Ma.

Aliyah Cassandra Mondelo BSN - 3D RLE 114 - Ma’am Leila Garcia

Endocrine Function

Slide 1: THE ENDOCRINE SYSTEM

● The endocrine system enables the body to grow and develop, reproduce, metabolize energy,
maintain homeostasis, and respond to stress and injury. This complex system consists of glands
that synthesize and secrete hormones.
● With aging, the endocrine system experiences changes that can be diverse and interrelated in
that some changes are compensatory responses for others.
● Knowledge of these changes and their effects is beneficial in interpreting symptoms and advising
older adults regarding practices to promote optimal health.

Slide 2: EFFECTS OF AGING ON ENDOCRINE FUNCTION

● As people age, the thyroid gland gradually atrophies, leading to lower basal metabolic rate,
reduced iodine uptake, and decreased thyrotropin secretion.
● While thyroid activity decreases, it generally remains sufficient for daily needs.
● Aging also reduces adrenocorticotropic hormone, which in turn lowers adrenal production of key
hormones (e.g., estrogen, progesterone, and glucocorticoids).
● Additionally, pituitary gland volume and growth hormone levels decrease, and insulin production
declines with reduced sensitivity in body tissues. This can impair glucose metabolism, especially
after consuming high glucose.
● Endocrine health promotion includes giving attention to these effects of aging and any symptoms
of endocrine dysfunction in older adults in order to facilitate intervention and treatment.

Slide 3: SELECTED ENDOCRINE CONDITIONS AND RELATED NURSING CONSIDERATIONS

1. Diabetes Mellitus
● A blend of various knowledge and skills is required when caring for older adults who have
diabetes.
● Type 2 diabetes, the seventh leading cause of death among older adults, affects 20% of the older
population and has a particularly high prevalence among African Americans and people who are
65 to 74 years of age.
● Consequently, nurses must be adequately informed of how the detection and management of
diabetes in older adults differs from that in other age groups.
● Glucose intolerance is common in older adults and was once attributed to natural age-related
declines in glucose tolerance. However, obesity and inactivity, often seen in older adults, are now
significant contributors to this condition. These factors may partly explain the high incidence of
diabetes.

Slide 4: DIAGNOSIS OF DIABETES IN OLDER ADULTS

● Classic diabetes symptoms may be absent in older adults, making early detection challenging.
● Non-specific symptoms like confusion, neuropathy, and infections may be the only signs.
● Recommended screening: Fasting blood sugar tests every 3 years for those over 45
● Signs of diabetes in older adults: Orthostatic hypotension, periodontal disease, stroke, gastric
hypotony, impotence, neuropathy, glaucoma, and infections.
● The diagnosis of diabetes is usually established if one of the following criteria exists:
1. Symptoms of diabetes and a random blood glucose concentration ≥200 mg/dL.
2. Glycosylated hemoglobin (HbA1c) ≥6.5%.
3. Fasting blood glucose concentration ≥126 mg/dL (8-hour fast).
4. Blood glucose concentrations 2 hours after an oral glucose intake ≥200 mg/dL during an oral glucose
tolerance test. The test should be performed as described by the World Health Organization, using a
glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.
● These results are usually confirmed by repeat testing on a different day.

Slide 5: PATIENT EDUCATION

● In managing diabetes, patient education is crucial to ensure effective self-care and prevent
complications.
● This education includes understanding diabetes mellitus, with a focus on basic anatomy,
physiology, and nutrient metabolism. Older adults are educated on how age can impact glucose
metabolism, symptom presentation, and lead to complications.
● Nutritional guidance is provided, emphasizing food groups, balanced meal plans, reading food
labels, and flexible dietary choices that maintain blood glucose stability.
● Physical activity is encouraged, with a focus on coordinating exercise goals with healthcare
providers, monitoring glucose levels, staying well-hydrated, and recognizing exercise-related
risks.
● Medication education covers the correct administration, dosages, potential side effects, and drug
interactions. Individuals also learn about the importance of regular glucose monitoring, with
guidelines on procedures and goals.
● Recognizing the symptoms of hypoglycemia and hyperglycemia is critical, along with
understanding preventive actions and appropriate responses.
● To prevent long-term complications, individuals receive guidance on foot care, regular eye exams,
and adjusting diabetes management during illness, with an emphasis on recognizing early signs
of complications such as infections or neuropathy.

Slide 6: CARE PLAN GOALS FOR THE PATIENT WITH DIABETES

● To verbalize understanding of diabetes and its management

● To demonstrate proper technique for administration of antidiabetic medication
● To demonstrate correct method of blood glucose testing
● To be free from signs of hypoglycemia and hyperglycemia
● To describe signs and symptoms of hypoglycemia and insulin shock
● To adapt management of diabetes to lifestyle
● To maintain weight at appropriate level or to lose specified amount
● To engage in a regular exercise program
● To be free from injury
● To be free from infection
● To be free from impairments in skin integrity
● To be free from complications associated with diabetes

