Adult Health Exam 3

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Hormones exert their effects on…

target tissue

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The regulation of hormones levels in the blood depends on highly specialized mechanism called…

feedback

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Negative Feedback

the gland responds by increasing or decreasing the secretion of a hormone based on feedback from various factors

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Positive Feedback

increasing hormone levels cause another gland to release a hormone that then stimulates further release of the first hormone

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Thyroid-Stimulating Hormone (TSH)

stimulates the thyroid gland to secrete thyroid hormones

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Adrenocorticotropic Hormone (ACTH)

stimulates the adrenal cortex to secrete corticosteroids

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Follicle-stimulating Hormone (FSH)

stimulates secretion of estrogen along with the development of ova in women and sperm in men

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Luteinizing Hormone (LH)

stimulates ovulation in women and secretion of sex hormones in both men and women

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Growth Hormone (GH)

affects protein, lipid, and carbohydrate metabolism, it has an effect on all body tissues

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Antidiuretic Hormone (ADH)

regulates fluid volume by stimulating reabsorption of water in the kidneys

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Oxytocin stimulates…

ejection on milk into the mammary ducts and contraction of uterine smooth muscle

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Pineal Gland

secretes melatonin and helps regulate circadian rhythm and reproduction

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Thyroid Gland

The major function of the thyroid gland is the production, storage, and release of the thyroid hormones: Thyroxine (T4) and triiodothyronine (T3).

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Calcitonin is a hormone made by…

C Cells (Parafollicular Cells) in response to high circulating calcium levels

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Parathyroid Glands

* four small, oval structures usually arranged in pairs behind each thyroid lobe
* secretes parathyroid hormone (PTH), which regulates the blood level of calcium

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Adrenal Gland

* are small, paired, highly vascularized glands found on the upper part of each kidney
* composed of the adrenal medulla and adrenal cortex

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Adrenal Medulla secretes…

catecholamines epinephrine (major hormone), norepinephrine, and dopamine

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Adrenal cortex secretes…

several steroid hormones, including glucocorticoids, mineralocorticoids, and androgens.

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Cortisol helps…

regulate blood glucose concentration, inhibit inflammatory action, and support the stress response.

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Aldosterone

is a potent mineralocorticoid that maintains extracellular fluid volume

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Pancreas

secretes several hormones including glucagon and insulin

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Glucagon

* catabolic hormone
* increases blood glucose by stimulating glycogenolysis, \n gluconeogenesis, and ketogenesis.

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Insulin

* anabolic hormone
* is the principle regulator of the metabolism and storage of ingested carbohydrates, fats, and proteins

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Normal Aging on the Endocrine System

* decreased hormone production and secretion
* altered hormone metabolism and biologic activity
* decreased responsiveness of target tissues to hormones, and changes in circadian rhythms

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The nurse should ask about…

* the use of hormone replacements
* previous hospitalizations
* surgery
* chemotherapy and radiation therapy, especially of the head and neck.

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Assessment of the Thyroid Gland

Inspection


1. observe the normal position (from the side)
2. slight extension
3. while swallowing

Palpate the thyroid


1. assess the size, shape, symmetry, and tenderness

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Laboratory Tests for the Endocrine System

Blood and Urine tests.

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Anterior Pituitary Gland produces…

Prolactin, Thyrotropin, & Somatotropin

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Labs for the Anterior Pituitary Function

* GH
* Prolactin
* FSH
* LH
* TSH
* ACTH

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Labs for the Thyroid Function

* TSH (most common)
* Total T4 & T3

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Radioactive Iodine Uptake (RAIU)

measures the thyroid functioning in terms of its activity

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Chvostek’s Sign is a sign of…

Hypocalcemia

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Diabetes Mellitus

is a chronic multisystem disorder of glucose metabolism related to absent or insufficient insulin

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Type 1 Diabetes

* generally affects people under 40 years of age
* autoimmune process: t-cells destroy pancreatic B-cells

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Symptoms of Type 1 Diabetes

* polyuria
* polydipsia
* polyphagia

(all caused by hyperglycemia)

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Individuals w/ Type 1 Diabetes require…

Insulin therapy. Without it, they will develop Diabetes-related ketoacidosis (DKA) → metabolic acidosis

