an adrenalectomy, observe for
BP changes
• Provide client teaching on possibility of lifelong
steroid replacement (for bilateral
adrenalectomy)

- severe hypertension can precipitate a cerebrovascular accident and/or sudden blindness
- acute attacks may be precipitated by emotional stress, physical exertion, and change in position
- clients with pheochromocytoma may present with manifestations of diabetes mellitus
-> instruct to avoid vigorous and prolonged exercise and intake of coffee, tea, chocolate, bananas, and vanilla-
flavored food at least two days prior to and during urine collection(note: clinicians may also order client to stop
taking medications like methyldopa, L-Dopa, paracetamol at least three days prior to urine collection as well)

- may influence catecholamine release
- clients are at risk for shock due to a drastic drop in
catecholamine.
The most common reason that a patient may need to have the
adrenal gland removed isexcess hormone production by a tumor
located within the adrenal

• Also known as Conn’s
syndrome
• Primary aldosteronism
is the result of an
increase in production
and secretion of
aldosterone from
adrenal cortex.
The possible cause of
this is from a benign
tumor of the adrenal
gland, which occurs in
people between 30 and
50 years of age

Aldosterone, the hormone responsible for
balancing potassium and sodium in the
body, thus having an effect on blood
pressure

Watch this
Video:
https://youtu.b
e/36xx8JsS0VI?
feature=shared

Headache Hypernatremia
Muscle Weakness Hypovolemia
Fatigue Hypertension
Numbness Hypokalemia
Elevated Plasma
Elevated Urinary Aldosteronism

Nursing Management
•Eat a healthy diet.
• Achieve a healthy weight.
•Exercise
•Don't smoke.

Nursing Management
•Diets that highlight a healthy variety offoods
— including grains, fruits,vegetables and
low-fat dairy products —can help with weight
loss and help lowerblood pressure. Try the
Dietary Approaches to Stop Hypertension
(DASH)diet — it has proven benefits for
yourheart. A healthy diet also limits
sodium,added sugar, saturated fat and
alcohol

Nursing Management
•If your body mass index (BMI) is 25 or more,
losing as little as 3% to 5% of your body
weight may lower your blood pressure

Nursing Management
•Regular aerobic exercise — taking a
moderately paced walk for 30 minutes most
days of the week can improve your health.
Try walking with a friend at lunch instead of
dining out

Nursing Management
•Quitting smoking improves your
overallheart and blood vessel health.
Talk toyour doctor about medications
that canhelp you stop smoking.

The pancreas is an oblong, flattened
gland located deep in the abdomen,
and plays a major role in both the
digestive and endocrine systems.

As an endocrine gland, the pancreas produces several important
hormones, including: 1) Insulin, 2) Glucagon, 3) Somatostatin. ll
three of these hormones play a significant role in carbohydrate, fat,
and protein metabolism.
As a digestive organ, the pancreas secretes pancreatic juice
containing digestive enzymes that assist the absorption of nutrients
and the digestion in the small intestine.

•Diabetes
mellitus (DM) is
the result of the
absolute
decreased
production of
insulin(Type I) or
resistance of
cells to
circulating insulin
(Type II)

Watch this Video: https://youtu.be/-B-
RVybvffU?feature=shared

Type I: genetics, autoimmune
disease, viralinfections
Type II: genetic factors, obesity
Gestational: pregnancy induced

Did You Know?
•The Centers for Disease Control and
Prevention (CDC) estimate that
approximately 27.8% of the population with
diabetes is undiagnosed.

Headache Hyperglycemia
Fatigue Polyuria
Lethargy Polydipsia
Reduced Energy level Polyphagia
Irritability Anorexia
Emotional lability Muscle Cramps
Vision Changes Type I presents usually emergently
Numbness Type II presents insidiously
Tingling

•Lability - refers to something that
is constantly undergoing change or is
likely to undergo change.

Pancreatitis
Pancreatitis - may cause impairment of
insulin production and secretion.
Inflammation of the pancreas occurs
due to edema, hemorrhage, or necrosis.

Watch this Video:
https://youtu.be/HPNJQi_b7NM?feature=shared

Possible Causes include:
Alcoholism Trauma Peptic ulcer disease Biliary tract disease
Pancreatic cysts or
tumors•
Drugs (sulfonomides,
thiazides,
birthcontrol pills,
NSAIDs)
Kidney failure Organ transplantation
Endoscopic exam of
the biliary tree

Anorexia Mottled Skin (skin that has patchy andirregular
colors)
Nausea Tachycardia
Malaise Dehydration
Severe, knife-like mid-epigastric abdominal
pain, which can radiate to the back
Hypovolemia
Hemodynamic instability
Crackles in lung bases
Abdominal Distention
Pleural Effusions
Increased serum amylase, lipase, and glucose

•Hypoglycemia-
(low blood
glucose
levels)may be
caused by
increased insulin
production,
secretion, and/or
administration.

