Assessment of Endocrine System


Hormones affect every body system and organs, causing great diversity in the signs and symptoms of endocrine dysfunction. Endocrine dysfunction may result from excessive or deficient hormone secretion, transport abnormalities, an inability of the target tissue to respond to a hormone or inappropriate stimulation of the target tissue receptor.
 

Subjective Data

The lack of clear cut manifestations of endocrine problems requires a conscientious and detailed heath history.
 
1.Health Information
· past health history :- The patient should be questioned about general state of health and previous and current endocrine abnormalities.
· medications :- The patient should be questioned about the use of all medications and dietary supplements.
· surgery or other treatment :- Nurse should enquire about previous surgery, chemotherapy or radiotherapy
 
2.Functional health patterns
Heredity
Heredity plays a major role in a major role in the occurrence of endocrine problems. The patient should be questioned about endocrine conditions in family members.
Nutritional or metabolic pattern
Reported change in appetite and weight can indicate endocrine dysfunction. Weight loss with increased appetite may indicate huperthyroidism or diabetes mellitus. Weight loss with decreased appetite may indicate hupopituitarism or hypocortisolism. Weight gain indicate hypothyroidism. Difficulty in swallowing or a change in neck size indicate thyroid disorder or inflammation.
The patient should be questioned about dietary intake. This record should be examined for foods that contain thyroid- inhibiting substances.
Elimination pattern
Increased thirst and urination can indicate Diabetes Mellitus or Insipidus. Frequent defecation may indicate hyperthyroidism. constipation is also seen in patients with diabetes mellitus, hypothyroidism, hypoparathyroidism or hypopituitarism.
Sleep-rest pattern
The patient with diabetes will complain of nocturia which can severely disrupt normal sleep patterns. The hyperthyroid patient may complain about inability to sleep. The hypothyroidism and hypopituitarism patient may sleep all the time, yet still being fatigued.
Cognitive-perceptual pattern
A patient with an endocrine dysfunction will frequently manifest apathy and depression. Memory deficits and an inability to concentrate are common in endocrine disorders.
Objective Data
Most endocrine glands are inaccessible to direct examination.

Physical Examination


1.Vital signs
Variations in temperature may associated with thyroid dysfunction. Cardiovascular changes such as bradicardia , tachycardia, hypotension or hypertension maybe seen with endocrine problems.
2.Height and weight
Changes in weight may be associated with endocrine problems. Growth pattern abnormalities suggest problems associated with growth hormone. Thyroid disorders and diabetes mellitus are example for disorders that can affect body weight.
3.Integument
The nurse should note the colour and text of the skin, hair, and nails. The hair distribution should be noted on the head, face,trunk, and extremities. Dull brittle hair, excessive hair growth or hair loss indicates endocrine dysfunction.
4. Head
The size of the head should be examined. Facial features should be symmetric. Eyes should be inspected for position shape and eye movement.
5. Neck
When inspecting the thyroid gland first observation should be made in the normal position, then in slight extension, and then as the patient swallows some water. The trachea should be in midline and neck should appear symmetric. If there is no noticeable enlargement of the thyroid gland, palpation can be done. Water should be available for the patient t swallow as a part of the examination. There are two types of thyroid palpation.
For anterior palpation the nurse stands in front of the patient, with patient’s neck flexed. The thumb is placed over the cricoid cartilage and moved over the isthmus as the patient swallows. Then each lateral lobe is palpated before and while the patient swallows water.
For posterior palpation , examiner stands behind the patient. With thumb of both hands rest on nape of the neck of the patient, uses the index and middle fingers for the thyroid isthmus and for the anterior surfaces of the lateral lobes. The thyroid is palpated for size shape, symmetry, tenderness and for any nodules.
6. Extremities
The size ,shape, symmetry, and general proportion of hand and feet should be noted. Muscle strength and deep tendon reflexes should be noted. In the upper extremities, the presence of tremors is assessed by placing a piece of paper in the outstretched fingers, palm down.

Diagnostic studies

Pituitary studies
Ø Growth hormone (GH)
(somatotrophin)
Ø Somatomedin C
Ø Growth hormone
Stimulation test.
Ø Water deprivation test
Radiologic studies-
Ø MRI:
Ø <5ng/ml in men, <10ng/ml in women, values >50ng /ml suggest acroegaly.
Ø normal values are 135-250ng/ml
Ø IGF-1 low level- GH deficiency, high level-GH excess .
Ø measures GH secretion in response to insulin. Baseline blood levels for GH, glucose obtains before administration of IV insulin GH should rise twofold over baseline. Response is subnormal in GH deficiency.
Ø use to find cause of polyuria. ADH is administered IV or subcutaneously. In central DI, urine osmolality increases after ADH administration. In nephrogenic DI there is no response to ADH.
Ø useful in identification of tumour involving hypothalamus or pituitary.

Thyroid function tests

Thyroid function tests (TFTs) is a collective term for blood tests used to check the function of the thyroid. TFTs may be requested if a patient is thought to suffer from hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid), or to monitor the effectiveness of either thyroid-suppression or hormone replacement therapy.

Ø Thyroid – stimulating hormone(TSH)

Ø Thyroxine(T4)
Ø Triiodothyronin(T3)
Ø Free T4
Ø T3 resin uptake Radiological studies
Ø Radioactive iodine uptake
Ø Thyroid scan

Ø normal 0.3-5.4mu/L

Ø 51-142nmol/L. useful in evaluating thyroid function
Ø 65-195ng/dl. Helpful in diagnosing hyperthyroidism.
Ø 1-3.5ng/dl
Ø indirectly measures binding capacity of thyroid- binding Globulin. Normal 25%-35%.
Ø patient is given radioactive iodine orally or IV. The uptake by the thyroid gland is measured with a scanner at intervals of 2to 4 hours and at 24 hours. Normal values are 3%-19% for 2-4 hours and 11%-30% for 24 hours.
Ø radioactive isotops are given orally or IV. In scan benign nodules appear as warm spots. Malignant tumors appear as cold spots.

 
Parathyroid studies
Ø Parathyroid hormone(PTH)
Ø Total serum calcium
Ø Serum phosphate
Ø measures PTH level in serum.
Ø normal 9-11 mg/dl. Hypercalcemia indicate hyperparathyroidism
Ø hyperphosphatemia indicates hypopaathyroidism. Normal 2.8-4.5 mg/dl.

 
Adrenal studies
Ø Cortisol
Ø Aldosterone
Ø Adrenocorticotropic hormone(ACTH)
Radiological studies
Ø Computed tomography (CT)
5-25mg/dl at 8am,10mg/dl at 8pm.
5-20ng/dl
<80pg/ ml-morning, <50pg/dl-evening.
use to detect tumour and size of tumour mass.

 
Pancreatic studies
Serum studies
Ø Fasting blood sugar(FBS)
Ø Oral glucose tolerance
Urine studies
Ø Glucose
Ø Ketones
Radiologic studies
Ø Computed tomography(CT)
Ø measures circulating glucose level. Normal 70-110mg/dl.
Ø patient drinks 75g of glucose, samples for glucose are drawn immediately,and at 30,60,120 minutes. Normal values: <200mg/dl at 30,60 min. and <140mg/dl at 1 hr.
Ø normal value is negative.
Ø normal value is negative.
Ø used to identify tumors or cysts.

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