Alterations in Endocrine Function: Nursing 210 Study Notes, Lecture notes of Nursing

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Alterations In Alterations In

Endocrine Endocrine

Function Function

Nursing 210 Nursing 210

The Endocrine System The Endocrine System

Consists of the body’s glands andConsists of the body’s glands and hormones hormones

Communication and control of otherCommunication and control of other body functions by secretion of body functions by secretion of hormones necessary for: hormones necessary for:  Metabolism of organic nutrientsMetabolism of organic nutrients  Fluid and electrolyte balanceFluid and electrolyte balance  Sexual reproduction and lactationSexual reproduction and lactation

Pituitary, thyroid, parathyroid, adrenalsPituitary, thyroid, parathyroid, adrenals

Requirements For Requirements For Normal Function: Normal Function:  Gland cells able to secrete functionalGland cells able to secrete functional hormones hormones  Good blood supply for hormonal transportGood blood supply for hormonal transport  Functional receptors on target cellsFunctional receptors on target cells  System of regulation for secretion ofSystem of regulation for secretion of hormones: hormones:  Negative feedback- an increase or decreaseNegative feedback- an increase or decrease in the level of a substance decreases or in the level of a substance decreases or increases the function of the organ increases the function of the organ producing the substance producing the substance

Assessment Assessment

 Health historyHealth history  (^) Changes in energy level and fatigueChanges in energy level and fatigue  (^) Changes in heat and cold toleranceChanges in heat and cold tolerance  (^) Changes in weightChanges in weight  Changes in sexual function and secondary sexChanges in sexual function and secondary sex characteristics characteristics  (^) Changes in mood, memory, ability to concentrate andChanges in mood, memory, ability to concentrate and altered sleep patterns altered sleep patterns  (^) Physical assessmentPhysical assessment  (^) Changes in skin textureChanges in skin texture  (^) Eye changesEye changes  (^) Changes in physical appearance (facial hair in women,Changes in physical appearance (facial hair in women, “moon face”, increased size of feet and hands, edema) “moon face”, increased size of feet and hands, edema)  (^) V/S (blood pressure, heart rate)V/S (blood pressure, heart rate)

Diagnostic Evaluation Diagnostic Evaluation

 Blood testsBlood tests 

Determine hormone blood levelsDetermine hormone blood levels



Radioimmunoassays (measurement of hormone usingRadioimmunoassays (measurement of hormone using

radioisotope labeled antigens); RIA radioisotope labeled antigens); RIA



Detect antibodiesDetect antibodies

 Urine testsUrine tests 

Measure amount of hormone or the end products ofMeasure amount of hormone or the end products of

hormones excreted by kidneys hormones excreted by kidneys

 Stimulation and suppresion testsStimulation and suppresion tests 

Determine how an endocrine gland responds to theDetermine how an endocrine gland responds to the

administration of stimulating hormones that are administration of stimulating hormones that are

normally produced or released by the hypothalamus normally produced or released by the hypothalamus

or pituitary gland or pituitary gland



Determine if negative feedback mechanism is intactDetermine if negative feedback mechanism is intact

Posterior Pituitary Posterior Pituitary

Vasopressin (antidiuretic hormoneVasopressin (antidiuretic hormone [ADH]) [ADH])  Controls excretion of water by kidneyControls excretion of water by kidney  Stimulated by increase in blood osmolalityStimulated by increase in blood osmolality or decreased blood pressure or decreased blood pressure  OxytocinOxytocin  Facilitates milk ejection during lactation andFacilitates milk ejection during lactation and increases uterine contractions during L&D increases uterine contractions during L&D  Stimulated during pregnancy and childbirthStimulated during pregnancy and childbirth

Posterior Pituitary Disorder: Posterior Pituitary Disorder: Diabetes Insipidus Diabetes Insipidus  Hyposecretion/deficiency of ADH/vasopressinHyposecretion/deficiency of ADH/vasopressin results in the inability to conserve water results in the inability to conserve water  Characterized by great thirst & large amountsCharacterized by great thirst & large amounts of dilute urine of dilute urine  Etiology: trauma gland, tumor, brain surgery,Etiology: trauma gland, tumor, brain surgery, head injury, CNS infection head injury, CNS infection  May also be caused by lack of renalMay also be caused by lack of renal responsiveness responsiveness  Pathophysiology: decreased ADH reduces thePathophysiology: decreased ADH reduces the ability of distal and collecting renal tubules to ability of distal and collecting renal tubules to concentrate urine concentrate urine

Diabetes Insipidus: Diabetes Insipidus: Clinical Manifestations Clinical Manifestations  Polyuria (large volume of dilute urine):Polyuria (large volume of dilute urine): 5L to 20L/day 5L to 20L/day  Polydipsia secondary to increased thirstPolydipsia secondary to increased thirst  Dehydration and hypernatremiaDehydration and hypernatremia  Decreased skin turgor, dry mucous membranesDecreased skin turgor, dry mucous membranes  FatigueFatigue  Muscle pain, weaknessMuscle pain, weakness  HeadacheHeadache  Hypotension and tachycardiaHypotension and tachycardia  Sleep disturbance from polyuriaSleep disturbance from polyuria  Mentation changes: irritability, mental dullnessMentation changes: irritability, mental dullness

Diabetes Insipidus: Diabetes Insipidus: Assessment and Diagnostic Assessment and Diagnostic Findings Findings  Serum osmolalitySerum osmolality (>290 mOsm/kg)(>290 mOsm/kg)  Urine osmolalityUrine osmolality  Low urine specific gravity (<1.006)Low urine specific gravity (<1.006)  Serum NaSerum Na  Decreased plasma levels of ADHDecreased plasma levels of ADH (vasopressin) (vasopressin)  Fluid deprivation test: positiveFluid deprivation test: positive

Diabetes Insipidus: Diabetes Insipidus: Nursing Management Nursing Management  IV fluids: hydration with saline and glucoseIV fluids: hydration with saline and glucose  Monitor VS, neuro status, I/O, daily weight,Monitor VS, neuro status, I/O, daily weight, and labwork and labwork  Encourage and support patient whileEncourage and support patient while undergoing studies for possible cranial undergoing studies for possible cranial lesion lesion  Instruct patient and family about follow-upInstruct patient and family about follow-up care and emergency measures care and emergency measures  Advise patient to wear medical ID braceletAdvise patient to wear medical ID bracelet  Use caution with administration ofUse caution with administration of vasopressin b/c of vasoconstriction effect vasopressin b/c of vasoconstriction effect

Posterior Pituitary Disorder: Posterior Pituitary Disorder: SIADH SIADH

““Syndrome of InappropriateSyndrome of Inappropriate Antidiuretic Hormone” Antidiuretic Hormone”

Increased secretion of ADHIncreased secretion of ADH

Etiology: Bronchogenic carcinoma,Etiology: Bronchogenic carcinoma, infectious pulmonary disease, infectious pulmonary disease, disorders of the CNS (head injury, disorders of the CNS (head injury, brain surgery or tumor, infection), brain surgery or tumor, infection), medications (tricyclic antidepressants, medications (tricyclic antidepressants, thiazide diuretics, nicotine thiazide diuretics, nicotine