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Major Endocrine Glands
• Hypothalamus• Pituitary gland• Thyroid gland• Parathyroid glands• Thymus• Adrenal glands• Pancreas• Gonads
– Ovaries– Testis
Hormones
• Chemical messengers of the body
• Act on specific target cells
• Increase or decrease in body function
Hormone Regulation
• “Negative Feedback”• When target cells release
too much hormone send back a message to reduce the hormone release.
• When too little hormone is released the target cell sends back a message to increase the normal level
Negative feedback
• i temperature • Unit (gland) • Heating unit turns on
and generates heat (hormone)
• h temperature • (Heating unit turns off)
Hypothalamus
• Location– Brain– Attached to the pituitary
gland
• Function– Controls the anterior
pituitary • Temperature• Fluid volume• growth
Pituitary Gland
• AKA: hypophysis• AKA: “Master gland”• Location– In the skull– Below the hypothalamus
Parts of the Pituitary Gland
• Anterior lobe– 6 hormones
• GH• PRL• FSH• LH• TSH• ACTH
• Posterior lobe– 2 hormones
• Oxytocin• ADH
Anterior Pituitary Gland
• Growth hormone (GH) – Bones & muscles
• Function– Stimulate growth– h blood glucose levels
Anterior Pituitary Gland
• Prolactin (PRL) – Mammary glands
• Function– Stimulate breast
development during pg– Milk secretion p\
delivery
Anterior Pituitary Gland• Follicle-Stim horm. (FSH)• Luteinizing Horm. (LH) – Testes or ovaries
• FSH – Sperm production – Estrogen secretion
• LH – Ovulation– Testosterone secretion
Anterior Pituitary Gland
• Thyroid Stimulating Hormone (TSH) – Thyroid
• Function– Stim. thyroid growth– Stim. secretion of
thyroid hormones
Anterior Pituitary Gland
• Adrenocorticotropic hormone (ACTH) – Adrenal Cortex
• Function– Stim. adrenal cortex
growth– Stim. secretion of
glucocorticoids
Posterior Pituitary Gland• Antidiuretic Hormone
(ADH) – Kidney
• Function– Stim. H2O retention – i urine output – h H2O in serum/body
Posterior Pituitary Gland
• Oxytocin– Uterus– Mammary glands
• Function: – Uterine contractions
during labor– “let-down” hormone
• Milk secretion
Thyroid Hormones• Hormones (3)– Thyroid Hormone
• Thyroxine (T4)
– Triiodothyronine (T3)– Necessary ingredient
• Iodine
– Calcitonin • i Ca+ levels in the blood.
– h Metabolism
Parathyroid Glands
• Location– Embedded on the
posterior lobes of the thyroid gland
• Number– @4-6
• Hormone– Parathyroid Hormone
(PTH)
• Necessary ingredient– Vitamin D
Parathyroid Hormone• i Serum Ca+ levels • PTH released – Bone (target cell) – Releases Ca+ into plasma
• h Serum Ca+ levels
Adrenal Cortex
• Corticosteroids – Glucocorticoids
• cortisol
– Mineralocorticoids• Aldosterone
• Androgens
Glucocorticoids
• Cortisol– Primary Action
• ___ blood glucose levels– h
– Secondary action• Anti-inflammatory
– Primary purpose• Handle stress
Mineralocorticoids
• i blood volume / blood pressure
• Adrenal Cortex • Aldosterone • Kidney • Retains Na+ and H2O • h blood volume / blood
pressure
Adrenal Medulla• Epinephrine
– Adrenaline
• Norepinephrine • Action
– h heart rate– h Force of heart
contraction– Constrict blood vessels
• Purpose:– Physical Stress Response– Fight or Flight!
• Stress • Fight or Flight response • Adrenal Medulla • Epi/norepinephrine – Heart h heart rate/contraction– Blood Vessels constriction
• Handle Stress
Small Group Questions1. What is negative feedback?2. What is the “Master Gland”? Why is it called that?3. What are the target cells of GH?4. What hormone targets the mammary glands?5. What hormones target the gonads?6. What are the targets cells of ACTH?7. What is the action of the thyroid hormones?8. What is the action of PTH9. What is the purpose and action of Glucocorticoids?10. What is the action of Epinephrine? What response does it
elicit?
