regularoty*needs*– endocrine:*concept*...
TRANSCRIPT
REGULAROTY NEEDS –ENDOCRINE: CONCEPT OF METABOLISM
• The collec(on of biochemical reac(ons that occur in body cells to produce energy, repair cells, and maintain life
• Hormones secreted by endocrine glands
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CONCEPTS RELATED TO METABOLISM
• Diabetes Mellitus • Syndrome of Inappropriate An(diure(c Hormone (SIADH)
• Diabetes Insipidus (DI) • Hyperthyroidism • Hypothyroidism • Hyperparathyroidism • Hypoparathyroidism • Cushing Syndrome • Addison’s Disease
• Fluid & Electrolytes • Mobility • Perfusion • Reproduc)on • Stress & Coping
(Collabora(on) *Describe each concept *What nursing physical assessments are involved?
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CONCEPT RELATIONSHIP TO METABOLISM
NURSING IMPLICATIONS
F & E § é Aldosterone produc(on èéNa+ & H2O reten(on è fluid excess è edema
§ Dehydra(on and hypovolemia èéADH hormone and
é aldosterone è Na+ & H20 reten(on § Metabolic disorders (e.g.
Cushing syndrome, DI) è hypernatremia
§ Adrenal insufficiency è hyponatremia & hyperkalemia
§ Fluid deficit/excess excess will cause changes in VS
§ Assess skin turgor, UOP, urine specific gravity, weight
§ Monitor older adults closely for dehydra(on
§ For older adults, changes in fluid may cause changes in mental status
§ Monitor F&E levels
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CONCEPT RELATIONSHIP TO METABOLISM
NURSING IMPLICATIONS
Mobility § êCa+ è ê bone density è é bone fractures è
ê mobility
§ Older adults with low Ca+ or low bone density should be monitored for risk for falls, which lead to bone fractures, especially hips
§ Individuals with bone fractures should be instructed to consume adequate levels of calcium to promote calcium deposi(on in bones
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CONCEPT RELATIONSHIP TO METABOLISM
NURSING IMPLICATIONS
Perfusion § é Aldosterone è éNa+ & H2O reten(on èépreload èéoverstretching of heart muscle è ineffec(ve heart contrac(on è heart failure
§ é Aldosterone è éNa+ & H2O reten(on èé blood volume èéBP
§ êAldosterone èêNa+ & H20 reten(on è fluid deficit èêpreloadèêCOèéHR & êBP
§ Regula(on of electrolytes by hormones è ion availability èheart muscle contrac(on
§ Closely monitor pa(ents with altera(ons in metabolism for change in perfusion
§ Closely monitor HR and BP, because change in these VS are ocen early signs of problems
§ Monitor I&O, water and electrolyte levels, edema, as they can radically alter blood volume and heart workload
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CONCEPT RELATIONSHIP TO METABOLISM
NURSING IMPLICATIONS
Perfusion (con’t)
§ Thyrotoxicosis/hyperthyroidism è myocardial oxygen demand è angina
§ Hypothyroidism èévascular resistance èéBP
§ Ischemia of heart vessels è electrolyte imbalances and hormone release èêmyocardial contrac(lity èêCO, êBP, and ê(ssue perfusion
§ Insulin resistance èDMèéBP and obesityèérisk of stroke
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CONCEPT RELATIONSHIP TO METABOLISM
NURSING IMPLICATIONS
Stress & Coping
§ éStressèécor(solè êinflammatory response and changes in metabolism of carbohydrates and fats
§ All assessments related to metabolic disorders should also include as assessment of the pa(ent’s stress level and coping ability
Collabora)on § Pa(ents with endocrine or metabolic disorders may have comorbidi(es that require care by mul(ple healthcare providers
§ Many metabolic disorders are rare and may require working with a specialist; some may require surgery, which requires working with a surgical team and others
§ Advocate for pa(ents with metabolic disorders to receive care by the appropriate specialist
§ Maintain adequate communica(on among all healthcare providers to develop a complete understanding of the pa(ent’s condi(on(s)
Gerontologic Considera(ons Effects of Aging on Endocrine System
• Decreased production and secretion • Altered metabolism and biologic activity • Decreased responsiveness • Assessment difficult • Co-‐morbid conditions and medications alter response
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Assessment of Endocrine System • Dysfunction: too much or too little of a
hormone – Onset of symptoms is often gradual – Vague symptoms can be misinterpreted – Many metabolic disorders are not observable
• Therefore, nurse should be aware of visible signs associated with metabolic disorders
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Central Obesity
Graves’ Disease
Goiter
Abdominal Striae Careful interview focusing on chief complaint (e.g. change in: body weight (gain/loss), skin color, texture, increased urina(on, energy levels, menstrual cycle, memory, feelings of anxiety, restlessness, confused, heart palpita(ons, pain/s(ff muscle joints + many more
Assessment of Endocrine System
• Those who present with acute symptoms may need immediate intervention for life-‐threatening conditions – What conditions r/t this system and the concepts of metabolism do you consider are life-‐threatening?
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REGULATORY NEEDS: DIAGNOSTIC STUDIES
• SERUM LABS: Thyroid-‐s(mula(ng hormone (TSH),Triiodothyronine (T3), Thyroxine (T4), Free thyroxine (FT4), Thyroid an(bodies, Thyroglubulin; Parathyroid hormone (PTH), Calcium(total/ionized), Phosphate; Cor(sol, Aldosterone, Adrenocor(cotropic hormone (ACTH), ACTH s(mula(on/suppression; Fas(ng blood glucose, Oral glucose tolerance test, Glycosylated hemoglobin (A1C); Serum electrolytes
• URINE ANALYSIS: Glucose, Ketones
• RADIOLOGIC STUDIES: Computed tomography (CT), Magne(c resonance imaging (MRI), Ultrasound(US), Thyroid/Parathyroid Scan
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