Slide 7: SELECTED ENDOCRINE CONDITIONS AND RELATED NURSING CONSIDERATIONS

2. Hypothyroidism
● Thyroxine (T4) and triiodothyronine (T3) are crucial hormones produced by the thyroid gland,
which experiences age-related changes like atrophy, fibrosis, and increased colloid nodules.
● Although T4 production declines with age, this is believed to be a compensatory response, and
serum thyroid hormone levels typically remain stable.
● Hypothyroidism, marked by low thyroid hormone levels in tissues, becomes more common with
age, particularly in women. It can be primary, resulting from thyroid destruction, or secondary, due
to low thyroid-stimulating hormone (TSH) secretion from the pituitary gland.
● Primary hypothyroidism features low free T4 and elevated TSH, while secondary presents with
low T4 and TSH.
Slide 8: DIAGNOSIS OF HYPOTHYROIDISM IN OLDER ADULTS

● Symptoms of hypothyroidism can be easily missed or attributed to other conditions and include
the following: Fatigue, weakness, and lethargy Depression and disinterest in activities Anorexia
Weight gain and puffy face Impaired hearing Periorbital or peripheral edema Constipation Cold
intolerance Myalgia, paresthesia, and ataxia Dry skin and coarse hair

Slide 9: TREATMENT

● Treatment includes replacement of thyroid hormone using a synthetic T4 (e.g., synthroid and
thyroxine).
● Initially, a low dose is recommended to avoid exacerbation of asymptomatic coronary artery
disease.
● Regular monitoring provides feedback for the need for dosage adjustments.
● Initially, thyroid replacement is prescribed at a low dose and gradually increased under close
supervision to prevent cardiac complications.
● Nursing measures should support the treatment plan and assist patients with the management of
symptoms (e.g., prevention of constipation and provision of extra clothing to compensate for cold
intolerance).
● It is important that patients understand that thyroid replacement will most likely be a lifelong
requirement.

Slide 10: SELECTED ENDOCRINE CONDITIONS AND RELATED NURSING CONSIDERATIONS

3. Hyperthyroidism
● In this disorder, the thyroid gland secretes excess amounts of thyroid hormones.
● Hyperthyroidism is less prevalent than hypothyroidism in older adults; it affects women more than
men.
● A potential cause of hyperthyroidism in older patients that should be considered is related to the
use of amiodarone, a cardiac drug containing iodine that deposits in tissue and delivers iodine to
the circulation over very long periods of time.
● Amiodaroneinduced thyroid dysfunction is prevalent; initial screening and periodic monitoring
should be done with patients on amiodarone to evaluate its impact on thyroid function.

Slide 11: DIAGNOSIS OF HYPERTHYROIDISM IN OLDER ADULTS

● Classic symptoms of hyperthyroidism include diaphoresis, tachycardia, palpitations, hypertension,

tremor, diarrhea, stare, lid lag, insomnia, nervousness, confusion, heat intolerance, increased
hunger, proximal muscle weakness, and hyperreflexia.
● However, as with hypothyroidism, hyperthyroidism can present with atypical symptoms in older
adults. For example, increased perspiration may not occur, and for the person with a history of
chronic constipation, diarrhea may be displayed by now having regular bowel movements.
● Diagnostic testing for hyperthyroidism can be challenging, especially in malnourished older
adults, as their T3 levels may be low despite excess secretion. This can result in T3 levels
appearing normal. Accurate diagnosis depends on evaluating T4, free T4, TSH, and increased
uptake on radionuclide thyroid scans.

Slide 12: TREATMENT

● Treatment of hyperthyroidism depends on the cause.

● Treatment for hyperthyroidism varies based on the underlying cause.
● In cases of Graves’ disease, an autoimmune disorder leading to antibody production that
stimulates thyroid growth and hormone overproduction, treatment usually involves antithyroid
medications or radioactive iodine.
● Patients with a history of thyroid disease require careful monitoring during acute illness, surgery,
or trauma, as these situations can trigger severe thyrotoxicosis (thyroid storm), potentially
necessitating hospitalization to stabilize thyroid levels.
 ● Resource/s:

Eliopoulos, C. (2018). Gerontological Nursing (9th ed.). Wolters Kluwer.

References:
Abbatecola, A. M., Barbagallo, M., Incalzi, R. A., Pilotto, A., Bellelli, G., et al. (2015). Severe
hypoglycemia is associated with antidiabetic oral treatment compared with insulin analogs in nursing
home patients with type 2 diabetes and dementia: Results from DIMORA study. Journal of the American
Medical Directors Association, 16, 349.e7–349.12. Published online February 7, 2015 at
http://www.jamda.com/article/S1525- 8610(14)00839-1/abstract

Farhan, H., Albulushi, A., Taqi, A., Al-Hashim, A., Al-Saidi, K., et al. (2013). Incidence and pattern of
thyroid dysfunction in patients on chronic aniodarone: Experience at a tertiary care center in Oman.
Open Cardiovascular Medicine Journal, 7, 122–126, Published online November 7, 2013 at
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866614/

Rawlings, A. M., Sharrett, A. R., Schneider, A. L. C., Coresh, J., Albert, M., et al. (2014). Diabetes in
midlife and cognitive change over 20 years. Annals of Internal Medicine, 161(11), 785–793.