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Chapter 32Metabolic and EndocrineConditions

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Functions of the Endocrine System

•Body growth and development

•Reproduction

•Metabolism of energy

•Maintenance of homeostasis

•Response to stress and injury

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Characteristics of the Endocrine System

•Consists of glands that synthesize and secrete hormones

•Two major classes of hormones:

–Steroids and thyronines

•lipid soluble

–Polypeptides and catecholamines

•water soluble.

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Increased Incidence of GlucoseIntolerance

•A physiologic deterioration of glucose tolerance occurswith increasing age.

•Improvement of diagnostic techniques enable morepersons with the condition to be detected.

•There is an increase in the incidence of diabetesthroughout the general population.

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Indications of Diabetes in Elders

•Orthostatic hypotension

•Periodontal disease

•Stroke

•Gastric hypotony

•Impotence

•Neuropathy

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Indications of Diabetes in Elders (cont.)

•Confusion

•Gaucoma

•Dupuytren contracture

•Infection

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Criteria for the Diagnosis of Diabetes

•Random plasma glucose concentrations are greater thanor equal to 200 mg/dL.

•Fasting blood glucose concentrations are greater than orequal to 136 mg/dL on two occasions.

•Plasma glucose concentrations after oral glucose intakeare greater than or equal to 200 mg/dL.

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Patient Education for Diabetes

•General overview

•Nutrition

•Activity and exercise

•Medications

•Monitoring

•Recognizing hypoglycemia and hyperglycemis

•Recognition of symptoms

•Prevention of complications

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Primary Symptoms of Hypoglycemia

•Behavioral disorders

•Convulsions

•Somnolence

•Confusion

•Disorientation

•Altered sleep

•Nocturnal headache

•Slurred speech

•Cardiac symptoms

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Effects of Aging on the Thyroid Gland

•Moderate atrophy

•Fibrosis

•Increasing colloid nodules

•Some lymphocytic infiltration

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Hypothyroidism

•Definition

–A subnormal concentration of thyroid hormone in thetissues.

• Types

–Primary: results from a disease process that destroysthe thyroid gland

–Secondary: caused by insufficient pituitary secretionof thyroid-stimulating hormone (TSH).

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Symptoms of Hypothyroidism

•Fatigue, weakness, and lethargy

•Depression and disinterest in activities

•Anorexia

•Weight gain

•Impaired hearing

•Periorbital or peripheral edema

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Symptoms of Hypothyroidism (cont.)

•Constipation

•Cold intolerance

•Myalgia, paresthesia, and ataxia

•Dry skin and coarse hair

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Symptoms of Hyperthyroidism

•Diaphoresis

•Tachycardia

•Palpitations

•Hypertension

•Tremor

•Diarrhea

•Stare

•Lid lag

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Symptoms of Hyperthyroidism (cont.)

•Insomnia

•Nervousness

•Confusion

•Heat intolerance

•Increased hunger

•Proximal muscle weakness

•Hyperreflexia

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Treatment of Hyperthyroidism

•Graves’ Disease or Single Autonomous Nodule

–Treatment typically includes antithyroid medicationsor radioactive iodine.

•Toxic Multinodular Goiter

–Surgery may be preferred due to the delayed andincomplete response to medications.

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Factors Contributing to Hyperlipidemia

•Increase in low-density lipoprotein (LDL) with aging

•Uncontrolled diabetes

•Hypothyroidism

•Uremia

•Nephrotic syndrome

•Use of corticosteroids, thiazide diuretics, and other drugsthat increase the risk.

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Treatment for Hyperlipidemia

•Dietary changes

•Exercise

•Weight reduction

•Limiting alcohol intake

•Medications

•Alternative and complementary therapies

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Source

•Eliopoulos, C. (2005). Gerontological Nursing, (6thed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN0-7817-4428-8).