Angelite Nurses

Health History

1. Presenting problem: symptoms may include
1. Change in appearance: hair, nails, skin (change in texture or pigmentation); change in size, shape, or symmetry of head, neck, face, eyes, or tongue
2. Change in energy level
3. Temperature intolerance
4. Development of abnormal secondary sexual characteristics; change in sexual function
5. Change in emotional state, thought pattern, or intellectual functioning
6. Signs of increased activity of sympathetic nervous system (e.g., nervousness, palpitations, tremors, sweating)
7. Change in bowel habits, appetite, or weight; excessive hunger or thirst
8. Change in urinary pattern
2. Life-style: any increased stress
3. Past medical history: growth and development (any delayed or excessive growth); diabetes, thyroid disease, hypertension, obesity, infertility
4. Family history: endocrine diseases, growth problems, obesity, mental illness

Physical Examination

1. Check height, weight, body stature, and body proportions.
2. Observe distribution of muscle mass, fat distribution, any muscle wasting.
3. Inspect for hair growth and distribution.
4. Check condition and pigmentation of skin; presence of striae.
5. Inspect eyes for any bulging.
6. Observe for enlargement in neck area and quality of voice.
7. Observe development of secondary sex characteristics.
8. Palpate thyroid gland (normally cannot be palpated): note size, shape, symmetry, any tenderness, presence of any lumps or nodules.

Laboratory/Diagnostic Tests
A variety of tests may be performed to measure the amounts of hormones present in the serum or urine in assessing pituitary, adrenal, and parathyroid functions; these tests will be referred to when appropriate under specific disorders of the endocrine system.

Thyroid Function

1. Serum studies: nonfasting blood studies (no special preparation necessary)
1. Serum T₄ level: measures total serum level of thyroxine
2. Serum T₃ level: measures serum triiodothyronine level
3. TSH: measurement differentiates primary from secondary hypothyroidism
2. Radioactive iodine uptake (RAIU)
1. Administration of ¹²³I or ¹³¹I orally; measurement by a counter of the amount of radioactive iodine taken up by the gland after 24 hours
2. Performed to determine thyroid function; increased uptake indicates hyperactivity; minimal uptake may indicate hypothyroidism
3. Nursing care
1. Take thorough history; thyroid medication must be discontinued 7-10 days prior to test; medications containing iodine, cough preparations, excess intake of iodine-rich foods, and tests using iodine (e.g., IVP) can invalidate this test.
2. Assure client that no radiation precautions are necessary.
3. Thyroid scan
1. Administration of radioactive isotope (orally or IV) and visualization by a scanner of the distribution of radioactivity in the gland
2. Performed to determine location, size, shape, and anatomic function of thyroid gland; identifies areas of increased or decreased uptake; valuable in evaluating thyroid nodules
3. Nursing care: same as RAIU

Pancreatic Function

1. Fasting blood sugar: measures serum glucose levels; client fasts from midnight before the test
2. Two-hour postprandial blood sugar: measurement of blood glucose 2 hours after a meal is ingested
1. Fast from midnight before test
2. Client eats a meal consisting of at least 75 g carbohydrate or ingests 100 g glucose
3. Blood drawn 2 hours after the meal
3. Oral glucose tolerance test: most specific and sensitive test for diabetes mellitus
1. Fast from midnight before test
2. Fasting blood glucose and urine glucose specimens obtained
3. Client ingests 100 g glucose; blood sugars are drawn at 30 and 60 minutes and then hourly for 3-5 hours; urine specimens may also be collected
4. Diet for 3 days prior to test should include 200 g carbohydrate and at least 1500 kcal/day
5. During test, assess the client for reactions such as dizziness, sweating, and weakness
4. Glycosylated hemoglobin (hemoglobin A_1c) reflects the average blood sugar level for the previous 100-120 days. Glucose attaches to a minor hemoglobin (A_1c). This attachment is irreversible.
1. Fasting is not necessary.
2. Excellent method to evaluate long term control of blood sugar.