REBOSURA, MARY ELLAINE N.

BSN3A
Assignment for Week 7
NCM 116A
1.Give the risk factors among clients that contribute to the development of
problems in Endocrine System Functions.
A number of factors increase the risk of developing endocrine disorders. Not all
people with risk factors will develop endocrine disorders. Risk factors for endocrine
disorders include:

 Elevated cholesterol levels

 Family history of endocrine disorder
 Inactivity
 Personal history of autoimmune disorders, such as diabetes
 Poor diet
 Pregnancy (in cases such as hyperthyroidism)
 Recent surgery, trauma, infection, or serious injury

2.Give the Significant Subjective data and relevant information from the client
history to include eleven functional patterns.
Subjective Data
It is important to begin by obtaining a thorough history of complaints related to the
endocrine system. You will need to elicit information about any complaints of endocrine
disease or disorders.
Endocrine disease usually manifests as the presence of one or more of the following:
• Fatigue or lethargy • Weight gain or loss
• Dizziness • Feelings of depression, irritability, or anxiety
• Pain • Decreased libido
• Nausea and vomiting • Changes in urinary or bowel habits
• Changes in vision • Intolerance to heat or cold
• Change in appetite
Subjective Data (Syndrome of Inappropriate ADH (SIADH)
Key subjective assessment findings are:
•Anorexia • Nausea
• Headache • Fatigue
• Irritability

Subjective Data (Diabetes Insipidus (DI)

Key subjective assessment findings are:
• Abrupt onset of polydipsia and polyuria • Nocturia
• Sleep disturbances related to nocturia • Fatigue
• Headache • Visual disturbances
Subjective Data (Hypothyroidism - Chronic deficiency of T4 & T3)
Key subjective assessment findings are:
• Diminished hearing • Cold intolerance
• Fatigue • Lethargy
• Complaints of constipation
Subjective Data (Myxedema Coma - Acute deficiency of T4 & T3)
Key subjective assessment findings are:
• Diminished hearing • Cold intolerance
• Fatigue • Lethargy
• Complaints of constipation
Subjective Data (Hyperthyroidism - Chronic increase in T4 & T3)
Key subjective assessment findings are:
• Irritability • Restlessness
• Heat intolerance • Complaints of diarrhea
• Insomnia
Subjective Data (Thyrotoxicosis or Thyroid Storm)
Key subjective assessment findings are:
• Restlessness • Agitation
• Changes in LOC
Subjective Data (Sick Euthyroid Syndrome)
Key subjective assessment findings may be absent.
Subjective Data (Secondary Adrenal Insufficiency)
Key subjective assessment findings are:
• Nausea Abdominal pain • Fatigue
• Malaise • Weakness
Subjective Data (Adrenal Crisis)
Key subjective assessment findings are:
• Nausea • Abdominal pain
• Fatigue • Malaise
• Weakness
Subjective Data (Cushing’s Disease)
Key subjective assessment findings are:
• Weakness • Increased appetite
• Irritability • Emotional lability
• Headache • Complaints of easy bruising
• Reports symptoms associated with decreased stress and immunologic response
Subjective Data (Pheochromocytoma (Adrenal Neoplasm)
Key subjective assessment findings are:
• Headache • Palpitations
• Dizziness • Complaints of constipation
• Anxiety
Subjective Data (Primary Aldosteronism)
Key subjective assessment findings are:
• Headache • Muscle weakness
• Fatigue • Numbness
Subjective Data (Diabetes Mellitus)
Key subjective assessment findings are:
• Headache • Fatigue
• Lethargy • Reduced energy levels
• Irritability • Emotional lability
• Vision changes • Numbness
• Tingling
Subjective Data (Pancreatic Neoplasms)
Key subjective assessment findings are:
• Anorexia • Nausea
• Malaise • Abdominal or back pain
Subjective Data (Pancreatitis)
Key subjective findings are:
• Anorexia • Nausea
• Malaise
Subjective Data (Hypoglycemia)
Key subjective assessment findings are:
• Dizziness • Weakness
• Nervousness • Agitation
• Headache • Mental dullness
Subjective Data (Diabetic Ketoacidosis (DKA)
Subject Key subjective assessment findings are:
• Myalgias
• Flu-like signs and symptoms
• Lethargy
• Nausea
• Decreased level of consciousness
• Comative Data (Diabetic Ketoacidosis (DKA)
Overall Assessment Findings: Subjective
 Area of Assessment Key Questions for Rationale
Assessments
Family history Does anyone in your family Some disorders are
have diabetes, thyroid hereditary
problems, or another
endocrine disorder?
Mood & memory Have you noticed a Hypoglycemia can cause
change in your agitation or confusion; may
mood or memory? or may not be related to
undiagnosed diabetes
• Hypothyroidism can dull
mental
function
• Mood swings may occur
with
•Cushing’s syndrome.

