NCM 321

ASSESSMENT OF
ENDOCRINE AND
METABOLIC SYSTEMS
The new standard of patient care
 Flow of Discussion
Assessment Methods
• Patient History
LESSON • Physical Assessment
• Psychosocial Assessment
HIGHLIGHTS • Diagnostic Assessment
• Laboratory
• Imaging Studies
Assessment Methods
Learning Outcomes:
After the discussion, the students will be able to:
• Identify assessment techniques used to detect
changes in function of each of the endocrine
glands;
• Determine nursing safety priority in the
assessment of the endocrine system; and
• Describe the diagnostic tests used to determine
alterations in function of each of the endocrine
glands.
 THE APPROACH
PATIENT HISTORY
• Use a system approach to obtain the history
• The age and gender of the patient provide baseline
assessment data.
• Manifestations of endocrine disorders can be
gender related
• Assess for a History of endocrine dysfunction
• Ask about past and current drugs and the use of
exogenous hormone drugs
NUTRITION HISTORY
Nutrition changes or GI tract
disturbances may reflect many
different endocrine problems.
• Ask about a history of nausea, vomiting, and
abdominal pain.

• An increase or decrease in food or fluid intake may

also indicate specific disorders.

• Nutrition deficiencies from an inadequate diet,

especially of protein and iodide-containing foods
may be a cause of an endocrine disorder
FAMILY HISTORY AND CURRENT HEALTH
GENETIC RISK PROBLEMS

• family history of obesity, growth • Focus on the patient's

or development difficulties, reason for seeking
diabetes mellitus, infertility, or health care
thyroid disorders.
 40

CURRENT HEALTH
• Elimination
PROBLEMS 30

• Sexual and Reproductive

functions
20

10

• Physical appearance
0
Item 1 Item 2 Item 3 Item 4 Item 5

changes
PHYSICAL ASSESSMENT
• Inspection
❑ Use a head-to-toe approach for inspection.
❑ Observe the patient's general appearance, and assess height, weight, fat
distribution, and muscle mass in relation to age.
❑ When examining the head, focus on abnormalities of facial structure,
features, and expression
❑ Check the lower neck for a visible enlargement of the thyroid gland.
❑ Observe skin color, and look for areas of pigment loss(hypopigmentation) or
excess (hyperpigmentation).
 Vitiligo (patchy areas of
PA- pigment loss)

INSPECTION
Truncal obesity and “buffalo
hump” HIRSUTISM

Observe the size of the scrotum and penis

or of the labia and clitoris in relation to
standards for the patient's age.
• The distribution and
quantity of pubic hair are often affected
in hypogonadism.
PHYSICAL ASSESSMENT
• Palpation
❑ The thyroid gland and the testes can be examined by palpation.
❑ Nursing Safety Priority
Action Alert
Always palpate the thyroid gently because vigorous palpation can
stimulate a thyroid storm in a person who has or is suspected to have
hyperthyroidism.
 AUSCULTATION
• Auscultate the chest to assess cardiac
rate and rhythm to use later as a
means of assessing treatment
effectiveness.
• Some endocrine problems induced
dysrhythmias.
• If an enlarged thyroid gland is
palpated, auscultate the area of
enlargement for bruits.
 Psychosocial
Assessment
• Many endocrine problems can change
a patient's behaviors, personality, and
psychological responses.
• A number of endocrine disorders
affect the patient's perception of self.
• Patients with endocrine problems may
require lifelong drugs and
follow-up care.
✔ Assess the patient's coping skills,
support systems, and health-related
beliefs.
✔ Encourage the patient to express his
or her feelings and concerns about a
change in appearance or in sexual
function.
✔ Assess their readiness to learn and
ability to carry out
specific self-management skills.
 Diagnostic
Assessment

LABORATORY
ASSESSMENT
- are an essential part of the
diagnostic process for
possible endocrine problems
STIMULATION/
ASSAYS SUPPRESSION
TESTS.
❑ Failure of the hormone
level to increase with
An assay measures
stimulation indicates
the level of a specific hypofunction.
hormone in blood or
other body ❑ Failure of hormone
fluid. production to be suppressed
during standardized testing
indicates hyperfunction.
 Diagnostic
Assessment

RADIOACTIVE T3 AND T4 THYROID-

RESIN UPTAKE STIMULATING
IODINE UPTAKE TEST HORMONE
-Blood tests are
- This thyroid function test used to diagnose
measures the absorption of thyroid
an iodine isotope to ❑ Blood test is used
disorders. to differentiate the
determine how the thyroid
diagnosis of
gland is functioning.
primary
hypothyroidism.
 METHODS

Venous Sampling Urine Tests Tests for glucose

 Best Practice for Patient Safety
& Quality Care
Endocrine Testing

For Blood Tests:

• Check your laboratory's method of handling
hormone test samples for tube type, timing, drugs
to be administered as part of the test, etc.

