Ch 61 Endocrine Assessment

Parathyroid Glands

4 small glands on the posterior of the thyroid gland Secretes PTH

A nurse cares for a client with a deficiency of aldosterone. Which assessment finding should the nurse correlate with this deficiency? a. Increased urine output b. Vasoconstriction c. Blood glucose of 98 mg/dL d. Serum sodium of 144 mEq/L

ANS: A Aldosterone, the major mineralocorticoid, maintains extracellular fluid volume. It promotes sodium and water reabsorption and potassium excretion in the kidney tubules. A client with an aldosterone deficiency will have increased urine output. Vasoconstriction is not related. These sodium and glucose levels are normal; in aldosterone deficiency, the client would have hyponatremia and hyperkalemia.

A nurse cares for a client with excessive production of thyrocalcitonin (calcitonin). For which electrolyte imbalance should the nurse assess? a. Potassium b. Sodium c. Calcium d. Magnesium

ANS: C Parafollicular cells produce thyrocalcitonin (calcitonin), which regulates serum calcium levels. Calcitonin has no impact on potassium, sodium, or magnesium balances

A nurse cares for a client with a hypofunctioning anterior pituitary gland. Which hormones should the nurse expect to be affected by this condition? (Select all that apply.) a. Thyroid-stimulating hormone b. Vasopressin c. Follicle-stimulating hormone d. Calcitonin e. Growth hormone

ANS: A, C, E Thyroid-stimulating hormone, follicle-stimulating hormone, and growth hormone all are secreted by the anterior pituitary gland. Vasopressin is secreted from the posterior pituitary gland. Calcitonin is secreted from the thyroid gland

A nurse teaches an older adult with a decreased production of estrogen. Which statement should the nurse include in this clients teaching to decrease injury? a. Drink at least 2 liters of fluids each day. b. Walk around the neighborhood for daily exercise. c. Bathe your perineal area twice a day. d. You should check your blood glucose before meals.

ANS: B An older adult client with decreased production of estrogen is at risk for decreased bone density and fractures. The nurse should encourage the client to participate in weight-bearing exercises such as walking. Drinking fluids and performing perineal care will decrease vaginal drying but not decrease injury. Older adults often have a decreased glucose tolerance, but this is not related to a decrease in estrogen.

Adrenocorticotropic hormone, corticotropin (ACTH)

Adrenal cortex: Stimulates synthesis and release of corticosteroids and adrenocortical growth

How does PTH increase blood calcium levels by using the GI tract?

Enhances absorption of calcium and phosphorus from guy via activated vitamin D.

Pancreas

Exocrine and Endocrine functions

Adrenal Cortex Hormones

Glucocorticoids (cortisol) Mineralocorticoids (aldosterone)

Pancreas Hormones

Insulin Glucagon Somatostatin

Epinephrine

Neurotransmitter secreted by the adrenal medulla in response to stress. Also known as adrenaline. Alpha 1 & 2 receptors

Adrenal Medulla

Releases hormones by SNS. Secretes Epinephrine and Norephinphrine

Gonads

Sex glands: ovaries and testes

Testes Hormones

Testosterone

Oxytocin

Uterus and mammary glands: Stimulates uterine contractions and ejection of breast milk

How does the renin-angiotensin system work?

When ECF is low -> Renine converts Angiotensinogen to angiotensin I. Angiotensin I converts into the active form Angiotensin II. Angiotensin II stimulates the secretions of Aldosterone.

Ovary Hormones

estrogen and progesterone

Adrenal Glands

glands that help the body recover from stress and respond to emergencies

Thyroid Gland

endocrine gland that surrounds the trachea in the neck. Secretes of Follicular and Parafollicular cells.

parafollicular cells

produce hormone calcitonin

Follicular cells

produces thyroxine (T4) and triiodothyronine (T3) Controlled by hypothalamic-pituitary-thyroid. Invovles negative feedback system

Aldosterone

promotes sodium retention in the kidneys and potassium excretion.

Parathryoid hormone

regulates calcium and phosphorus metabolism by acting on bones, kidneys and GI tract.

What is aldosterone regulated by?

renin-angiotensin system, ACTH and potassium

testes and ovaries

testosterone and estrogen

Adrenal Cortex

the outer portion of the adrenal glands Secretes Mineralocorticoid and Glucocorticoids

anterior pituitary

(adenohypophysis) Regulates growth metabolism and sexual development

Norepinephrine

A neurotransmitter involved in arousal, as well as in learning and mood regulation. Beta 1-3 receptors

negative feedback

A type of regulation that responds to a change in conditions by initiating responses that will counteract the change. Maintains a steady state. Provides homeostasis

Cortisol Affects

Bodies response to stress -Carbs, protein and fat metabolism -Emotional stability -Immune function -Na+ and H2O balance

Growth Hormone

Bone and Soft tissue: Promotes growth through liolysis, protein anabolism and insulin antagonism

exocrine glands

involves secretion of digestive enzymes thru ducts that empty into duodenum.