Area of Assessment Key Questions for Rationale

Assessments
Neuromuscular •Have you noticed any? •Excessive secretion of
twitching or muscle antidiuretic hormone
spasms? (SIADH) or
• Do you have numbness, hypoparathyroidism can
tingling, or pain in your cause twitching and
feet, muscle spasms from
legs, or hands? calcium
depletion
• Numbness and tingling
can be neuropathy from
diabetes, or low calcium
from
hypoparathyroidism
Nutrition, energy, • Have you unintentionally • Weight gain may be
GI/GU gained or lost weight? associated with
• Have you noticed hypothyroidism, water
excessive thirst or retention (could be from
urination? Cushing’s syndrome, or
• Have you noticed a SIADH)
change in your energy • Weight loss may result
level? from uncontrolled
 diabetes, hyperthyroidism,
or dehydration (may
be related to Addison’s
disease.)
• Excessive thirst and
urination can indicate
diabetes mellitus and
diabetes insipidus.
• Diabetes,
hypothyroidism,
hyperthyroidism,
Addison’s disease, or
pituitary disorders can be
associated with a lack of
energy.

Area of Assessment Key Questions for Rationale

Assessments
Vital signs • Change in pulse or • Elevated due to
temperature increased metabolic rate in
• Elevated blood pressure hyperthyroidism;
• Decreased blood decreased due to slowed
pressure metabolic rate in
hypothyroidism.
• Increased catecholamine
release in
pheochromocytoma or fluid
retention in
Cushing’s syndrome can
elevate blood
pressure
• Sodium and water loss in
Addison’s disease
can lower blood pressure
Mood • Depressed mood or • Hypothyroidism can
affect cause depression
• Nervousness • Hyperthyroidism,
 pheochromocytoma can
cause nervous behavior

Area of Assessment Key Questions for Rationale

Assessments
Neuromuscular, • Tremor • Tremor can be seen with
Head and Neck • Exophthalmos (bulging hyperthyroidism,
eyes) hypoglycemia, or
• Fat pads on neck and pheochromocytoma
shoulders (“buffalo • Fat deposits and edema
hump”), round “moon” behind the eyes is a sign
face of Graves’ disease
• Enlarged thyroid gland • Cushing’s syndrome
causes accumulation of fat
deposits
• Thyroid gland enlarges
with TSH stimulation in
hypothyroidism or
hyperthyroidism
Nutrition, fluid balance • Weight loss • Weight loss may be
• Weight gain caused by increased
• Poor skin turgor metabolic rate in
hyperthyroidism,
uncontrolled
diabetes, or dehydration
• Weight gain may be from
excess fluid or
decreased metabolic rate
in hypothyroidism
• Skin turgor is affected by
dehydration from water
loss in Addison’s disease,
diabetes

Area of Assessment Key Questions for Rationale

Assessments
Integumentary • Hyperpigmentation of • Addison’s disease results
skin in skin
• Dry, scaly skin hyperpigmentation
• Dusky lower extremities • Dry skin can be a sign of
with weak peripheral hypothyroidism
pulses • Circulatory changes in
are seen in diabetes
mellitus
3.Give the Principles and Techniques of Physical Examination in Adults and older
adults related to problems in Endocrine Function.
Physical Exam Techniques
Inspection & Auscultation
Physical exam techniques used in a focused endocrine assessment are the same
techniques used in a general exam:
• Inspection
• Auscultation
• Percussion
• Palpation
During inspection, you are looking for conditions you can observe with your eyes, ears
or nose. Examples of what to inspect related to endocrine abnormalities are:
• Generalized appearance
• Skin color
• Location of lesions
• Bruises or rashes
• Symmetry
• Size of body parts
• Abnormal sounds or odors
Physical Exam Techniques
Auscultation is used in your focused endocrine assessment before percussion or
palpation. Examples of exam findings
you will auscultate during your focused endocrine assessment include:
• Murmurs
• Cardiac irregularities
• Adventitious breath sounds
• Alterations in bowel sounds
Physical Exam Techniques
Palpation & Percussion
Palpation is another physical exam technique you will use in your focused endocrine
assessment. During light palpation, compress the skin about ½ inch to 3/4 inch with the
pads of your fingers. When using deep palpation, use your finger pads and compress
the skin about 1½ inches to 2 inches. Palpation allows you to assess for texture,
tenderness, temperature, moisture, pulsations, masses, and internal organs (Jarvis,
2011; Shaw, 2012).
Physical Exam Techniques
Percussion is used in your focused endocrine assessment to allow you to elicit
tenderness or sounds that point to underlying problems. When percussing directly over
suspected areas of tenderness, monitor the patient for signs of discomfort. Examples of
endocrine abnormalities you may percuss are an enlarged pancreas, a pleural effusion
associated with specific endocrine abnormalities, or a hormone-secreting tumor (Jarvis,
2011; Shaw, 2012).
4.What are the Results and Implications of Diagnostic Laboratory Exams of
clients with problems in Endocrine functions?

