Presented by:

Group 6 BSN 3 LEININGER

Ochaque, Kia France
Ocon, Jaslyn Mei
Orais, Kent Joseph

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ENDOCRINE FUNCTION
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 The endocrine system is a network of
glands in the body that make the hormones that
help cells talk to each other. They’re responsible
for almost every cell, organ, and function in the
body.
• Makes hormones that control your moods, growth
and development, metabolism, organs, and
reproduction
• Controls how your hormones are released
• Sends those hormones into your bloodstream so
they can travel to other body parts

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Andropause and Menopause
Older men and women experience a decline in the
biosynthesis and balance of their sex hormones from
the cholesterol precursor as they age. In both genders,
the hypothalamus-anterior pituiatary-testes or ovary
system declines, although the timing is gender specific.
• Both genders may experience hot flashes, night
sweats, depression, and sexual dysfunction in
response to age-related declines in androgen or
estrogen.

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Adrenopause
Weighing approximately 4 grams (g), the adrenal glands
sit on the top of the kidneys and are composed of the
adrenal medulla and cortex. A total loss of
adrenocortical function causes death within days;
however, age- related decreases;
• Mineralocorticoids
• Glucocorticoids
• Androgenic hormones manifest changes in body composition
• Skeletal mass
• Muscle strength
• Body weight
• Metabolism

Age – related decreases in DHEA and norepinephrine

may produce fluid and electrolyte imbalances and
changes in glucose, protein and fat metabolism. The
decline of DHEA with age parallels that of growth
hormone, so by age 65, the human body makes only 6
10% to 20% of what it made at age 20.
Somatopause
It focuses on the neuron-hypothalamus-pituitary axis
and the failure of CNS integration of the endocrine and
nervous systems, which causes peripheral endocrine
gland insufficiency contributing to a disrupted feedback
axis in aging. Specifically, somatotropin secretion from
the hypothalamus-pituitary axis influences many age-
related changes in;
• Nutrition
• Metabolism
• Body temperature and circadian rhythm
• Circulation
• Salt-water balance
• Growth
• Reproduction 7
The Metabolic Syndrome – Diabetes
Continuum
It is common multifactorial syndrome in aging.
Suspected endocrine influences on the syndrome
include corticosteroid axis derangement, polycystic
ovary syndrome, and dysglycemia. Insulin resistance
causes;
• Increased production of inflammatory cytokines
correlating
• The development of diabetes mellitus – type 2
• Atherosclerotic vascular disease.

Primary risk factors for the syndrome are;

• abdominal obesity
• Insulin resistence
• Physical activity 8
• Hormonal balance
Diabetes Mellitus – Type 2
Age-related changes combine with genetics
and lifestyle factors to produce a hyperglycemic state.
Starting with compensatory hyperinsulinemia that
affects insulin receptors on target tissues, which leads
to insulin resistance that produces hyperglycemia,
diabetes mellitus – type 2 is a disorder of relative insulin
insufficiency. It affects 40% of the older adult
population.

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 ASSESSMENT INTERVENTION
• Comprehensive nursing assessment of the older adult includes a thorough review
of past medical, surgical and family histories.
• The nursing care of an older adult patient with
diabetes mellitus – type 2 is often complex. Usually,
• Ask a client about current medications, particularly diuretics, beta- blockers, many issues must b dealt with; therefore, it is
anticonvulsants, antihypertensive and steroids would help the nurse asses for
potential problems related to drug interactions.. important to prioritize patient problems. In general,
• Nutritional assessment includes a current weight measurement and recent patterns
emergent issues or life- threatening crises such as
of loss or gain, typical dietary patterns, changes in the sense of taste or smell, severe hyperglycemia, hypoglycemia, and sepsis are
dentition, and ability to shop for and prepare foods. top priorities.
• Evaluate for the presence of fecal incontinence, constipation, and diarrhea
• Ask if the individual lives alone or with others, if living arrangements afford ability to
prepare food, and if adequate financial resources are available for food and shelter.
• Assess a patient’s ability to learn before assessing knowledge of diabetes and its
management. Cognitive function and learning styles vary, so knowing the patient’s
preferred learning style facilities education.
• Evaluate current and past blood glucose results. Assess both the older adult’s
ability to remember simple facts and his or her mood and level of anxiety