Endocrine System Assessment
• Hormone affect all body systems
• Health Hx– Energy– Wt– Cold/ heat– Nervousness– Hydration
Endocrine System Physical Assessment
• General appearance• Skin– Color– Temp– Moisture
• Hair& Nails• Exophthalmos• Visual acuity• Palpate thyroid
What endocrine glad secretes ADH?
A. ThyroidB. Anterior PituitaryC. Posterior PituitaryD. Adrenal CortexE. Adrenal Medulla
What is the function / action of ADH?
A. Stimulates H2O retention leading to i urine output
B. Increased blood glucose levelsC. Decreases blood calcium levelsD. Increases blood calcium levelsE. Increases metabolism, increased heart rate
and blood pressure
What effect would insufficient ADH have?
A. EdemaB. Decreased urinary outputC. Increased urinary outputD. Decreased blood calcium levelsE. Increased blood calcium levels
S&S of DI
• Polyuria (5-15 L/day)• Thirst• Urine specific gravity
– i
• Urine color– Pale
• Dehydration– Pulse
• Tachy
– Poor skin turgor– Dry mucous membranes
On your own QUIZ
• What would be the priority nursing diagnosis for a client with a medical diagnosis of diabetes Insipidus?– Fluid Volume Deficit
Nursing Interventions
• Monitor – I&O– Specific gravity of urine– Vital signs– Skin turgor– Neuro function
• Daily weights• Provide adequate fluids• Administer meds per
order– Monitor for S/E
What endocrine gland secretes ADH?
A. Adrenal MedullaB. ThyroidC. Anterior PituitaryD. Adrenal CortexE. Posterior Pituitary
What is the function / action of ADH?
A. Decreases blood calcium levelsB. Increases blood calcium levelsC. Increased urine outputD. Decrease urine outputE. Increased blood glucose levels
What effect would excess ADH secretion have?
A. Decreased urinary outputB. Increased urinary outputC. Decreased blood calcium levelsD. Increased blood calcium levelsE. Dehydration
S&S of SIADH
• Decreased urine output• Concentrated urine
– Specific Gravity • h
• Hyponatremia– i sodium levels
• No edema• H/A• Weight gain• Anorexia
On your own QUIZ
• What would be the priority nursing diagnosis for a client with a medical diagnosis of SIADH?– Fluid Volume Excess
Nursing Interventions
• Monitor– I&O– V/S– LOC– Serum Na+ levels
• Daily weights• Auscultate lungs• Fluid– Restriction
• Provide mouth care
• Administer meds per MD order– Diuretics
• Lasix
– Monitor for S/E• Hypokalemia
• Seizure precaution
What is a normal Serum Na+ level?
A. 3.5 – 5.3 mEq/LB. 135-140 mEq/LC. 12-18 g/dLD. 4,500 – 10,000 /mm3E. 36 – 54%
Which of the following is a S&S of hyponatremia?
A. ThirstB. Postural hypotensionC. Positive Chvostek’s signD. ConvulsionsE. Dysrhythmias
What is a normal Serum K+ level?
A. 3.5 – 5.3 mEq/LB. 135-140 mEq/LC. 12-18 g/dLD. 4,500 – 10,000 /mm3E. 36 – 54%
Which of the following is a S&S of hypokalemia?
A. ThirstB. Postural hypotensionC. Positive Chvostek’s signD. ConvulsionsE. Dysrhythmias
Small Group Questions
1. What hormonal imbalance is assoc. with DI?2. What are the characteristic S&S of DI?3. What is the primary nursing diagnosis for DI?4. Identify 5 nursing interventions for a client with DI (give
rationales for those nursing interventions)5. What hormonal imbalance is assoc. with SIADH?6. What are the characteristic S&S of SIADH?7. What is the primary nursing diagnosis for SIADH?8. Identify 5 nursing interventions for a client with SIADH
(give rationales for those nursing interventions)
What is the function/ action of TH?
A. Decreases blood calcium levelsB. Increases blood calcium levelsC. Increased urine outputD. Increase metabolic functionE. Increased blood glucose levels
S&S of Hyperthyroidism
• Think FAST & HOT• Neuro– Hand tremors– Nervousness
• C/V– HTN– Tachycardia
• G/I– Diarrhea– Weight loss
What is the priority medical need for a person diagnosed with hyperthyroidism?A. More CalciumB. Less CalciumC. More THD. Less THE. More fluids
Medical Management• Goal: reduce production of
TH– Meds
• Anti-thyroid drugs– Action
• Inhibit thyroid hormone production
– Surgery
• Goal: Prevent complications– Beta-Adrenergic Blockers
What is the action of Beta-blockers?
