Assessment of the Endocrine System

Group Of 3 :

Amirah Apriesta

Harry Prasetya

Rian Seprino

Rudolfo Ciroy S

Tetti Mardianti

Widya Eka Putri

Zulfariki

STUDY OF NURSING HEALTH UNIVERSITY

FORT DE KOCK BUKITTINGGI

YEAR 2013/2014

KATA PENGANTAR

Puji dan syukur kehadirat Allah SWT karena berkat rahmat dan hidayah-Nya,

sehingga saya dapat menyelesaikan Laporan Keperawatan Pada Melanoma Ganas ini

tepat pada waktu yang ditentukan.

Dalam penyusunan Laporan ini, penulis menyadari masih banyak kekurangan,

terutama disebabkan terbatasnya pengalaman dan pengetahuan. Untuk itu penulis

mengharapkan masukan saran dan keritik yang bersifat membangun dari para pembaca

untuk kesempurnaan dimasa yang akan datang.

Dalam penyusunan Laporan ini, penulis banyak mendapat bantuan dari semua

pihak, maka dalam kesempatan ini penulis dengan segala kerendahan hati mengucapkan

terimakasih yang sebesar-besarnya.

Semoga amal baik semua pihak yang telah memberi bantuan kepada penulis mendapat

balasan yang setimpal dari Allah SWT serta Laporan ini dapat bermanfaat bagi kita

semua. Amin Yarabbal `Alamin.

Bukittinggi, Maret 2014

Penulis

I. Endocrine system

1. Endocrine system (ES) – the nervous system and the interconnected network of glands

2. A key feature of all endocrine glands (EG) is the secretion of hormones

3. Hormones are biochemicals that exert their effect on target tissues

4. Target tissues (TT) – usually located some distance from the endocrine gland, with no

direct physical connection between EG and TT

5. For this reason EG are called “ductless” glands and must use circulatory system to

transport secreted hormones to the TT

6. EG include the following:

a. Pituitary gland

b. Adrenal glands

c. Thyroid gland

d. Islet cells of the pancreas

e. Parathyroid glands

f. Gonads

7. The endocrine system works with the nervous system to regulate overall physiologic

function – neuroendocrine regulation

8. The ES keeps the constant normal balance (homeostasis) of the organs and systems in

response to environmental changes

9. Hormones:

a. steroid – hydrocortisone

b. peptide (protein) – insulin

c. amine – epinephrine

10. Negative feedback control mechanisms

a. In the healthy physiologic state, hormone concentration in the bloodstream is

maintained at a relatively constant level

b. When the hormone concentration rises, further production of that hormone is

inhibited

c. When the hormone concentration falls, the rate of production of that hormone

increases

II. Assessment History

1. Demographic data

age and gender (some disorders are age related: hyperosmolar states, loss of ovarian

function, decreased thyroid and parathyroid function; and gender related – sexual

effects of hyperpituitarism and hypopituitarism)

2. Personal and family history

a. family history of obesity, grows or development difficulties, diabetes mellitus,

infertility, or thyroid disorders

b. assess the client of the following: endocrine dysfunction; signs or symptoms that

could indicate an endocrine disorder; hospitalisations

c. past and current medications (hydrocortisone, levothyroxine, oral contraceptives,

antihypertensive drugs)

3. Diet history

a. Nutritional changes and GI tract disturbances may reflect a variety of endocrine

problems (nausea, vomiting, abdominal pain)

b. Changes in food and fluid intake (diabetes insipidus, diabetes mellitus)

c. Rapid changes in weight without accompanying changes in diet (diabetes

mellitus, thyroid disfunction)

4. Socioeconomic status

are the clients resources adequate to maintain the healthy diet, purchase needed

medications

5. Current health problems

a. did the client’s symptoms occur gradually, or was the onset sudden?

b. has the client been treated for this problem in the past?

c. How have the current symptoms interfered with activities of daily living?

d. energy levels (changes in energy levels are associated with a number of endocrine

problems: thyroid, adrenal glands)

e. elimination

1) urine amount and frequency. Does he or she urinate frequently in large

amounts? Does the client wake during the night to urinate (nocturia), or does

he or she experience pain on urinaton (dysuria)?

