Assessment of the Endocrine System
Dec 28, 2015
Endocrine system Endocrine system (ES) – the nervous
system and the interconnected network of glands
A key feature of all endocrine glands (EG) is the secretion of hormones
Hormones are biochemicals that exert their effect on target tissues
Target tissues (TT) – usually located some distance from the endocrine gland, with no direct physical connection between EG and TT
Endocrine system For this reason EG are called “ductless”
glands and must use circulatory system to transport secreted hormones to the TT
EG include the following: Pituitary gland Adrenal glands Thyroid gland Islet cells of the pancreas Parathyroid glands Gonads
Endocrine system
The endocrine system works with the nervous system to regulate overall physiologic function – neuroendocrine regulation
The ES keeps the constant normal balance (homeostasis) of the organs and systems in response to environmental changes
Endocrine system Hormones:
steroid - hydrocortisone peptide (protein) - insulin amine – epinephrine
Negative feedback control mechanisms In the healthy physiologic state, hormone
concentration in the bloodstream is maintained at a relatively constant level
When the hormone concentration rises, further production of that hormone is inhibited
When the hormone concentration falls, the rate of production of that hormone increases
Assessment. History
Demographic data age and gender (some disorders are age
related: hyperosmolar states, loss of ovarian function, decreased thyroid and parathyroid function; and gender related – sexual effects of hyperpituitarism and hypopituitarism)
Assessment. History Personal and family history
family history of obesity, grows or development difficulties, diabetes mellitus, infertility, or thyroid disorders
assess the client of the following: endocrine dysfunction; signs or symptoms that could indicate an endocrine disorder; hospitalisations
past and current medications (hydrocortisone, levothyroxine, oral contraceptives, antihypertensive drugs)
Assessment. History Diet history
Nutritional changes and GI tract disturbances may reflect a variety of endocrine problems (nausea, vomiting, abdominal pain)
Changes in food and fluid intake (diabetes insipidus, diabetes mellitus)
Rapid changes in weight without accompanying changes in diet (diabetes mellitus, thyroid disfunction)
Assessment. History Socioeconomic status
are the clients resources adequate to maintain the healthy diet, purchase needed medications
Current health problems did the client’s symptoms occur gradually, or
was the onset sudden? has the client been treated for this problem in
the past? How have the current symptoms interfered with
activities of daily living?
Assessment. History energy levels (changes in energy levels are
associated with a number of endocrine problems: thyroid, adrenal glands)
elimination urine amount and frequency. Does he or she
urinate frequently in large amounts? Does the client wake during the night to urinate (nocturia), or does he or she experience pain on urinaton (dysuria)?
information about the frequency of bowel movements and their consistency and color
Assessment. History sex and reproduction. Women are asked
about any changes in the menstrual cycle (increased flow, duration, frequency of menses; pain or excessive cramping; or a recent change in the regularity of menses). Men are asked whether they have experienced impotence. Both have to be asked about changes in libido or any fertility problems
Assessment. History Physical appearance. The client is asked
about changes in the following: hair texture and distribution facial contours voice quality body proportions secondary sexual characteristics
Physical Assessment
Inspection use a head-to-toe approach observe a general client’s appearance,
height, weight, fat distribution, muscle mass in relation to age
head: prominent forehead, jaw; round or puffy face; dull or flat face expression; exophtalmos (protrunding eyeballs and retracting upper lids)
Physical Assessment Inspection
lower half of the neck – visible enlargement of the thyroid gland (N – isthmus can be observed during the swallowing)
jugular vein dilation – can indicate fluid overload skin – color, areas of hypo- or
hyperpigmentation; fungal skin infections, slow wound healing, petechiae (adrenocortical hyperfunction); skin infections, foot ulcers, slow wound healing (diabetes mellitus)
Physical Assessment Vitiligo (patchy areas of depigmentation
with increased pigmentation at the edges) – primary hypofunction of the adrenal glands. Most often occur on the face, neck and extremities. Mucous membranes can exhibit a large areas of pigmentation
Necessary to document the location, distribution, color, size of all skin discolorations and lesion
fingernails – malformation, thickness, or brittleness (thyroid gland difficulties)
Physical Assessment the extremities and the base of the spine
are assessed for edema (disturbance in fluid and electrolyte balance)
trunk abnormalities in chest size and simmetry truncal obesity, supraclavicular fat pads
and a “buffalo hump” – adrenocortical excess
secondary sexual characteristics – breasts of both men and women for size, symmetry, pigmentation and discharge
Physical Assessment Striae (usually reddish purple “stretch
marks”) on the breasts or abdomen are often seen with adrenocortical excess
hair distribution – hirsutism (abnormal grows of body hair, especially on the face, chest, and the linea alba of the abdomen of women), excessive hair loss, or change in hair texture
genitalia (hypogonadism)
Physical Assessment
Palpation Thyroid gland (size, symmetry, general
shape, presence of nodules or other irregularities) the nurse palpates the thyroid gland
standing either behind (may be easier) or in front of the client
offering the client sips of water to promote swallowing during the examination helps palpate the thyroid gland
Physical Assessment the client is asked to sit and to lower the
chin using the posterior approach, the thumbs of
both hands are placed on the back of the clients neck, with the fingers curved around to the front of the neck on either side of the trachea
the client is asked to swallow, and the nurse locates the isthmus of the thyroid and feels it rising. The anterior surface of the thyroid lobe is also identified
Physical Assessment to examine the right lobe, the nurse:
turns the client’s head to the right displaces the thyroid cartilage to the right with
the fingers of the left hand palpates the right lobe with the right hand
this procedure is reversed for examination of the left lobe
Physical Assessment Auscultation
the nurse auscultates the client’s chest to establish baseline vital signs and to determine irregularities in cardiac rate and rhythm
the nurse documents any difference in client’s blood pressure and pulse in the lying, standing, or sitting positions (orthostatic vital signs) – many endocrine disorders can cause dehydration and volume depletion
Physical Assessment
Auscultation if an enlarged thyroid gland is palpated,
the area of enlargement is auscultaded for bruits (hypertrophy causes an increase in vascular flow)
Diagnostic Assessment Laboratory tests
Best practice for endocrine testing explain the procedure to the client emphasize the importance of taking a medication
prescribed for the test on time. Tell the client to set an alarm if the medication is to be taken during the night
instruct the client to begin the urine collection (whether for 2, 4, 8, 12 or 24 hours) by emptying his or her bladder. Tell the client NOT to save the urine specimen that begins the collection. The timing for the urine collection begins after this specimen. To end the collection, the client empties his or her bladder at the end of the timed period and adds that urine to the collection
Diagnostic Assessment make sure that the preservative has
been added to the collection container at the beginning of the collection, if necessary. Tell the client of its presence in the container
Diagnostic Assessment check your laboratory’s method of
handling hormone test samples. Blood samples drawn for certain hormones (e.g., catecholamines) must be placed on ice and taken to the laboratory immediately
if you are drawing blood samples from a line, clear the IV line thoroughly. Do not use a double- or triple-lumen line to obtain samples; contamination or dilution from another port is possible