Posterior Pituitary Hormones

vasopressin (antidiuretic hormone, ADH) and oxytocin

functions of glucocorticoids

-Prevents hypoglycemia by increasing liver glucose production and inhibiting peripheral glucose use. -Maintains excitability and responsiveness of cardiac muscle -Increase lipolysis, releasing glycerol and free fatty acids Increase protein catabolism -Degrade collagen and connective tissue -Increase the # of mature neutrophils released from bone marrow -Exert anti-inflammatory cells to sites of injury -Maintain behavior and cognitive functions.

What is renin?

Secreted by the kidney in response to decrease blood flow and promotes vasoconstriction and release of aldosterone from the adrenal cortex.

A nurse evaluates laboratory results for a male client who reports fluid secretion from his breasts. Which hormone value should the nurse assess first? a. Posterior pituitary hormones b. Adrenal medulla hormones c. Anterior pituitary hormones d. Parathyroid hormone

ANS: C Breast fluid and milk production are induced by the presence of prolactin, secreted from the anterior pituitary gland. The other hormones would not cause fluid secretion from the clients breast

Hypothalamus Hormones

Corticotropin-releasing hormone (CRH) Thyrotropin-releasing hormone (TRH) Gonadotropin-releasing hormone (GnRH) Growth hormone-releasing hormone (GHRH) Growth hormone-inhibiting hormone (somatostatin GHIH) Prolactin-inhibiting hormone (PIH) Melanocyte-inhibiting hormone (MIH)

Mineralocorticoids

Helps control fluid and electrolytes Aldosterone is the main hormone

How doest PTH increase blood calcium levels by using bones?

Increases net release of calcium and phosphorus from bone into ECF. Decreases bone formation and increases bone breakdown.

Endocrine glands

Involves Islets of Langehans. Has 3 cell types

Follicle-stimulating hormone (FSH)

Ovary: Stimulates estrogen secretion and follicle maturation Testis: Stimulates spermatogenesis

Luteinizing hormone (LH)

Ovary: Stimulates ovulation and progesteron secretion Testis: Stimulates testosterone secretion

parathroid hormones

Parathyroid hormone (PTH)

Glucocorticoids

Produced by adrenal cortex; produces cortisol. Regulated by ACTH and CRH.

What dietary intake is needed to produce thyroid hormones?

Protein and iodine

Anterior Pituitary Hormones

Thyroid-stimulating hormone (TSH), also known as thyrotropin Adrenocorticotropic hormone (ACTH, corticotropin) Luteinizing hormone (LH), also known as Leydig cell-stimulating hormone (LCSH) Follicle-stimulating hormone (FSH) Prolactin (PRL) Growth hormone (GH) Melanocyte-stimulating hormone (MSH)

Thyroid-stimulating hormone or thyrotropin (TSH)

Thyroid: Stimulates synthesis and release of thyroid hormone

Hypothalamus location and connections

Under Thalamus Nerve fibers connects CNS Shares hormones with anterior and posterior pituitary gland

Functions of Thyroid Hormones

• Control metabolic rate of all cells • Promote sufficient pituitary secretion of growth hormone and gonadotropins • Regulate protein, carbohydrate, and fat metabolism • Exert effects on heart rate and contractility • Increase red blood cell production • Affect respiratory rate and drive • Increase bone formation and decrease bone resorption of calcium • Act as insulin antagonists

List major endocrine glands

• Hypothalamus gland • Pituitary gland • Adrenal glands • Thyroid gland • Islet cells of the pancreas • Parathyroid glands • Gonads

Vasopressin (ADH)

Kidney: Promotes water reabsorption

A nurse cares for a client who is prescribed a 24-hour urine collection. The unlicensed assistive personnel (UAP) reports that, while pouring urine into the collection container, some urine splashed his hand. Which action should the nurse take next? a. Ask the UAP if he washed his hands afterward. b. Have the UAP fill out an incident report. c. Ask the laboratory if the container has preservative in it. d. Send the UAP to Employee Health right away

ANS: A For safety, the nurse should find out if the UAP washed his or her hands. The UAP should do this for two reasons. First, it is part of Standard Precautions to wash hands after client care. Second, if the container did have preservative in it, this would wash it away. The preservative may be caustic to the skin. The nurse can call the laboratory while the UAP is washing hands, if needed. The UAP would then need to fill out an incident or exposure report and may or may not need to go to Employee Health. The UAP also needs further education on Standard Precautions, which include wearing gloves.