• Assess the patient’s skin condition, paying particular attention to the skin on
the feet, legs, and elbows because these areas are at greatest risk for skin
breakdown from pressure.
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• Assess circulation, the nurse should take an apical pulse, noting rate and
rhythm; check pedal pulse bilaterally; and note the presence of hair on the
lower extremities.
 Hyperthyroidism
In seniors is often caused by multinodular
and uninodular toxic goiter rather than Graves disease,
which is the most common cause in younger adults.
• Iodine hyperthyroidism – common type of
hyperthyroidism among older patients using
amiodarone, a cardiac drug containing iodine, which
deposits in tissue and delivers iodine to the
circulation over long periods.
• Subclinical hyperthyroidism – a condition in which an
otherwise healthy.

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Hypothyroidism
A common hypo functioning endocrine state
that results from inadequate thyroid hormone function. It
caused by primary thyroid gland failure is an elevation
of the serum TSH level. As the thyroid gland ages, it
develops;
• Moderate atrophy
• Fibrosis
• Colloid nodules
• Lymphocyte infiltration

Hypofunctioning thyroid states may result from defects in hormone

production, target tissues or receptors.
When the defect involves a hypofunctioning peripheral gland like the thyroid,
it is called primary hypothyroidism. If the hypothyroid state is result of a
nonfunctional anterior pituitary gland, the condition is called secondary
hypothyroidism.
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Tertiary hypothyroidism results from a defect in the hypothalamus.
Primary Osteoporosis

Osteoporosis is a legitimate concern in

postmenopausal women and andropausal men because of
the influence of systemic sex hormones on bone.
Characterized by low bone mass leading to fragile bones
that break easily. Low bone mass may result from a failure to
reach peak bone mass as a young adult, increased bone
resorption, or decreased bone formation.

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Sexual Dysfunction
Erectile Dysfunction (ED) and female secual
dysfunction (FSD) have garnered increased interest and
research dollars in recent years as many older people strive
to retain the vitality of their younger years.
Hormonal changes associated with ED begin at 40 years
old in the aging man and include decreased testosterone,
decreased bioavailability of testosterone, increased sex
hormone – binding globulin, decreased DHEA, mildly
increased estradiol – 17- beta, decreased meltonin , and
decreased growth hormone and IGF – 1

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URINARY FUNCTION
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 The urinary system works as a filter,
removing toxins and wastes from the body
through urine. It uses a series of tubes and
ducts to pass this waste. These tubes are
connected to the blood vessels and digestive
system. The urinary system helps the rest of
the body work properly. Different parts of the
urinary system perform tasks including:

• Filtering blood.
• Separating the toxins you don’t need from the
nutrients you do need.
• Storing and carrying urine out of your body.

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• Bladder capacity decreases, the prevalence of involuntary bladder
contractions increases, and more urine is produced at night.
• The
. reduction in bladder capacity and increased involuntary bladder
contractions may lead to urgency and frequency.
• Increased urine formation at night leads to nocturia, defined as waking to
urinate one or more times during the night.
• Changes occur in the urethra because of the aging process and because
of decreased levels of astrogen after menopause.
• Thinning and increased friability of the urethral mucosa may contribute to
urgency and frequency.
• A decrease in muscle tone and bulk may decrease urethral resistance.
• Declining estrogen levels affect pelvic floor muscle tone and function.
• As men age, the prevalence of benign prostatic hypertrophy (BPH)
increases, with more than 50% experiencing BPH by the time they are
over age 65.
• Enlargement of the prostate may interfere with bladder emptying and
precipitate involuntary bladder contractions.
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 UI is common in older adults, affecting
approximately 30% of individuals. More common among
nursing facility residents, affecting 50% to 75% of all nursing
.
residents. Is an independent predictor for nursing facility
admission and is associated with irritant dermatitis, pressure
ulcers, falls, significant sleep, interruptions and UTIs

Myths and Attitudes

Despite the significant number of older adults with
UI, most do not report the condition or seek medical treatment.
This may be attributed to embarrassment, the belief that it is a
normal consequence of aging, or the belief that it cannot be
treated.
Many health care providers do not ask patients
about incontinence. Even when patients inform them about
incontinence, many providers ignore the problem and do not
provide adequate diagnosis and treatment.

