Nursing Study Guide/Care of Endocrine Needs

The type and range of nursing intervention will depend on the gland affected. Most hormone imbalances occur as deficiency, but some as excess. Clients with hormonal problems may be suffering from severe body image distress as a result of their perceived 'deficiency'. Some clients will accept monitoring of their condition which may range from occasional blood assay to hourly pin-prick or urine testing. Nurses have a pivotal role in health screening, during assessment of clients undergoing the care of nursing services.

diabetic neuropathy increases the risk of foot damage

Diabetes

insulin self injection

glucagon antidote for insulin overdose

blood glucose monitoring

lancets for blood glucose monitoring

By far the most common endocrine disorder, affecting the majority of people in retirement and over-represented in Aboriginal populations.

Symptoms

• Polydipsia - excessive thirst
• Polyuria - excessive urine production
• Polphagia - excessive hunger and eating

Diabetes management should be deployed with concern for long term complications as well as immediate relief. Impaired circulation is a common problem for patients with diabetes. Circulatory conditions can cause tissue hypoxia (lack of oxygen). Neuropathy associated with diabetes reduces ability to sense pressure. As a result, patients with diabetes may experience trauma, especially to the feet, without realizing it. Diabetic ulcers heal more slowly because of the poor circulation. The wounds are prone to infection because of the high levels of sugar in circulation, and immunocompromise may also be present. Necrosis of the toes and feet, leading to amputation, are common enough that regular podiatrist appointments are usual.

Diabetes also leads to renal failure and glaucoma (increased pressure in the eye), leading to blindness.

Management

Referral for diabetes education and dietetics. A cochrane study showed short term benefit from specialist diabetes nursing. There may be some benefit from Cinnamon bark

sugar monitor

Thyroid disease

left thyroid cancer

Hypothyroidism is the most common thyroid disease. Excessive Thyroxine secreted by cancer is most often treated surgically, in which case hypothyroidism is the result and supplemental treatment with thyroxine required. Iodine deficiency goitre was once common in inland peasant farmers, but this is less an issue due to iodized salt and improved nutrition generally. Thyroid function Test is part of a routine medical work-up and few cases are missed in industrial societies.

Symptoms

Thyroid hormones regulate the body metabolism and changes to this function are expected in illness

• sleep
• libido
• apetite
• activity
• mood

A Goitre is a large soft thyroid mass which forms as the body adapts, to concentrate sufficient electrolytes to manufacture adequate thyroid hormones, in response to dietary lack of Iodine. Exopthalmos is the protrusion of the eyes in Hyperthyroidism. Mood alterations are sometimes misdiagnosed as Endogenous depression or mania depending on the direction of affective deflection.

References

Essentials of Critical Care Nursing