A nurse collaborates with an unlicensed assistive personnel (UAP) to provide care for a client who is prescribed a 24-hour urine specimen collection. Which statement should the nurse include when delegating this activity to the UAP? a. Note the time of the clients first void and collect urine for 24 hours. b. Add the preservative to the container at the end of the test. c. Start the collection by saving the first urine of the morning. d. It is okay if one urine sample during the 24 hours is not collected.

ANS: A The collection of a 24-hour urine specimen is often delegated to a UAP. The nurse must ensure that the UAP understands the proper process for collecting the urine. The 24-hour urine collection specimen is started after the clients first urination. The first urine specimen is discarded because there is no way to know how long it has been in the bladder, but the time of the clients first void is noted. The client adds all urine voided after that first discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids one last time and adds this specimen to the collection. The preservative, if used, must be added to the container at the beginning of the collection. All urine samples need to be collected for the test results to be accurate.

A nurse assesses a client diagnosed with adrenal hypofunction. Which client statement should the nurse correlate with this diagnosis? a. I have a terrible craving for potato chips. b. I cannot seem to drink enough water. c. I no longer have an appetite for anything. d. I get hungry even after eating a meal

ANS: A The nurse correlates a clients salt craving with adrenal hypofunction. Excessive thirst is related to diabetes insipidus or diabetes mellitus. Clients who have hypothyroidism often have a decrease in appetite.

A nurse plans care for an older adult who is admitted to the hospital for pneumonia. The client has no known drug allergies and no significant health history. Which action should the nurse include in this clients plan of care? a. Initiate Airborne Precautions. b. Offer fluids every hour or two. c. Place an indwelling urinary catheter. d. Palpate the clients thyroid gland.

ANS: B A normal age-related endocrine change is decreased antidiuretic hormone (ADH) production. This results in a more diluted urine output, which can lead to dehydration. If no contraindications are known, the nurse should offer (or delegate) the client something to drink at least every 2 hours. A client with simple pneumonia would not require Airborne Precautions. Indwelling urinary catheterization is not necessary for this client and would increase the clients risk for infection. The nurse should plan a toileting schedule and assist the client to the bathroom if needed. Palpating the clients thyroid gland is a part of a comprehensive examination but is not specifically related to this client

A nurse cares for a client who has excessive catecholamine release. Which assessment finding should the nurse correlate with this condition? a. Decreased blood pressure b. Increased pulse c. Decreased respiratory rate d. Increased urine output

ANS: B Catecholamines are responsible for the fight-or-flight stress response. Activation of the sympathetic nervous system can be correlated with tachycardia. Catecholamines do not decrease blood pressure or respiratory rate, nor do they increase urine output.

A nurse assesses a female client who presents with hirsutism. Which question should the nurse ask when assessing this client? a. How do you plan to pay for your treatments? b. How do you feel about yourself? c. What medications are you prescribed? d. What are you doing to prevent this from happening?

ANS: B Hirsutism, or excessive hair growth on the face and body, can result from endocrine disorders. This may cause a disruption in body image, especially for female clients. The nurse should inquire into the clients body image and self-perception. Asking about the clients financial status or current medications does not address the clients immediate problem. The client is not doing anything to herself to cause the problem, nor can the client prevent it from happening.

A nurse cares for a client who is prescribed a drug that blocks a hormones receptor site. Which therapeutic effect should the nurse expect? a. Greater hormone metabolism b. Decreased hormone activity c. Increased hormone activity d. Unchanged hormone response

ANS: B Hormones cause activity in the target tissues by binding with their specific cellular receptor sites, thereby changing the activity of the cell. When receptor sites are occupied by other substances that block hormone binding, the cells response is the same as when the level of the hormone is decreased.

15. A nurse cares for a client who is prescribed a serum catecholamine test. Which action should the nurse take when obtaining the sample? a. Discard the first sample and then begin the collection. b. Draw the blood sample after the client eats breakfast. c. Place the sample on ice and send to the laboratory immediately. d. Add preservatives before sending the sample to the laboratory

ANS: C A blood sample for catecholamine must be placed on ice and taken to the laboratory immediately. This sample is not urine, and therefore the first sample should not be discarded nor should preservatives be added to the sample. The nurse should use the appropriate tube and obtain the sample based on which drugs are administered, not dietary schedules

pituitary gland

The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands.