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Type 2 Diabetes Mellitus

* accounts for 90% of patients with diabetes
* biggest risk factor is obesity

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Symptoms of Type 2 Diabetes

* fatigue
* recurrent infections (vaginal yeast infections)
* prolonged wound healing
* visual changes

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Prediabetes

is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes

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Encourage people w/ prediabetes to…

have their blood glucose and A1C checked regularly

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Glycosylated Hemoglobin Names

* GHb
* GHB
* glycohemoglobin
* hemoglobin A1C \[Hb A1C\]
* diabetic control index
* glycated protein

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Glycosylated Hemoglobin Ranges

Nondiabetic adult/child: 4%–5.6%

Prediabetes: 5.7%–6.4%

Good diabetic control:

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Gestational Diabetes

* develops during pregnancy
* usually screened for and detected at 24-28 weeks of gestation by a oral glucose tolerance test

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Diagnostic tests for Diabetes

1. Fasting plasma glucose
2. Random plasma glucose measurement with symptoms
3. 2-hour oral glucose tolerance test
4. A1C Test

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Goals for Diabetes Management

* prevent complications of hyper/hypoglycemia
* prevent or delay onset of long term complications

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Bolus Insulin (Short acting)

is used at mealtimes to prevent postprandial hyperglycemia

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Basal Insulin (Long-acting)

provides a background level of insulin throughout the day.

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Side effects of Insulin Therapy

* Hypoglycemia
* Allergic Reactions
* Lipodystrophy
* Hypertrophy
* Somogyi Effect

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Lipodystrophy

may occur if the same injection sites are used frequently

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Hypertrophy

is a thickening of the subcutaneous tissue. Injecting into a hypertrophied site may result in erratic insulin absorption

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Somogyi Effect

elevated morning glucose levels

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Dawn Phenomenon

is characterized by hyperglycemia that is present on awakening in the morning, resulting from the increased release of counterregulatory hormones in the predawn hours

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Oral Agents

* Metformin (Glucophage)
* Sulfonylureas
* Meglitinides
* a-Glucosidase Inhibitors
* Thiazolidinediones

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Metformin (Glucophage)

* biguanide glucose-lowering agent
* reduce glucose production by the liver
* combine with lifestyle interventions

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Sulfonylureas

* increase insulin production from the pancreas

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Meglitinides

* increase insulin production from the pancreas
* rapidly absorbed and eliminated
* have a lower risk for hypoglycemia
* taken before meals

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a-Glucosidase Inhibitor

* “starch blockers” - slow down carbohydrate absorption in the small intestine

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Thiazolidinediones

* most effective for people who have insulin resistance
* severe adverse effects, the 2 drugs in the class are rarely used

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Noninsulin Injectable Agents

* Glucagon-like peptide (GLP)-1 receptor agonists
* Sodium-glucose co-transporter 2 (SGLT2) inhibitors
* Dipeptidyl peptidase IV (DPP-4) inhibitors
* Pramlintide (Symlin)

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Glucagon-like peptide (GLP)-1 receptor agonists

* target the incretin hormones
* improve blood glucose levels
* reduce body weight

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Sodium-glucose co-transporter 2 (SGLT2) inhibitors

* decrease renal glucose reabsorption
* increase urinary glucose excretion

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Dipeptidyl peptidase IV (DPP-4) inhibitors

* slow the degradation of the incretin hormone GLP-1
* inhibited secretion of glucagon
* increased insulin secretion
* slowed gastric emptying
* decreased appetite

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Pramlintide (Symlin)

* synthetic analog of human amylin
* a hormone secreted by the B cells of the pancreas
* taken concurrently with insulin

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Nutrition Therapy

is to help people with diabetes in making healthy food choices and eating a varied diet that will lead to healthy blood glucose levels

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People with diabetes should eat…

* whole grains
* healthy fat
* lean
* limited saturated/trans fat
* plant-based foods

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Regular, consistent exercise is an essential part of diabetes and prediabetes management

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Diabetics should exercise _______ after a meal or have 10-15 g carbohydrate snack and check their blood glucose before exercising.

1 hour

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Patients should delay activity if the blood glucose level is over ________.

250 mg/dL and ketones are present in the urine

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Self-monitoring of blood glucose (SMBG)

is a cornerstone of diabetes management. By providing a current blood glucose reading. SMBG enables the patient to make self-management decisions about food, exercise, and medication.

