Endocrine System Nursing Assessment

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PURPOSE

— The purpose of this article is to familiarize you with conducting a focused endocrine assessment. This will allow you to observe in your patient’s endocrine signs and symptoms and intervene effectively.

— hormones secreted by your endocrine organs execute their effects on specific cells and tissues to maintain homeostasis within the body. If there is an overproduction or underproduction of these hormones, the patient

— usually presents with symptoms. It is your duty as the patient’s nurse to recognize these symptoms and to act upon them as needed.

OBJECTIVES

— After successful completion of this course, you will be able to:

— 1. Identify assessment findings in common endocrine abnormalities.

— 2. Briefly discuss the role specific hormones play in selected disease processes.

Endocrine Assessment

— Every cell in our body is under the influence of our endocrine system. The endocrine system acts to maintain homeostasis at the cellular level and is a vital link in proper body operations.

— When there is an upset to this system, illness or death can result.

— Treatment usually requires management of the deviant hormone by either reducing or increasing its production or secretion from its associated endocrine gland.

ASSESSING COMMON ENDOCRINE ABNORMALITIES

— Physical exam techniques used in your focused endocrine assessment are the same techniques used in your general exam; inspection, auscultation, percussion, and palpation. During inspection, you are looking for things.

— you can observe with your eyes, ears or nose. Examples of what to inspect related to endocrine abnormalities are skin color, location of lesions, bruises or rashes, symmetry, size of body parts, and abnormal sounds orodors.

— Auscultation is used in your focused endocrine assessment before percussion or palpation. Examples of exam

— findings you will auscultate during your focused endocrine assessment include:

— Murmurs.

— Cardiac irregularities.

— Adventitious breath sounds.

— Alterations in bowel sounds.

— Palpation is another physical exam technique you will use in your focused endocrine assessment.

— During light palpation, you press the skin about ½ inch to 3/4 inch with the pads of your fingers.

— When using deep palpation, use your finger pads and compress the skin about 1½ inches to 2 inches.

— Palpation allows you to assess for texture, tenderness, temperature, moisture, pulsations, masses, and internal organs

— Finally, percussion is used in your focused endocrine assessment to allow you to elicit tenderness or sounds that point to underlying problems. When percussing directly over suspected areas of tenderness, monitor the patient for signs of discomfort. Examples of endocrine abnormalities you may percuss are an enlarged pancreas,

— pleural effusion associated with specific endocrine abnormalities, or a hormone-secreting tumor.

Pituitary Disorders

– The pituitary gland, also known as the hypophysis, is located at the base of the brain. It is actually two very different glands; the anterior pituitary and the posterior pituitary. Each gland has a unique link to the hypothalamus. Antidiuretic hormone (ADH), or vasopressin, is the major hormone secreted by the posterior pituitary. The anterior pituitary’s major hormones are growth hormone (GR), thyroid stimulating hormone (TSH), and adrenocorticotropin (ACTH).

– The hypothalamus, also known as the “master” gland, produces and releases hormones that stimulate the pituitary gland, namely growth hormone releasing hormone (GRH), thyrotropic-releasing hormone (TRH), and corticotropin releasing hormone (CRH).

Syndrome of Inappropriate ADH (SIADH)- Above normal ADH release

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Diabetes Insipidus (DI)

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Thyroid Disorders

– The thyroid gland lies in the anterior portion of the neck and straddles the trachea. It secretes two hormones that play a major role in the body’s metabolism, thyroxine (T4) & triiodothyronine (T3). Absence of these hormones may decrease the body’s basal metabolic rate by 60% and excess of these hormones may increase the body’s basal metabolic rate by 100%.

– The following tables summarize key assessment findings and their associated disorder or disease, aberrant hormone, potential causes of the disorder or disease, and key subjective and objective assessment findings.

Hypothyroidism – Chronic deficiency of T4 & T3

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Hyperthyroidism – Chronic increase in T4 & T3

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Adrenal Disorders

– The adrenal glands are two organs located atop of each kidney.

– They are responsible for the secretion of mineralocorticoids, glucocorticoids and the corticosteriods, epinephrine and norepinephrine. Aldosterone accounts for 95% of all mineralocorticoids produced and secreted by the adrenal cortex.

– Cortisol is the primary glucocorticoid secreted by the adrenal cortex. Epinephrine and norepinephrine are hormones secreted from the adrenal medulla

– Primary Adrenal Insufficiency or Addison’s Disease – Chronic deficiency or secretion of cortisol (from adrenal cortex) (Aldosterone is usually unaffected)

– Secondary Adrenal Insufficiency – Chronic deficiency of ACTH (from the anterior pituitary), which stimulates cortisol release from the adrenal cortex

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Pancreatic Disorders

– The endocrine pancreas produces and secretes insulin, glucagon, and somatostatin. All three of these hormones play a significant role in carbohydrate, fat, and protein metabolism.

– The following table summarizes key assessment findings and their associated disorder or disease, aberrant hormone, potential causes of the disorder or disease, and key subjective and objective assessment findings

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