Fine needle aspiration (FNA)

A thin needle is inserted into the area of interest (usually a thyroid nodule) and cells are
removed, spread on a slide, and evaluated by a cytopathologist (someone who
diagnoses diseases on a cellular level). This process is repeated around three to six
times. It is often performed under ultrasound guidance. The image shown will let doctors
know what the diagnosis is.

Sestamibi scan
A nuclear medicine scan that detects abnormally enlarged parathyroid glands after
radioactive dye is injected into the blood stream. Scans are repeated a few times
throughout the day. This test can locate parathyroid adenoma (benign tumors) around
75 to 80% of the time.

We routinely use SPECT imaging (a more sensitive and accurate type of scan). The
radioisotope is taken up by both the thyroid gland and the enlarged parathyroid
adenoma immediately. The isotope washes out of the thyroid gland but stays in the
parathyroid adenoma, as seen in the image taken at 2 hours. This test is useful to
determine if a patient is eligible for minimally invasive parathyroidectomy

Ultrasound
An ultrasound uses sound waves to detect masses or fluid in soft tissues. It is especially
useful in evaluating thyroid nodules, lymph nodes in the neck, and can identify enlarged
parathyroid glands.
Endoscopic ultrasound
An ultrasound probe is inserted into the stomach and duodenum by a gastroenterologist
to see the pancreas and surrounding structures. This ultrasound is very useful to
localize small pancreatic neuroendocrine tumors, especially insulinomas (a rare, insulin
producing tumor of the pancreas).

Computerized tomography (CT)

CT is cross sectional imaging using x-rays. It generates highly detailed images of the
neck, chest, and abdomen. It is sometimes used to evaluate if a goiter extends into the
chest, or to look for a parathyroid gland that is not in its usual location. In the abdomen,
it is very useful for evaluating pancreas, liver, and adrenal masses. We recommend that
a non-contrast CT scan be done if there is any suspicion of thyroid cancer in most
cases.

4D CT scan
This is a new test that is useful for imaging of abnormal parathyroid glands, especially in
cases of failed parathyroid surgery. It utilizes the special dye uptake and washout of the
parathyroid gland to distinguish it from other similar structures in the neck such as
lymph nodes.

Magnetic resonance imaging (MRI)

This test uses a magnetic field to generate cross sectional images of the body. It is
particularly good at distinguishing different types of soft tissue masses. It can also be
used to identify parathyroid glands, and to better characterize adrenal and liver masses.

Positron emission test (PET)

PET scanning can image the increased metabolism of glucose found in most cancers. It
is useful in finding otherwise undetected areas of cancer growth. It is also used to image
thyroid cancers that do not take up radioactive iodine.

Radioactive iodine scan (RAI)

Thyroid cells are designed to take up iodine, and therefore a whole body scan following
the administration of radioactively labelled iodine is a very sensitive test for the
detection of normal and most cancerous thyroid cells both in the neck and throughout
the rest of the body. It also gives information on the function of those thyroid cells. I 123 or
I131 are the isotopes used in this test.

Octreoscan
Octreotide is a synthetic form of somatostatin, a hormone that binds to the somatostatin
receptors on many neuroendocrine tumors. It is used to image carcinoid tumors and
pancreatic NETs, and to evaluate if the tumors will bind to octreotide for potential
treatment with the drug.
Meta iodo benzo guanidine (MIBG) scan
This radioactive iodine compound is taken up by cells that synthesize catacholamines. It
is used to image pheochromocytomas and paragangliomas. It is particularly useful in
detecting metastatic and bilateral disease. With advances in CT and PET imaging, its
use is decreasing.

Venous sampling
Venous sampling is an invasive technique done by interventional radiology where a
catheter is inserted into a vein to withdraw blood samples for analysis of hormone levels
from specific locations. The purpose of the test is to localize the source of abnormal
hormone secretion. It is used sometimes prior to preoperative parathyroid surgery, in
hyperaldosteronism, and in insulinomas or gastrinomas.

REFERENCES:
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Endocrine Disorders. (2014, June 4). Healthgrades. https://www.healthgrades.com/right-

care/endocrinology-and-metabolism/endocrine-disorders

Endocrine system diagnostic tests. (2016, July 2). University of Iowa Hospitals & Clinics.

https://uihc.org/health-topics/endocrine-system-diagnostic-tests

Microsoft Word—Focused Endocrine Assessment_ Print Version.docx [PDF]—Free Online

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