2) information about the frequency of bowel movements and their consistency

and color

6. Sex and reproduction

Women are asked about any changes in the menstrual cycle (increased flow,

duration, frequency of menses; pain or excessive cramping; or a recent change in

the regularity of menses). Men are asked whether they have experienced

impotence. Both have to be asked about changes in libido or any fertility

problems

7. Physical appearance

The client is asked about changes in the following:

a. hair texture and distribution

b. facial contours

c. voice quality

d. body proportions

e. secondary sexual characteristics

8. Inspection

a. use a head-to-toe approach

b. observe a general client’s appearance, height, weight, fat distribution, muscle

mass in relation to age

c. head: prominent forehead, jaw; round or puffy face; dull or flat face

expression; exophtalmos (protrunding eyeballs and retracting upper lids)

d. lower half of the neck – visible enlargement of the thyroid gland (N – isthmus

can be observed during the swallowing)

e. jugular vein dilation – can indicate fluid overload

f. skin – color, areas of hypo- or hyperpigmentation; fungal skin infections, slow

wound healing, petechiae (adrenocortical hyperfunction); skin infections, foot

ulcers, slow wound healing (diabetes mellitus)

1) Vitiligo (patchy areas of depigmentation with increased pigmentation at

the edges) – primary hypofunction of the adrenal glands. Most often occur

on the face, neck and extremities. Mucous membranes can exhibit a large

areas of pigmentation

2) Necessary to document the location, distribution, color, size of all skin

discolorations and lesion

g. fingernails – malformation, thickness, or brittleness (thyroid gland difficulties)

h. the extremities and the base of the spine are assessed for edema (disturbance

in fluid and electrolyte balance)

i. trunk

1) abnormalities in chest size and symmetry

2) truncal obesity, supraclavicular fat pads and a “buffalo hump” –

adrenocortical excess

3) secondary sexual characteristics – breasts of both men and women for

size, symmetry, pigmentation and discharge

4) Striae (usually reddish purple “stretch marks”) on the breasts or abdomen

are often seen with adrenocortical excess

j. hair distribution – hirsutism (abnormal grows of body hair, especially on the

face, chest, and the linea alba of the abdomen of women), excessive hair loss,

or change in hair texture

k. genitalia (hypogonadism)

9. Palpation

Thyroid gland (size, symmetry, general shape, presence of nodules or other

irregularities)

a. the nurse palpates the thyroid gland standing either behind (may be easier) or

in front of the client

b. offering the client sips of water to promote swallowing during the

examination helps palpate the thyroid gland

c. the client is asked to sit and to lower the chin

d. using the posterior approach, the thumbs of both hands are placed on the back

of the clients neck, with the fingers curved around to the front of the neck on

either side of the trachea

e. the client is asked to swallow, and the nurse locates the isthmus of the thyroid

and feels it rising. The anterior surface of the thyroid lobe is also identified

f. to examine the right lobe, the nurse:

1) turns the client’s head to the right

2) displaces the thyroid cartilage to the right with the fingers of the left hand

3) palpates the right lobe with the right hand

g. this procedure is reversed for examination of the left lobe

10. Auscultation

a. the nurse auscultates the client’s chest to establish baseline vital signs and to

determine irregularities in cardiac rate and rhythm

b. the nurse documents any difference in client’s blood pressure and pulse in the

lying, standing, or sitting positions (orthostatic vital signs) – many endocrine

disorders can cause dehydration and volume depletion

c. if an enlarged thyroid gland is palpated, the area of enlargement is auscultaded for

bruits (hypertrophy causes an increase in vascular flow)

11. Diagnostic Assessment

a. Laboratory tests

1) Best practice for endocrine testing

a) explain the procedure to the client

b) emphasize the importance of taking a medication prescribed for the

test on time. Tell the client to set an alarm if the medication is to be

taken during the night

c) instruct the client to begin the urine collection (whether for 2, 4, 8, 12

or 24 hours) by emptying his or her bladder. Tell the client NOT to

save the urine specimen that begins the collection. The timing for the

urine collection begins after this specimen. To end the collection, the

client empties his or her bladder at the end of the timed period and

adds that urine to the collection

d) make sure that the preservative has been added to the collection

container at the beginning of the collection, if necessary. Tell the client

of its presence in the container

e) check your laboratory’s method of handling hormone test samples.

Blood samples drawn for certain hormones (e.g., catecholamines) must

be placed on ice and taken to the laboratory immediately

f) if you are drawing blood samples from a line, clear the IV line

thoroughly. Do not use a double- or triple-lumen line to obtain

samples; contamination or dilution from another port is possible

b. Stimulation/suppression tests

c. Radioimmunoassay

d. Urine tests

e. Tests for glucose