chapter 48 endocrine assessment

Nursing Assessment:Nursing Assessment:

Endocrine SystemEndocrine System

Chapter 48 OverviewChapter 48 Overview

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Structures and Structures and Functions of Endocrine Functions of Endocrine

SystemSystem

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.2

Fig. 48-1. Location of the major endocrine glands. The parathyroid glands lie on the posterior surface of the thyroid.


SystemSystem GlandsGlands HormonesHormones

Classifications and functionsClassifications and functions Hormone transportHormone transport Targets and receptorsTargets and receptors



SystemSystem


Fig. 48-2. The target cell concept. Hormones act only on cells that have receptors specific to that hormone, because the shape of the receptor determines which hormone can react with it. This is an example of thelock-and-key model of biochemical reactions.


SystemSystem HormonesHormones

Targets and receptors, Targets and receptors, continued continued

Steroid hormone receptorsSteroid hormone receptors



SystemSystem


Fig. 48-3. A, Protein hormones bind to receptors located in the cell membrane. The hormone-receptor interactionstimulates the formation of cAMP, thereby activating various cell processes. B, Steroid hormones penetrate thecell membrane and interact with intracellular receptors. The hormone-receptor complex activates the cell bystimulating protein synthesis.



Targets and receptors, Targets and receptors, continued continued

Protein hormone receptorsProtein hormone receptors



SystemSystem Hormones, continued Hormones, continued

Regulation of hormonal Regulation of hormonal secretionsecretion

Simple feedbackSimple feedback



SystemSystem


Fig. 48-4. Feedback mechanism between blood glucose and insulin. A, Increased blood glucose stimulatesincreased insulin secretion from the pancreas. B, As blood glucose levels decline, insulin secretion decreases.


SystemSystem


Fig. 48-5. Feedback mechanism between parathyroid hormone (PTH) and calcium.



Regulation of hormonal Regulation of hormonal secretion, continuedsecretion, continued

Complex feedbackComplex feedback



SystemSystem


Fig. 48-6. General model for control and negative feedback to hypothalamus-pituitary target organ systems.Negative feedback regulation is possible at three levels: target organ (ultrashort feedback), anterior pituitary(short feedback), and hypothalamus (long feedback).



Regulation of hormonal Regulation of hormonal secretion, continuedsecretion, continued

Nervous system controlNervous system control RhythmsRhythms



SystemSystem


Fig. 48-7. Circadian rhythm of cortisol secretion.


SystemSystem HypothalamusHypothalamus



SystemSystem


Table 48-2. Hormones of the Hypothalamus.


SystemSystem PituitaryPituitary

Anterior pituitaryAnterior pituitary



SystemSystem


Fig. 48-8. Relationship between the hypothalamus, pituitary, and target organs. The hypothalamus communicateswith the anterior pituitary via a capillary system and with the posterior pituitary via nerve tracts. The anterior andposterior pituitary hormones are shown with their target tissues.



Anterior pituitary, continued Anterior pituitary, continued Tropic hormonesTropic hormones Growth hormoneGrowth hormone ProlactinProlactin

Posterior pituitaryPosterior pituitary Antidiuretic hormoneAntidiuretic hormone



SystemSystem


Table 48-3. Factors Affecting ADH Release.


SystemSystem


Fig. 48-9. Relationship of plasma osmolality to antidiuretic hormone (ADH) release and action.



Posterior pituitary, continued Posterior pituitary, continued OxytocinOxytocin



SystemSystem



SystemSystem


Fig. 48-10. Thyroid and parathyroid glands. Note the surrounding structures.


SystemSystem Thyroid Gland, continued Thyroid Gland, continued

Thyroxine and Thyroxine and triiodothyroninetriiodothyronine

CalcitoninCalcitonin Parathyroid GlandsParathyroid Glands

Parathyroid hormoneParathyroid hormone



SystemSystem Adrenal GlandsAdrenal Glands



SystemSystem


Fig. 48-11. The adrenal gland is composed of the adrenal cortex and the adrenal medulla.


SystemSystem Adrenal Glands, continuedAdrenal Glands, continued

Adrenal medullaAdrenal medulla Adrenal cortexAdrenal cortex

CortisolCortisol AldosteroneAldosterone Adrenal androgensAdrenal androgens

PancreasPancreas GlucagonGlucagon InsulinInsulin



SystemSystem


Table 48-4. Factors Influencing Insulin Secretion.

Gerontologic Considerations:Gerontologic Considerations:Effects of Aging on Endocrine Effects of Aging on Endocrine

System System


Assessment of Assessment of Endocrine SystemEndocrine System

Subjective DataSubjective Data Important health informationImportant health information

Past health historyPast health history MedicationsMedications Surgery or other treatmentsSurgery or other treatments



Subjective Data, continuedSubjective Data, continued Functional health patternsFunctional health patterns

Health perception–health Health perception–health management patternmanagement pattern

Nutritional-metabolic patternNutritional-metabolic pattern Elimination patternElimination pattern Activity-exercise patternActivity-exercise pattern Sleep-rest patternSleep-rest pattern Cognitive-perceptual patternCognitive-perceptual pattern



Subjective DataSubjective Data Functional health patterns, Functional health patterns,

continued continued Self perception–self-concept Self perception–self-concept patternpattern

Role-relationship patternRole-relationship pattern Sexuality-reproductive patternSexuality-reproductive pattern Coping–stress tolerance patternCoping–stress tolerance pattern Value-belief patternValue-belief pattern



Objective DataObjective Data Physical examinationPhysical examination

Vital signsVital signs Height and weight Height and weight Mental-emotional statusMental-emotional status IntegumentIntegument HeadHead NeckNeck




Fig. 48-12. Posterior palpation of the thyroid gland.

Assessment of Assessment of Endocrine SystemEndocrine System Objective DataObjective Data

Physical examination, Physical examination, continued continued

ThoraxThorax AbdomenAbdomen ExtremitiesExtremities GenitaliaGenitalia


Diagnostic Studies of Diagnostic Studies of Endocrine System Endocrine System

Laboratory StudiesLaboratory Studies Pituitary studiesPituitary studies Thyroid studiesThyroid studies Parathyroid studiesParathyroid studies Adrenal studiesAdrenal studies Pancreatic studiesPancreatic studies


chapter 48 endocrine assessment

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