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 Acute Incontinence
Has a sudden onset, is
generally associated with some
medical or surgical condition, and
generally resolves when the underlying
cause is corrected. Medication is
common cause and should always be
suspected in cases of new-onset
incontinence.
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Chronic Incontinence
Is not related to an acute illness. It
continues over time, often becoming worse.
Major types of persistent incontinence include
urge, stress, overflow, functional , and mixed
incontinence.
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 Urge Incontinence Stress Incontinence
Most common type of incontinence. Second most common form incontinence
Associated with an overactive bladder. in women. Occurs as pressure in the bladder
Common causes of urge incontinence include exceeds urethral resistance. This may be cause by
local genitourinary conditions such as UTI, lack of estrogen, obesity, previous vaginal deliveries,
surgeries, or all of these factors.
medications, bladder irritants, bowel issues,
dementia, stroke, Parkinson disease and
cancers of the uterus and urinary system. Is
often accompanied by nocturia and
complaints of daytime frequency, with
individuals often needing to void more than
seven times per day.

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 Overflow Incontince
Occurs when bladder pressure in a
chronically full bladder rises to a level higher
than urethral resistance, causing involuntary
loss of urine. It is the second most common
form of incontinence in men.
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Functional Incontinence
It results from physical, mental,
psychological, or environmental factors
interfering with the ability to make it to the
toilet on time. Physical disabilities affecting
their gait or their ability to undress. Individuals
with cognitive impairment may not recognize
their need to void. Psychological problems
such as severe depression may lack the
motivation to toilet appropriately.
Environmental factors may play a role in
causing incontinence, especially in acute and
long-term settings.
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 Mixed Incontinence

Described as a combination of two or more other type:

stress, urge, overflow, or functional incontinence. Among
community-dwelling older adults, mixed urge incontinence and
stress incontinence is common.

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Functional Assessment
• Place the patient 15 feet from the
toilet
• Ask the patient to approach the
toilet, either on foot or in a
wheelchair , and to prepare to take
the position for voiding.
• Note the time it takes the patient to
reach the toilet and any difficulty in
getting undressed or positioning for
voiding
• If the patient is unable to toilet
independently and a caregiver
normally assists the patient,
observe the toileting procedure with
caregiver assistance.
ASSESSMENT
Environmental Assessment Psychosocial Assessment
• Proximity of the toilet • Ask the patient how incontinence has
• Any barriers between the patient’s affected social activities.
usual location and the toilet, for • Assess the patient’s desire and
example, poor lighting, steps willingness to participate in treatment
furniture, or other objects
program for incontinence.
• The size of the bathroom: is it
large enough to accommodate the
patient and any assistive devices
(wheelchair or walker) that must
be used?
• Toilet height: is it adequate or too
high or low?
• Presence of grab bars, if needed
• Availability of caregiver or nursing
staff assistance, if needed
• Availability of a call bell, if needed
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 INTERVETION
• Focus on lifestyle modifications and behavioral therapies.
• Lifestyle Modifications – Individuals with UI may decrease fluid intake in an effort to prevent accidents. This is not an effective
method of managing incontinence and may lead to urinary tract infection, constipation and dehydration. Patients and caregivers
should be cautioned not to decrease fluid intake to less than six glasses a day.
• Cognitively Intact Patients- Two behavioral intervention useful in cognitively intact individuals are bladder retraining and pelvic
floor muscle exercises.
• Bladder Retraining –Retraining is useful for correcting the habit of frequent toileting and for diminishing urgency. This procedure is most useful
for patients with urge incontinence and frequent urination.
• Pelvic Floor Muscle Exercises- consist of alternating contraction and relaxation of the levator ani muscles, which are the muscles of the pelvic
floor.
• Cognitively Impaired Patients- Treating UI in individuals with cognitive impairment requires the use of other behavioral
techniques that depend on the caregiver rather than the patient.
• Scheduled Toileting- the patient assisted in voiding on a regular, preset schedule. Family or professional caregivers simply
take the patient to the toilet at the scheduled times, often every 2 hours.
• Habit Training – Patterned urge response training (PURT ) , initially a patient’s baseline voiding pattern is assessed. The
patient is assisted in voiding at the established times.
• Prompted Voiding – The goal is to increase a patient’s awareness of the need to void and increase the frequency of self –
initiated toileting. 24
• Kidneys decrease in size and number nephrons with
aging.
.• In addition, individuals with atherosclerosis
experience decreased renal blood flow due to fibrous
tissue and calcification hardening renal vasculature.
• Glomerular filtration rate decrease
• Renal mass decreases by 80 grams between 40 and
90 years of age
• Renal blood flow decreases by 10% for every
decade beyond the age of 40.