Watch This Video:
https://youtu.be/SRSJILKSx18?feature=shared

Dizziness Pallor
Weakness Cool, clammy skin
Nervousness Diaphopretic
Agitation Polyphagia
Headache Tachycardia
Mental Dullness Palpitation
Confusion
Blurred Vision
Paresthesia
Seizures
Comma
Decreased blood glucose level (<60-80mg/dL)

• Diaphjoretic - heavy sweating
• Polyphagia - excessive or extreme hunger/hyperphagia,
• Paresthesia - is an abnormal sensation of the skin (tingling,
pricking, chilling, burning, numbness) with no apparent physical
cause
• Normal Blood Glucose Level:
The expected values for normal fasting blood glucose
concentration are between 70 mg/dL (3.9 mmol/L) and 100
mg/dL (5.6 mmol/L). When fasting blood glucose is between 100
to 125 mg/dL (5.6 to 6.9 mmol/L)

• Diabetic Ketoacidosis
(DKA) Hyperglycemia (high
blood glucose levels)may
be caused by decreased
insulin administration in
Type I diabetics.
• Diabetic ketoacidosis
(DKA) is a potentially life-
threatening complication
inpatients with diabetes
mellitus.
• DKA results from a
shortage of insulin; in
response the body burns
fatty acids for energy and
produces acidic ketone
bodies that cause most of
the symptoms and
complications

Watch This Video:
https://youtu.be/r2tXTjb7EqU?feature=shared

Lack of circulating insulin in Type I diabetics leading to a hyperosmolar and hyperglycemic state with ketone
production
New onset diabetes
Inadequate insulin use in a known diabetic patient
Stress (MI, CVA, trauma, surgery, emotional upset) in a known Type I diabetic
Medications (steroids, beta blockers, thiazide diuretics)
Alcohol use

Myalgia Increased blood glucose levels(approximately
300-700mg/dL)
*normal fasting blood glucose concentration
are between 70 mg/dL (3.9 mmol/L) and 100 mg/dL
(5.6 mmol/L)
Flu-like S/S Warm, Dry skin
Lethargy Polyuria (due to osmotic diuresis)
Nausea Polydipsia
Decrease LOC Increased BUN, Hct, Hgb, acetone
breath(exhalation of ketones)
Coma Dehydration
Positive Urine and Serum Ketones
Kussmaul's respirations
Increased serum osmolarity
Metabolic Acidosis

Polydipsia - is excessive thirst or excess drinking
Kussmaul's respirations – Kussmaul breathing is characterized by a deep, rapid breathing pattern
Metabolic acidosis – bicarbonate is high, ph is low
The serum or plasma osmolality is a measure of the different solutes in plasma
blood urea nitrogen test, which is also called a BUN or serum BUN test, measures how much of the
waste product you have in your blood

• Hyperglycemia
and Hyperosmolar hyperglycemi
c state (HHS) is a serious condition
most frequently seen in older
persons. HHS is usually brought on
by illness or infection.
• In HHS, blood sugar levels
rise, and the body attempts to lower
blood glucose levels by increasing
glucose excretion in the urine.
• If this state continues, severe
dehydration can result, causing
seizures, coma and eventually
death.
• The possible cause is a lack
of circulating insulin in Type II
diabetics, leading to a
hyperosmolar and hyperglycemic
state without ketone production

Watch this Video:
https://youtu.be/8Jaw4aq0ycM?feature=shared

Watch this Video:
https://youtu.be/sIvcwv2ZjL0?feature=shared

Myalgias Warm, dry skin
Flu-like signs and symptoms Increased blood glucose levels(approximately
400-2,000mg/dL)
Lethargy Increased blood glucose levels(approximately
400-2,000mg/dL)
Nausea Severe dehydration
Decrease LOC Increased BUN, Hct, Hgb
Coma Negative urine and serum ketones
Absence of acetone breath (no ketones, no
acidosis)
Increased serum osmolarity (>315mOsm/kg)
*The normal serum osmolarity is 275 to 295
mOsm/L
Wider variety of mental status changes
including hallucinations, seizures, aphasia

Over-all Assessment
•Assessment findings can be divided into
subjective (patient’s report of symptoms)
and objective (concrete facts) findings,
which the clinician must put together to
obtain a clear clinical picture of what is
occurring in the body

A subjective assessment includes
assessment of four main ideas:
Family history
Mood and memory
Neuromuscular status
Nutrition, energy and gastrointestinal (GI) or gastro-urinary (GU)

An objective assessment includes
•assessment of vital signs, mood,
neuromuscular abnormalities, nutrition
and fluid status, and assessment of the
integumentary system

Conclusion
• Integrating the health history and physical exam in a focused
endocrine assessment takes experience, and more
importantly, practice. It is not enough to simply ask the right
questions and perform the physical exam.
• As the nurse, you must critically analyze all of the data
you obtain, synthesize the data into a relevant problem
focus, and then identify a plan of care for your patient based
upon this synthesis.
• As the plan of care is being carried out, re-assessments must
occur on a periodic basis. How often these re-assessments
occur is unique to each patient, based upon their specific
endocrine disorder.

ENDOCRINE ASSESSMENT.pptx

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to ENDOCRINE ASSESSMENT.pptx

Similar to ENDOCRINE ASSESSMENT.pptx (20)

More from Rommel Luis III Israel

More from Rommel Luis III Israel (20)

Recently uploaded

Recently uploaded (20)

ENDOCRINE ASSESSMENT.pptx