S6: Fundamental of Nursing

Introductory activity 2

Introductory activity 2

Observe the picture above and answer the following questions:
1) What do you see on the picture above?
2) On your point of view, what is the role of each part mentioned on the 
picture above?
3) You receive a patient suspected of having endocrine disorder. What is 

general assessment you are going to perform

2.1. Specific History Taking on Endocrinology System

Learning activity 2.1

Observe the picture above and answer below questions:
1) What do you see on the picture above?
2) What are history to collect when suspecting a problem arising from the 
endocrine system?

2.1.1. Overview of history taking of endocrine system

The endocrine system is a series of glands and tissues that produce and secrete 
hormones, which are used by the body to regulate and coordinate vital bodily 
functions, including growth and development, metabolism, sexual function and 
reproduction, sleep and mood.
At the time of taking history of the patient focusing on endocrine system, the history 
regarding illness, personal history, family history and social history will be asked to 
patient. Furthermore, both subjective and objective data are assessed. Endocrine 
disorders and diseases usually manifest according to which endocrine hormone is 
being overproduced and secreted, or under-produced, at any given age.
History taking in endocrine system follows the general client history and focus on 
history regarding illness, personal history, family history, social history as well as 

subjective and objective data

a. History regarding illness
The health care professional asks the patient how and when the disease started. 
What are aggravating factors and what are alleviating factors of the disease.
b. Personal history
A personal history in endocrinology system is similar like other assessment and 
may include information about allergies, illnesses, surgeries, immunizations, and 

results of physical exams, tests, and screenings.

c. Family history
Family history is crucial in endocrinology system because a mutated gene 
causes different endocrine glands in the body to develop benign and cancerous 
neuroendocrine tumors. Endocrine glands secrete hormones, so tumors arising 
from these glands may also overproduce hormones that result in symptoms. Hence 
it can provide insight into a patient’s risk for developing certain cancers or even 
give a hint as to how aggressively a particular patient’s cancer might behave. 
Furthermore, many endocrinology systems develop along with a family because 
some families are exposed to develop a given disease example of diabetes. Health 
care provider asks a patient on history of the endocrinology disease in a given 
family.
d. Social history
The social history covers the patient’s lifestyle, such as marital status, occupation, 
education, and hobbies. It may also include information about the patient’s diet, use 
of alcohol or tobacco, and sexual history. Along with the chance to connect with the 
patient as a person, the social history can provide vital early clues to the presence 
of disease, guide physical exam and test-ordering strategies, and facilitate the 

provision of cost-effective, evidence-based care.

2.1.2. Subjective and objective data
After taking patient history, continue with subjective data and objective data
Ask the patient symptoms he /she is feeling and the patient can accuse one or 
more of the following symptoms: dizziness, fatigue or lethargy, weight gain or loss, 
changes in vision, feelings of depression, irritability, or anxiety, decreased libido, 
change in appetite, pain, nausea and vomiting, changes in urinary or bowel habits, 
intolerance to heat or cold. 
Objective data will focus on endocrinology system which will be discussed in this 
unit. Always assess patient from head to toe. 
Note:A patient with one endocrine disease (e.g., Hashimoto’s thyroiditis) is at greater 
risk for the development of other endocrine disorders (e.g., adrenal, testicular, or 

ovarian failure). 

Self-assessment 2.1 

1) The key to discovering the nature of the symptoms found during 
assessment is lying in understanding of the functions of the endocrine 
hormones. 
a. True 
b. False
2) Which sign will indicate a health professional to assess the endocrine 
system?
a. Fever
b. Bleeding
c. Frequent urination

d. Abdominal pain

2.2. General Survey in Endocrinology System 

Learning activity 2.2

The general appearance of a patient may provide diagnostic clues to the illness, 
severity of disease, and the patient’s values, social status, and personality. By 
gathering general survey in a person with endocrine system observing and focusing 
carefully on facies, features and expression, build & stature, nutrition, decubitus, 
neck vein, neck glands, anemia, cyanosis, clubbing, jaundice, edema, pulse, 

respiration, Temperature, BP, generalized skin & nail and extremities.

Note: stature and habitus: observe the patient’s body build. Very short stature 
will be seen in dwarfism, pseudo hypoparathyroidism, Turner’s syndrome, or 
prepubertal steroid therapy. Very tall and lanky people with long, thin extremities 
suggest Marfan’s syndrome.