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 Acute Kidney Injury
. is the sudden decline in renal function
accompanied by fluid and electrolyte alterations, and acid-
base disturbance. It may or may not be associated with
oliguria. AKI is classified as prerenal, intrinsic, or posternal
based on causative factors.

• Prerenal failure – occurs because of inadequate

perfusion.
• Intrinsic failure – occurs as a result of abnormalities
within the kidney and may be caused by ischemia,
sepsis, inflammation, or injury.
• Postrenal failure – results from an obstructive or
mechanical process in the urinary tract that interferes
with the outflow of urine.

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Chronic Kidney Disease
. Is the presence of kidney damage for more
than 3 months accompanied by decrease in GFR. The
symptoms manifested depend on the extent of the
disease. The five stages of CKD are as follows:
• Stage 1 – kidney damage with normal (>90 mL/min/1.73
m2) or increased GFR.
• Stage 2 – Kidney damage with GFR between 60 and 89
mL/min/1.73 m2 for 3 or more months
• Stage 3 – Moderately decreased GFR, between 30 and
59 mL/min/1.73 m2
• Stage 4 – Severely decreased GFR, between 15 and 29
mL/min/1.73 m2
• Stage 5 – Kidney failure with GFR less than 15
mL/min/1.73 m2; patients will require renal replacement
therapy (RRT)

. Patients with CKD stages 1 to 3 are asymptomatic. On entering stages 4 and

5, patients may develop weakness, edema, fatigue, hypertension, heart failure, impaired
cognition and immune function, dry skin and pruritus, anorexia, nausea, malnutrition, 27
increased bleeding, anemia, peripheral neuropathy, and an overall decreased quality of
life.
Urinary Tract Infection
. Is common in the older adult population.
The prevalence of bactiuria increases dramatically in
women and men older than the age of 80. The
incidence of bacteriuria is higher in women than men ,
partly because of the proximity of the urethral meatus to
the rectum. Clinical presentation of UTI in older adults
includes dysturia, urgency, frequency, and hematuria
secondary to damaged superficial blood vessels in
mucosa of the bladder. These symptoms are typical of
lower UTIs. If the infection is in the upper tract, older
patients may manifest;
• Fever
• Chills
• Flank tenderness
• Mental status changes
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ASSESSMENT
• A subjective assessment of urinary elimination patterns
should be completed, assessing for alterations in normal
voiding patterns and symptoms such as burning, urgency,
and frequency.
• The characteristic of the urine should also be noted.
Diagnosis
• Pain, related to altered urinary elimination
• Impaired Urinary Elimination, related to the
infectious process
• Deficient Knowledge, related to unfamiliarity with
treatment of UTI
Planning and expected Outcomes
• The patient will experience adequate pain control, as evidenced by
reports of no further dysuria or burning with urination
• The patient will resume a normal voiding pattern, free from frequency,
urgency, and dysuria.
• The patient or caregiver verbalizes knowledge of the causes and
treatment of UTI
INTERVENTION
• Education of older adults
• Appropriate perihygiene measures such as showering ,front-
to-back wiping techniques, adequate daily fluid intake ,
frequent bladder emptying, adherence to the prescribed
medication regimen and reprtable signs and symptoms of a
recurrent infection.
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Bladder Cancer
. Most common form of cancer originating in
the urinary system and is most often found in persons
over 70 years of age. Approximately 90% of all bladder
cancers are transitional carcinomas originating in the
epithelial lining of the urinary tract. The other 10% are
typically squamous cell carcinoma, small cell carcinoma
and adenocarcinoma. The biggest risk factor for
developing bladder cancer is cigarette smoking.