Thyroid Hormones

Triiodothyronine (T3) Thyroxine (T4) Calcitonin

posterior pituitary

neurohypophysis Vasopressim (ADH) and oxytocin produced in hypothalamus, stored in Neuropophysis, then released into the blood.

How does PTH increase blood calcium levels by using the kidneys?

Activates vitamin D Increases kidney reabsorption of calcium and magnesium Increases phosphorus, bicarbonate and sodium excretion.

Endocrine glands 3 cell types

Alpha: secretes glucagon, increase blood glucose levels. Triggered by decreased blood glucose and increased amino acid levels. Beta: Secretes insulin, promotes movement and storage of carbs, fat and protein. Delta: Secretes somatostatin, secreated by GI and brain also inhibits release glucagon and insulin from pancreas.

Melanocyte-Stimulating hormone

Melanocytes: promotes pigmentation

A nurse teaches a client who has been prescribed a 24-hour urine collection to measure excreted hormones. The client asks, Why do I need to collect urine for 24 hours instead of providing a random specimen? How should the nurse respond? a. This test will assess for a hormone secreted on a circadian rhythm . b. The hormone is diluted in urine; therefore, we need a large volume. c. We are assessing when the hormone is secreted in large amounts. d. To collect the correct hormone, you need to urinate multiple times

ANS: A Some hormones are secreted in a pulsatile, or circadian, cycle. When testing for these substances, a collection that occurs over 24 hours will most accurately reflect hormone secretion. Dilution of hormones in urine, secretion of hormone amounts, and ability to collect the correct hormone are not reasons to complete a 24-hour urine test.

A nurse assesses a client who is prescribed a medication that stimulates beta1 receptors. Which assessment finding should alert the nurse to urgently contact the health care provider? a. Heart rate of 50 beats/min b. Respiratory rate of 18 breaths/min c. Oxygenation saturation of 92% d. Blood pressure of 144/69 mm Hg

ANS: A Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions. The nurse expects an increase in heart rate and increased cardiac output. The client with a heart rate of 50 beats/min would be cause for concern because this would indicate that the client was not responding to the medication. The other vital signs are within normal limits and do not indicate a negative response to the medication.

. A nurse assesses clients who have endocrine disorders. Which assessment findings are paired correctly with the endocrine disorder? (Select all that apply.) a. Excessive thyroid-stimulating hormone Increased bone formation b. Excessive melanocyte-stimulating hormone Darkening of the skin c. Excessive parathyroid hormone Synthesis and release of corticosteroids d. Excessive antidiuretic hormone Increased urinary output e. Excessive adrenocorticotropic hormone Increased bone resorption

ANS: A, B Thyroid-stimulating hormone targets thyroid tissue and stimulates the formation of bone. Melanocyte- stimulating hormone stimulates melanocytes and promotes pigmentation or the darkening of the skin. Parathyroid hormone stimulates bone resorption. Antidiuretic hormone targets the kidney and promotes water reabsorption, causing a decrease in urinary output. Adrenocorticotropic hormone targets the adrenal cortex and stimulates the synthesis and release of corticosteroids.

A nurse cares for clients with hormone disorders. Which are common key features of hormones? (Select all that apply.) a. Hormones may travel long distances to get to their target tissues. b. Continued hormone activity requires continued production and secretion. c. Control of hormone activity is caused by negative feedback mechanisms. d. Most hormones are stored in the target tissues for use later. e. Most hormones cause target tissues to change activities by changing gene activity

ANS: A, B, C Hormones are secreted by endocrine glands and travel through the body to reach their target tissues. Hormone activity can increase or decrease according to the bodys needs, and continued hormone activity requires continued production and secretion. Control is maintained via negative feedback. Hormones are not stored for later use, and they do not alter genetic activity.

A nurse prepares to palpate a clients thyroid gland. Which action should the nurse take when performing this assessment? a. Stand in front of the client instead of behind the client. b. Ask the client to swallow after palpating the thyroid. c. Palpate the right lobe with the nurses left hand. d. Place the client in a sitting position with the chin tucked down

ANS: D The client should be in a sitting position with the chin tucked down as the examiner stands behind the client. The nurse feels for the thyroid isthmus while the client swallows and turns the head to the right, and the nurse palpates the right lobe with the right hand. The technique is repeated in the opposite fashion for the left lobe

Prolactin

Mammary glands: Stimulates breast milk production