Endocrine Assessment

Endocrine System

 

• Endocrine is the network of glands that do not have ducts and other structures that secrete hormones into the bloodstream.

• Differentiated exocrine , such as sweat glands, which secrete through duct into epithelial surface.

• Glands of the endocrine system include the thyroid and the parathyroid, the pituitary, the pancreas, the adrenal glands, and the gonads. The pineal gland is also thought of as a endocrine gland because it lacks ducts, although its precise function is not known. The thymus gland, once thought of as an endocrine gland, is now classed with the lymph system.

• Endocrine system with nervous system together , regulate important body function, including growth and development of body tissue , reproduction , energy production , metabolism and ability to adapted to stress.

 

Major Endocrine Glands

 

The pituitary glands or the hypophysis (master glands of endocrine system)

 

• Round structure ,located on the inferior aspect of the brain and connect with hypothalamus .

• It divided into anterior , intermediated and posterior lobes.

I. Anterior lobes secrete :

– Growth hormones (GH ),

– Follicle-Stimulating hormones ( FSH),

– Luteinizing hormone (LH) ,

– Prolactin,

– Adrenocorticotropic hormone (ACTH) ,

– Thyroid Stimulation hormone (TSH) .

II. Posterior lobes secrete :

• Vasopressin (Antidiuretic hormone ADH),

• Oxytocin .

 

Relationships of the endocrine organs

 

The Thyroid gland

• Butterfly- shaped organ located in the lower neck anterior to trachea . it consist of two lateral lobes connected by an isthmus.

– thyroxin T4,

– triidothyronine T3.

– Calcitonin

  • The Parathyroid glands: secrete (PTH)

The adrenal gland

There are two adrenal glands in the human , each attached to upper portion of the kidney . it consist of :

• Medulla at the center which secrete epinephrine (adrenaline) .

• Adrenal Cortex which secrete three kinds of steroid hormones ;

1. Aldosterone

2. Hydrocortisone

3. Sex hormones

 

The pancreas

located in upper abdomen , has both:

• exocrine (digestive enzyme) such as amylase , trypsin , lipase

• endocrine gland, consist of the islets of langerhans, which composed by the alpha, delta and delta cells.

1. Beta cells secrete insulin

2. Alpha secrete glycogen

3. Delta cells secrete somatosatatin

Testes and ovaries

• Which secrete testosterone and estrogen

 

Health history

The nurse should keep in mind that

• Endocrine system components function interdependently with each other and with other body organs

• Therefore, assessment required a holistic approach.

• Endocrine problems can alter a client’s life-style e.g. DM ,Cushing’s syndrome

 

Present and current illness

• Generalized weakness , feel tried , lethargic , muscle twitching, numbness or tingling in both arms and legs

• Appetite increased or decreased and weight loss/gained unintentionally.

• Change in normal behavior such as mood swings or nervousness. And memory and attention result from hypo/hyper prathyroidism or hypothyroidism

• Increase amount of urine ,feeling unusually thirsty lately (polyuria , polydipsia) result from diabetes mellitus or insipidis

• Notes change in skin such as acne , increase/decrease oiliness or dryness or change of color .

• Coldness or hotness

• Increased in size of your hands or feet’s

• Fingernails toenails seems brittle

• Distribution of hair of the body , change voice or any visual problems

• Constipation or diarrhea

 

Past history

• Radiation therapy can causes endocrine glands atrophy and dysfunction.

• Encephalitis or meningitis

• Growth and development stages

• Endocrine problem

Family history

• If Family members have ( DM ,Thyroid disease , HTN , Elevated blood fats)

 

Physical assessment

Equipment

• Tape measure

• Scale

• Stethoscope

• Glass of water

Techniques

• Inspection – Palpation -Auscultation

 

Assessing related body structure

• Vital signs , height and weight

• General appearance

• Skin, hair , and nails

• Chest

• Extremities

• Genitalia

 

Assessment of the Thyroid Gland

Assessment of the Thyroid Gland

 

Palpation the thyroid

Usually you will not able to palpate the client’s thyroid, but may feel the isthmus (center portion connection the two lobes of the thyroid) .

• You may , however, see or feel a normal thyroid in the client with an extremely thin neck.

• To palpate the thyroid from the front, face the client and locate the cricoid cartilage with pads of your index and middle fingers

• Ask the client to swallow as you palpate the thyroid isthmus just below the cricoid cartilage, Using the same fingers .

• To palpate the anterior of right lobe displace the client’s trachea to right with your right hands

• Grasp the sternocleidmastoid must with your left hand ( place the tip of your index and middle fingers behind the muscle your thumb in front).

• Palpate for the posterior of the right lobe of the thyroid between your left fingers.

• To palpate the left lobe, use your left hand to move the thyroid cartilage and your right hand to palpate

• To palpated the thyroid from behind the client (review chapter head and neck assessment )

 

Palpation the thyroid

 

 

Auscultation the thyroid

• If you palpate an enlarged thyroid gland auscultate it.

• Auscultation may detect systolic bruits . (review chapter head and neck assessment)

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