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 Diagnosis
• Anxiety, related to an uncertain prognosis
• Impaired Urinary Elimination, related to surgical
diversion
• Disturbed Body Image, related to surgical diversion
• Ineffective Coping, related to uncertain outcome of
treatment
• Sexual Dysfunction, related to anatomic alterations
INTERVENTION
• Focus on patient education, psychosocial support,
management of pain and maintenance of adequate fluid and
nutritional intake.
Planning and expected Outcomes
• The patient will experience reduced anxiety, as evidenced by a
decrease in symptoms
• The patient will develop a routine for managing urinary diversion
• The patient will verbalize acceptance of urinary diversion and
associated changes
• The patient will demonstrate the use of effective coping strategies, as
evidenced by verbalization of feelings and seeking of support
• The patient will verbalize concerns about sexuality
• The patient will express satisfaction with alternative positions for
intercourse
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Benign Prostatic Hypertrophy
. Is an age – related enlargement of the
prostate gland that constricts the urethra and obstructs
the outflow of urine. Approximately 80% of men may be
diagnosed with BPH by the age of 80. With early
prostatic enlargement, the patient may be
asymptomatic because the muscles compensate for
increased urethral resistance. As the prostate gland
enlarges, the patient begins manifest symptoms of an
obstructive process:

• Hesitancy
• Decrease in the force of the urinary stream
• Terminal dribbling
• Sensation of a full bladder after voiding
• Urinary retention
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ASSESSMENT
• Digital rectal examination (DRE) to evaluate the size, shape,
and consistency of the prostate gland
• Abdominal examination to determine the presence of
bladder distention, suprapublic tenderness, and
costovertebral and tenderness.
Diagnosis
• Impaired urinary elimination, related to bladder outlet
obstruction
• Risk of infection, related to stasis
• Sexual Dysfunction, related to erectile dysfunction
• Deficient Knowledge, related to new diagnosis
Planning and expected Outcomes
• The patient will maintain a regular schedule of complete bladder
emptying
• The patient will remain free from UTIs, as evidenced by the use of
measures to prevent infection
• The patient will verbalize sexual concerns and describe measures to
cope
• Patient demonstrates understanding of evualation and treatment of
BPH
INTERVENTION
• Education regarding the management of alterations in
urinary elimination should include establishment of frequent
voiding schedules.
• The educational plan should also include teaching patients
about the sympathomimetic actions of decongestant
medications and diet pills, as they cause acute urinary
retention
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Prostate Cancer
is the most common form of cancer
in men and the second leading cause of
cancer- related death. Risk factors include
advancing age, family history of the disease
and black race. Prostate cancer may
metastasize through the lymphatic system and
bloodstream to the lymph nodes, bones, lungs,
and liver

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ASSESSMENT
• Assessment of a patient with prostrate cancer is essentially
the same as that for a patient with BPH.
Diagnosis
• Impaired urinary elimination, related to bladder outlet
obstruction
• Anxiety, related to uncertain prognosis
• Sexual Dysfunction, related to treatment measures
• Deficient Knowledge, related to lack of previous
exposure to treatment modalities and prognosis
Planning and expected Outcomes
• The patient’s urinary elimination patterns will return to the premorbid
state.
• The patient’s expression of anxiety about the diagnosis, treatment, and
prognosis will be replaced with an understanding of the prognosis
• The patient and partner will have a mutually satisfying sexual
relationship
• The patient will demonstrate knowledge of treatment methods and
prognostic indicators.
INTERVENTION
• Administration of analgesics for pain control
• Suggestion of options for sexual counseling if the patient
indicates a need
• Education of the patient on the importance of a follow – up
check of PSA levels and evaluation for disease progression.
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