Tabloski ch19 lecture

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THIRD EDITION
CHAPTER
19
The Endocrine
System
Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.
All Rights Reserved

Learning Objectives
1. Describe age-related changes that
affect endocrine function.
2. Recognize the impact of age-related
changes on endocrine function.
Gerontological Nursing, Third Edition
Patricia A. Tabloski

Learning Objectives
3. Identify risk factors to health for the
older person with an endocrine
problem.
4. Understand unique presentations of
diabetes and thyroid problems in the
older person.

Learning Objectives
5. Apply appropriate nursing
interventions directed toward helping
older adults with endocrine problems
develop self-care abilities.
6. Identify and implement appropriate
nursing interventions to care for the
older person with endocrine problems.

Introduction
• The endocrine glands control the body’s
metabolic processes. The endocrine and
metabolic control systems offer many
of the greatest opportunities for
preventing the disabilities associated
with aging.
• Two major endocrine problems of
importance to gerontological nursing
are diabetes mellitus and thyroid
disease.

Introduction
• Knowledge of endocrine function and
metabolism and an understanding of
normal changes associated with aging
are crucial for gerontological nurses in
order to interpret signs and symptoms
of illness and advise older persons on
health promotion activities.

Diabetes Mellitus
• Diabetes mellitus (DM) is highly
prevalent and its incidence is increasing
in persons over 65, particularly in racial
and ethnic minorities.

Figure 19-3 U.S. diabetes prevalence in people age 20 years or older, 2010.
Source: Centers for Disease Control and Prevention. National diabetes fact sheet: National estimates and general
information on diabetes and prediabetes in the United States 2011, Atlanta, GA: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, 2011.

Risk Factors for Development of
Diabetes Mellitus
• Patients with type 2 DM are often
overweight and have higher
percentages of body fat.
• Blood glucose levels decrease and may
return to normal when the patient loses
weight.
• Lifestyle modification may delay or
prevent the development of type 2 DM
in high-risk individuals.

Diagnostic Criteria
• When an older person is identified as high
risk for diabetes and presents with the
symptoms of DM such as polyuria,
polydipsia, unexplained weight loss, plus a
random plasma glucose concentration of
>200 mg/dL, appropriate testing includes
a fasting plasma glucose (FPG) level
(preferred), a 2-hour oral glucose
tolerance test (OGTT), and a HbA1c
greater than 6.5.

Diagnostic Criteria
• The nurse should inform older persons
and their families regarding the need to
prepare carefully for the FPG and the 2-
hr OGTT and explain how the ingestion
of food can raise the blood glucose
levels and result in a false positive
diagnosis of DM.

Diagnostic Criteria
• The principal goals of therapy are to
enhance quality of life, decrease chance
of complications, improve self-care
through education, and maintain or
improve general health status.

Therapeutic Management
• The goals of management of DM in the older
person include achieving normal or near-normal
blood glucose levels through self-management
techniques, including self-monitoring
of blood glucose levels;
recognition, treatment, and prevention of
hypoglycemia; prevention, early detection,
and treatment of chronic complications;
nutrition therapy; regular physical activity;
and provision of continuing education.

Therapeutic Management
• Controlling DM in the older person
requires intervention in several areas:
–Weight management
–Appropriate use of medications
–Aggressive management of comorbid
conditions
– Prevention of complications

Weight Management
• Nutritional guidelines for older persons
with DM include:
– Eat less fat.
– Eat less sugar.
– Eat less salt.
– Eat foods with higher fiber.
–Avoid or reduce alcohol.
– Limit protein intake to about 20% of
daily energy intake.

Weight Management
• Regular exercise can reduce
cardiovascular risk factors, decrease
risk of falls, improve functional
capacity, and improve blood glucose
control.
• Walking is one of the easiest ways to
be active. It can be done almost
anywhere and anytime.

Medications Used to Control DM
• Pharmacologic therapy is recommended
for older adults who have been unable
to achieve optimal blood glucose
control after 6 months of intensive
lifestyle modification (exercise and
improved diet); have symptomatic
hyperglycemia; are ketotic; and/or
have concurrent illness, medications, or
surgery that worsen glycemic control.

Effect of Acute Illness
• The nurse and other members of the
healthcare team will attempt to
regulate medications and oral intake to
prevent dangerous variations in blood
glucose levels.

Nonketonic Hyperglycemic-hyperosmolar
Coma
• Nonketotic hyperglycemic-hyperosmolar
coma (NKHHC) is a
complication of type 2 DM that has a
high mortality rate.

General Health Promotion
• The nurse should teach older persons
with DM and their families self-management
skills including self-monitoring
for signs of hypoglycemia,
blood glucose monitoring skills and
medication adjustment, nutrition
management, and development and
maintenance of a physical activity plan.

Difficulties in Caring for Older
Adults with DM
• Six geriatric syndromes represent areas
where gerontological nurses can
intervene and collaborate with other
healthcare professionals to improve the
quality of care provided to older
persons with DM. They include:
– Polypharmacy
–Depression
–Cognitive impairment

Difficulties in Caring for Older
Adults with DM
• Six geriatric syndromes represent areas
where gerontological nurses can
intervene and collaborate with other
healthcare professionals to improve the
quality of care provided to older
persons with DM. They include:
– Urinary incontinence
– Injurious falls
– Pain

Thyroid Disorders
• When thyroid dysfunction is present,
and insufficient or excessive amounts
of thyroid hormone are produced, the
nurse may see dramatic effects in the
cardiovascular system, hematologic
system, and central nervous system.
• Hypothyroidism is characterized by a
generalized reduction in metabolic
function that most often manifests as a
slowing of physical and mental activity.

Thyroid Disorders
• Hyperthyroidism, or thyrotoxicosis, is
the result of excess thyroid hormone
with metabolic overstimulation of body
function.

Hyperthyroidism
• The nurse should obtain a
comprehensive health history and
physical assessment with emphasis on
weight and blood pressure, pulse rate
and rhythm, thyroid palpation,
neuromuscular examination, eye
examination, vision assessment, and
cardiovascular assessment.

Nursing Diagnoses Associated with
Endocrine Problems
• Nursing diagnoses associated with older
persons with endocrine problems are
diverse and depend upon the older
person’s severity of illness and success
of treatment:
– Imbalanced Nutrition
 More Than Body Requirements
–Risk for Infection and Risk for
Sensory/Perceptual Alterations
 Tactile

Nursing Diagnoses Associated with
Endocrine Problems
• Nursing diagnoses associated with older
persons with endocrine problems are
diverse and depend upon the older
person’s severity of illness and success
of treatment:
–Sleep Deprivation, Fatigue
–Risk for Activity Intolerance
– Ineffective Thermoregulation
–Risk for Imbalanced Body Temperature

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