For example, blood samples drawn for

catecholamines must be placed on ice and taken to
the laboratory immediately.

• Explain the procedure and any restrictions to the

patient.
•
 Best Practice for Patient Safety
& Quality Care
Endocrine Testing
For Blood Tests:
• If you are drawing blood samples from an IV
line, clear the line thoroughly.
Do not use a double- or triple-lumen line to
obtain samples; contamination or dilution from
another port is possible.

• Emphasize the importance of taking a drug

prescribed for the test on time.
Tell the patient to set an alarm if the drug is to
be taken during the night.
 Best Practice for Patient Safety
& Quality Care
For Urine Tests:
• Instruct the patient to begin the urine collection
(whether for 2, 4, 8, 12, or 24 hours) by first
emptying his or her bladder.
• Remind the patient to not save the urine
specimen that begins the collection. The timing
for the urine collection begins after this
specimen.
• Tell the patient to note the time of the
discarded specimen and to plan to collect all
urine from this time until the end of the urine
collection period.
• To end the collection, instruct the patient to
empty his or her bladder at the end of the timed
period and add that urine to the collection.
Best Practice for Patient
Safety & Quality Care
For Urine Tests:
• If needed, make sure that the
preservative has been added to the
collection container at the beginning of the
collection.
• Tell the patient about any preservative
and the need to avoid splashing urine from
the container, because some preservatives
make the urine caustic.
• If the specimen must be kept cool or cold,
instruct the patient to place the container
in an inexpensive cooler with ice.
The specimen container should not be kept
with food or drinks.
 Imaging Assessment

• Anterior, posterior, and lateral skull x-rays

may be used to view the sella turcica, the
bony pocket in the skull where the pituitary
gland rests.

• MRI with contrast is the most sensitive

method of imaging the pituitary gland,
although CT scans can also be used to
evaluate it.

• The thyroid, parathyroid glands, ovaries, and

testes are evaluated by ultrasound.
• CT scans are used to evaluate the adrenal
glands, ovaries, and pancreas.
Other Diagnostic Assessment
• Needle Biopsy
NURSING CONCEPTS AND CLINICAL
JUDGMENT REVIEW

1 2 3 4

VITAL SIGNS PHYSICAL PSYCHOLOGICAL LABORATORY

ASSESSMENT ASSESSMENT ASSESSMENT
Key Points to
Remember

HEALTH PSYCHOSOCIAL PHYSIOLOGICAL

PROMOTION
AND INTEGRITY INTEGRITY
MAINTENANCE
 Health Promotion and
Maintenance

Teach all patients that misusing

hormones or steroids can have an
adverse effect on endocrine
function.
PSYCHOSOCIAL INTEGRITY

✔ Encourage the patient to express concerns about a change in

✔ appearance, sexual function, or fertility as a result of a possible
✔ endocrine problem.
✔ Explain all diagnostic procedures, restrictions, and follow-up care to
the patient scheduled for endocrine tests.
✔ Ask family members about changes in the patient's personality or
behavior.
 Physiological Integrity
• Be aware that the onset of endocrine problems can be slow and
insidious or abrupt and life threatening.

• Ask the patient about other family members with endocrine disorders,
because some problems have a genetic component.

• Ask the patient what prescribed and over-the-counter drugs are taken
on a regular basis, because some drugs can alter endocrine function.

• Follow the laboratory's procedures for collecting and handling

specimens for endocrine function studies.

• Differentiate normal from abnormal laboratory test findings and

clinical manifestations for patients with possible endocrine problems.
 Thanks for Listening!
REFERENCES:

Hinkle, J L. & Kerry H. Cheever (2018). Brunner & Suddarth’s Textbook of Medical-
Surgical Nursing, 14th Edition (One-Volume 14th Edition). Wolter’s Kluwer
Lippincott Williams & Wilkins

Hyland, Judy (2018).NCLEX Content Review Guide, 6th Edition. Kaplan Nursing Inc.

Ignavictus, Donna D. & Chris Winkelman (2016). Clinical Companion for Medical-
Surgical Nursing Patient-Centered Collaborative Care, 8th Edition. Elsevier

Ignavictus, Donna D. et.al (2016). Medical-Surgical Nursing Patient-Centered

Collaborative Care, 8th Edition. Elsevier