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 clients 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 clients 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 clients 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 clients chest to establish baseline vital signs and to
determine irregularities in cardiac rate and rhythm
b. the nurse documents any difference in clients 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 laboratorys 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