A. Increased heart contractilityB. AnalgesicC. Decrease blood pressureD. Diuretic, increase urine outputE. Decreases inflammation
Priority Nursing Diagnosis
• Alt. Cardiovascular function
• Imbalanced nutrition• Fatigue• Visual deficits• Body image disturbance
Nursing Interventions
• Monitor – V/S– Breath sounds– Weight– Food intake
• Diet– High calorie– High protein– High fiber– 6 small meals
Nursing Interventions
• Teach relaxation• Provide rest periods• Cool showers• Protect eyes– Tinted glasses– Artificial tears
• Enc. To express feelings• Enc to ask questions
What is the function/ action of TH?
A. Increased urine outputB. Increase metabolic functionC. Increased blood glucose levelsD. Decreases blood calcium levelsE. Increases blood calcium levels
What would be the effect of decreased TH?
A. Fluid retentionB. Fluid lossC. Calcium imbalanceD. Decreased metabolism rateE. Increased metabolism rate
S&S of hypothyroidism
• Think SLOW & COLD• Neuro– Slow movement– Lethargy
• C/V– Hypotension– Bradycardia
• G/I– Constipation– Weight gain
• Integumentary– Cold– Hair loss
• Endocrine– Goiter
• Sensory– Edema around eyes
What is the priority need for a person diagnosed with hypothyroidism?
A. More CalciumB. Less CalciumC. More THD. Less THE. More fluids
Medical Management: Hypothyroidism
• Goal: • Replace TH• Thyroid preparations– Levothyroxine sodium
(Synthroid, Levothroid)– Action
• h blood TH levels
Nursing Implications: Thyroid preparations
• Give in AM a\breakfast• Check pulse a\ admin– If >100/min hold and call
MD
• Monitor S/E– Nervousness– Weight loss
• Rx for life
Dimensional Analysis Time
• The doctor orders 0.2 mg of Synthroid, PO q AM.
• How much would you give?
A. ½ tabletB. 1 tabletC. 1 ½ tabletD. 2 tabletsE. Unable to give with this
label/medication
Priority Nursing Diagnosis: Hypothyroidism
• Decreased Cardiac output• Imbalances nutrition: more than body
requirements• Constipation• Activity intolerance
Nursing interventions: Hypothyroidism
• Monitor – B/P– Apical pulse– Peripheral pulses
• Provide blankets• Increase room temp• Monitor resp status– Rate– Depth– Auscultate
Nursing Interventions: Hypothyroidism
• Monitor weight• Diet– Decreased calorie– High fiber
• Increase fluid – >2,000 mL/day
Enc exercise at toleratedRest periodsAssist with ADL’s
Nursing Interventions: Hypothyroidism
Administer stool softener per MD order
• Administer meds per MD order– Monitor for S/E
• Tachycardia• Nervousness• Weight loss
Small Group Questions1. What hormonal imbalance is assoc. with hyper & hypo thyroidism?2. What are the distinguishing characteristic of hyperthyroidism?3. What is the medical treatment for hyperthyroidism4. What are the primary nursing diagnosis for hyperthyroidism?5. What are 5 nursing interventions for a client with hyperthyroidism (give
rationales)?6. What are the distinguishing characteristic of hypothyroidism?7. What is the medical treatment for hypothyroidism8. What are the primary nursing diagnosis for hypothyroidism?9. What are 5 nursing interventions for a client with hypothyroidism (give
rationales)?
What gland secretes Cortisol?
A. ThyroidB. Anterior PituitaryC. Posterior PituitaryD. Adrenal CortexE. Adrenal Medulla
What is the primary function of Cortisol
A. Increase blood pressureB. Increase urine outputC. Stress managementD. Increase metabolismE. Increase Calcium levels
What are the two main actions of Cortisol?
