Assessment
Assessment is essential in the diagnosis of endocrine disorders. Hormones affect every body tissue and system, so assessment is key. Simple observations may give you a lot of information about what may be going on with the patient, however sometimes assessment may be difficult because "symptoms of endocrine disorders are vague or resemble other physical or mental disorders" (Timby & Smith, 2013, p. 753).
Do not forget about the nursing process---ADPIE:
History
Part of the initial assessment is of course obtaining the patient's health history, as well as diet and medication history. This information will allow the practitioner to gain insight into the patient's complete family history as part of the process. Several endocrine disorders are inherited or have a familial tendency such as thyroid disorders, pancreatic (diabetes mellitus) disorders, etc, thus making it an essential part of the intake process.
Information that is important to obtain:
Do not forget about the nursing process---ADPIE:
- Assessment
- Diagnosis
- Planning
- Implementation
- Evaluation
History
Part of the initial assessment is of course obtaining the patient's health history, as well as diet and medication history. This information will allow the practitioner to gain insight into the patient's complete family history as part of the process. Several endocrine disorders are inherited or have a familial tendency such as thyroid disorders, pancreatic (diabetes mellitus) disorders, etc, thus making it an essential part of the intake process.
Information that is important to obtain:
- allergies to iodine, shellfish, contrast (for thyroid test)
- previous diagnostic tests using iodine (intravenous pyelography, gallbladder series) within past 3 months (for thyroid test)
- current symptoms
Physical Examination
The physical exam is valuable to determine growth, development patterns, weight distribution/changes, and how it compares to normal variations.
REMEMBER steps in PE: Inspection, Auscultation, Percussion, Palpation
Important to obtain at this time are:
Points to remember:
The physical exam is valuable to determine growth, development patterns, weight distribution/changes, and how it compares to normal variations.
REMEMBER steps in PE: Inspection, Auscultation, Percussion, Palpation
Important to obtain at this time are:
- Height
- Weight
- Vital Signs
- General physical appearance- examine body structures for evidence of hyper-secretion or hypo secretion of hormones (p. 753)
- Inspection of skin (oily or dry)
- Inspect for excessive or absent areas of pigmentation
- Inspect excessive hair growth or loss
- Inspect for skin with poor healing
- Examine shape and color of nails (thickness- thick or thin?; brittleness?)
- Examine eyes for exophthalmos, which is an abnormal bulging (protrusion) of the eye seen in hyperthyroidism, and for periorbital swelling
- Observe patient facial expression and general features
- Visually inspect neck for thyroid enlargement and gently palpate the thyroid gland. Remember that repetitive palpation of the thyroid may "result in a sudden release of a large amount of thyroid hormones, which can have serious implications" (p. 754), so be GENTLE.
- Note rate and rhythm of pulse (hyperthyroidism causing increased pulse)
- Examine extremities for edema and pigmentation alterations
- Auscultate lungs for abnormal sounds
- Examine outstretched hands for tremors
- Determine if loss of motor function or decreased sensitivity to pain or touch in the extremities (DM may cause neuropathy which decreases the patient's ability to feel pain).
- Assess mental and emotional status and demeanor/affect (dull, apathetic, extremely nervous)
- Determine patient's ability to process information and respond to questions
Points to remember:
- Dysfunction may result from deficiency of excessive hormone secretion, transport abnormalities, an inability of the target tissue to respond to a hormone (resistance), or inappropriate stimulation of the target-tissue receptor
- Some signs of dysfunction are specific, such as the classic “polys”…polyuria, polydipsia, and polyphagia…in diabetes mellitus and exophthalmus in hyperthyroidism
- Common nonspecific symptoms are fatigue and depression, changes in energy levels, sleep patterns, mood, affect, weight, skin, hair, personal appearance,and sexual function.
- Assessment of endocrine system includes growth and development patterns, weight distribution and changes, and comparisons of these factors with normal findings
Diagnostic Tests
Fortunately, with emerging technology and research many diagnostic tests are available to diagnose endocrine disorders. Of course, the type of test - laboratory or diagnostic test - will vary depending on the tentative medical diagnosis (Timby & Smith, 2013).
Lab tests are performed to rule out disorders especially since endocrine disorders may be vague and to give a general status of the client.
The following tests may be ordered:
- Hormone levels can measure hormone levels and estimate production, transport, and catabolism of hormones
- Radiography (X-Ray), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)
- Radionuclide Studies, including radioimmunoassay and nuclear scan
Review on your own, see page 754-755.
Points to remember:
- Lab tests aid an confirm diagnosis.
- Several types of lab tests are used to determine endocrine status, including radioimmunoassay – to measure amounts of circulating hormones -, immunometric assay, radio receptor assay, and vitro bioassays.
- More discussion of labs with disorders in the next section
Nursing Management
Preparing the client for these diagnostic exams is an important role for the nurse. Teaching strategies for the nurse to use are providing verbal and written instructions which include the rationale for actions, if possible. Take note that if the patient is an older adult with cognitive changes, a family member or caregiver must be included during teachable moments and when giving instructions to ensure that they are followed correctly and accurately (Timby & Smith, 2013).
- Explain the procedure: purpose, type of test, and how it will be performed.
- Always give patient time to process the information received and allow time for questions.
- Provide patient with the proper preparation instructions for the type of test they are getting (i.e. fasting, avoiding certain foods or medications, save all urine voided during a set time, return for additional testing, etc.)
- Reassure patient if concerned about use of radioactive materials for tests.