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Pancreas Transplatation

treatment used for Type 1 Diabetes. Transplants are done for patients with end-stage kidney disease and who had or are having a kidney transplant.

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Diabetes-related Ketoacidosis

is a life-threatening condition caused by deficiency of insulin. Is characterized by hyperglycemia, ketosis, acidosis, and dehydration. Occurs more in Type 1 Diabetes.

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Hyperosmolar Hyperglycemia Syndrome (HHS)

is a life-threatening syndrome that can occur in the patient with diabetes who is able to make enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

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Chronic Complications of Diabetes Mellitus

* Macrovascular Complications
* Microvascular Complications

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Macrovascular Complications

are diseases of the large and medium-sized blood vessels (heart, peripheral vascular system, and brain) that occur with greater frequency and with an earlier onset in people with diabetes.

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Microvascular Complications

affect the tiny vessels of the eyes, kidneys, and nerves. They \n result from several pathways, all in response to chronic hyperglycemia.

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Retinopathy

refers to the process of microvascular damage in the retina because of chronic hyperglycemia. There are 2 types: proliferative and Non-proliferative. Because the earliest and \n most treatable stages cause no vision changes, teach persons with diabetes to have an annual dilated eye examination.

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Nephropathy

is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidneys. Teach patients to get screened annually for albuminuria. A measure of albumin-creatinine ratio from a urine specimen may also be used to assess renal function

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Neuropathy

is nerve damage that occurs because of the metabolic derangements associated with diabetes. The 2 major categories of diabetes-related neuropathy are sensory neuropathy, which affects the peripheral nervous system, and autonomic neuropathy.

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Sensory Neuropathy

is distal symmetric neuropathy, which affects the hands and/or feet bilaterally.

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Autonomic Neuropathy

can affect nearly all body systems and lead to hypoglycemia \n unawareness, delayed gastric emptying (gastroparesis), constipation, diarrhea, urinary retention, and sexual dysfunction.

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Foot Complications with Diabetes

* most common causes of hospitalization in the person with diabetes
* proper care of foot ulcers is critical to prevent infections

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Skin Complications with Diabetes

* 2/3 of patients develop-related skins problem
* Acanthosis Nigricans
* Dermatopathy
* Necrobiosis Lipoidica Diabeticorum

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People with diabetes have increased rates of…

* mental health disorders (depression)
* infections

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GFR ranges

Normal: 125 mL/min

Only 1 mL/min of glomerular filtrate is excreted a urine

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Urinary Tract Infections (UTIs)

are the second most common bacterial disease and the most common bacterial infection in women.

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Risk factors for UTIs

* pregnancy
* menopause
* habitual delay of urination
* instrumentation
* sexual intercourse

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Catheter-associated urinary tract infections (CAUTIs)

are the most common health care–associated infection (HAI)

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What is the most common pathogen that causes CAUTIs?

\n Escherichia coli (E. coli)

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Symptoms of UTIs

* dysuria
* frequency (voiding more than every 2 hours)
* urgency and suprapubic discomfort or pressure

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How are UTIs diagnosed?

* Urinalysis with the presence of nitrites, WBCs and leukocytes esterase
* Using the clean-catch urine method is preferred

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First Line Drugs for UTIs

* trimethoprim/sulfamethoxazole (TMP-SMX)
* nitrofurantoin
* cephalexin
* fosfomycin

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Pyelonephritis

is an inflammation of the renal parenchyma and collecting system, including the renal pelvis.

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Cause of Pyelonephritis

bacterial infection in the lower urinary tract

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Manifestations of Pyelonephritis

sudden onset of chills, fever, vomiting, malaise, flank \n pain, and the lower UTI characteristics.

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Treatment of Pyelonephritis

Antibiotic therapy w/ adequate hydration

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Urethritis

inflammation of the urethra, most often from a STD or viral infection

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Manifestations of Urethritis

* discharge
* in men w/ dysuria urgency and frequency

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Treatment for Urethritis

* Drugs for bacterial infections

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Urethral Diverticula

outpouchings in the urethra that result from obstruction and rupture of the periurethral glands.

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Manifestations of Urethral Diverticula

* Dysuria
* Postvoid dribbling
* Frequency
* Urgency
* Dyspareunia