A. Increase blood glucose levels & anti-inflammation
B. Increase blood glucose levels & fluid retention
C. Increase blood glucose levels & diuresisD. Decrease blood glucose levels & anti-
inflammationE. Decrease blood glucose levels and diuresis
What would be the effect of increased Cortisol
A. Increased blood pressureB. Decreased blood pressureC. Increase blood sugar levelsD. Decreased blood sugar levelsE. Fluid retention
S&S of Cushing’s syndrome
• Moon face• Buffalo hump• Easy bruising• Slow wound healing• Hirsutism– Excessive facial hair
What would be the priority medical need of a client with Cushing’s syndrome?
A. Decrease CortisolB. Increase CortisolC. Decrease THD. Increase THE. Increase ADHF. Decreased ADH
Which of the following Nrs Dx would you expect with a client diagnosed with
Cushings disease?
A. Fluid volume excessB. Fluid volume deficit
Priority Nursing Diagnosis: Cushing Syndrome
• Fluid volume excess• Risk for injury• Risk for infection• Disturbed body image
Nursing Interventions• Monitor
– Weight– I&O– B/P– V/S
• Safe environment• Assistive devices• Provide rest periods• Private room/limit visitors• Assess wounds• Sterile tech with procedures
What gland secretes Glucocorticoids and Mineralocorticoids?
A. ThyroidB. PituitaryC. Adrenal CortexD. Adrenal MedullaE. Parathyroid
What is the primary function of Glucocorticoids & Mineralocorticoids?
A. Increase blood pressureB. Increase urine outputC. Stress managementD. Increase metabolismE. Increase Calcium levels
What are the two main actions of Cortisol?
A. Decrease blood glucose levels & anti-inflammation
B. Decrease blood glucose levels and diuresisC. Increase blood glucose levels & fluid
retentionD. Increase blood glucose levels & diuresisE. Increase blood glucose levels & anti-
inflammation
What would be the effect of decreased Cortisol
A. Increased blood pressureB. Decreased blood pressureC. Increase blood sugar levelsD. Decreased blood sugar levelsE. Fluid retention
What is the main action of mineralocorticoids?
A. Increase blood glucose levels B. Decrease blood glucose levelsC. Anti-inflammationD. Calcium balanceE. Sodium and water balance
S&S of Addison’s disease
• Skin– Bronze color
• C/V– Postural hypotension– Weak pulse
• CNS– Dizzy– Lethargy
• G/I– Anorexia– N/V
What is the primary medical need of a client with Addison’s disease?
A. Decrease CortisolB. Increase CortisolC. Decrease THD. Increase THE. Increase ADHF. Decreased ADH
Medical Management: Addison’s
• Goal: replace corticosteroids and Mineralocorticoids– Cortisone (Cortone)
Nursing Implications
• Cortisone– Give with food– S/E
• h B/P• Edema• Weight gain• Bruising• Poor wound healing
Which of the following would be the priority Nursing diagnosis for a client with Addison’s disease?
A. Fluid volume excessB. Fluid volume deficit
Priority Nursing Diagnosis
• Fluid volume deficit• Activity intolerance• Imbalanced nutrition: Less than body
requirements
Nursing interventions
• Monitor– I&O– S&S of dehydration– Orthostatic B/P
• Enc fluids– 3,000 L/day
• Rest slowly increase activities
• Diet– High calorie– 6 small meals
Small Group Questions
1. What is the hormonal imbalance assoc. with Cushing’s disease?
2. What are the distinguishing and important S&S of Cushing’s disease?
3. What is the medical management for a client with Cushing's disease?
4. What are the primary nursing diagnosis of a client with Cushing’s disease?
5. What are 5 nursing interventions for a client with Cushing’s disease? Prioritize you interventions and give a rational
Small Group Questions
1. What is the hormonal imbalance assoc. with Addison’s disease?
2. What are the distinguishing and important S&S of Addison’s disease?
3. What is the medical management for a client with Addison’s disease?
4. What are the primary nursing diagnosis of a client with Addison’s disease? Prioritize your dx.
5. What are 5 nursing interventions for a client with Addison’s disease - give a rational?
Pop Quiz: Which gland if it swells us can cause asphyxiation?
A. PituitaryB. HypothalamusC. ThymusD. ThyroidE. Adrenal gland
Pop Quiz: What term is used to describe hormone regulation?
A. Negative feedbackB. Auto-immuneC. Balancing actD. Show stopperE. Break through
Pop Quiz: What is the most important hormone for the regulation of metabolism?
A. EpinephrineB. CortisolC. Thyroxine D. TestosteroneE. Anti-diuretic hormone