Self-assessment 2.2 

1) What should you focus more while conducting general survey on 
endocrine system?
2) You receive a 30-year-old male with 90cm of height, what is the first 

disorder you think on your first sight?

2.3. Physical exam of endocrine system

Learning activity 1.9

Physical examination techniques in a focused endocrine assessment follows 
the same steps used in a general exam and it made of inspection, auscultation, 
percussion and palpation. 
2.3.1. Inspection
During inspection, a health professional inspect overall patient and note any 
abnormalities. He/she looks for generalized appearance, skin color, any lesion and 
its location, bruises or rashes, body shape and symmetry, size of body parts, any 
abnormal sounds, any abnormal odors, inspect the neck from the front.
2.3.2. Auscultation
Auscultation is done before palpation and percussion. 
2.3.3. Palpation
Palpation is done to assess endocrine system on the area where the organs linked 
to endocrine system are located. It can be light or deep palpation. Palpation helps 
health care professional to assess for texture, tenderness, temperature, moisture, 
pulsations, masses, and internal organs.
When palpating the neck where located thyroid gland, the patient sits with the neck 
muscles relaxed and stand behind him. Health care provider palpate gently the 
thyroid on the front of the patient’s neck, with index fingers just touching lateral to 
the trachea where the thyroid is located. In normal conditions, thyroid gland is not 
palpable.
Shape and surface: Simple goiter is relatively symmetrical in their earlier stages 
but often become nodular with time
Mobility: Most goiters move upwards with swallowing. Very large goiters may be 
immobile, and invasive thyroid cancer may fix the gland to surrounding structures. 
Consistency: Nodules in the substance of the gland may be large or small, and 
single or multiple, and are usually benign. A very hard consistency suggests 
malignant change in the gland. 
Large: firm lymph nodes near a goiter suggest thyroid cancer.
Tenderness: Diffuse tenderness is typical of viral thyroiditis, whereas localized 
tenderness may follow bleeding into a thyroid cyst. 
Thyroid bruit: This can be found during auscultation and indicates abnormally high 
blood flow and can be associated with a palpable thrill. It occurs in hyperthyroidism. 
A thyroid bruit may be confused with other sounds. A bruit arising from the carotid 
artery or transmitted from the aorta will be louder along the line of the artery. 
Transient gentle pressure over the root of the neck will interrupt a venous hum from 

the internal jugular vein.

Endocrine organs namely testes and thyroid glands are the only endocrine glands 

that may be accessible for physical examination. 

2.3.4. Percussion
Percussion helps to produce 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 area to percuss in endocrine disorder: enlarged pancreas, a pleural 
effusion associated with specific endocrine abnormalities, or a hormone-secreting 

tumor

Self-assessment 2.3

1) Outline 2 examples of organs that can be assessed during palpation in 
endocrine system.

2) Name other endocrine organs of the human body

2.4. Interpretation of specific findings in endocrine 

system

Learning activity 10

Observe the image below

1) The image above shows a male patient, what are particularities seen on 
this patient?
A comprehensive physical examination and its interpretation is required in endocrine 
system. Symptoms of endocrine disturbance are varied and non-specific, and affect 
many body systems.
The main endocrine glands are the pituitary, thyroid, parathyroid, pancreas, adrenals 
and gonads (testes and ovaries). These glands synthesize hormones which are 
released into the circulation and act at distant sites.
Examination sequence
The initial greeting may suggest a diagnosis. Inspect the face for a ‘spot’ endocrine 
diagnosis 
Observe the patient behavior: if the patient restless and agitated (hyperthyroidism)? 
or slow and lethargic (hypothyroidism)? 
Examine the entire skin surface, looking for abnormal pallor (hypopituitarism), 
vitiligo, plethora (Cushing’s or carcinoid syndrome) or pigmentation (Addison’s 
disease). 
If the patient is obese, is the adiposity centrally distributed (Cushing’s syndrome 
and growth hormone deficiency)? 
Observe the body hair in quality and amount: look for hirsutism in females with 
menstrual disturbance, especially on the face, chest and abdomen 
Examine the hands for excessive sweating, soft tissue overgrowth (acromegaly), 
skin crease pigmentation (Addison’s disease) and wasting of the thenar muscles 
due to carpal tunnel syndrome. Assess the pulse rate, rhythm and volume. Record 
the blood pressure because hypertension is a feature of several endocrine 
conditions. Check for postural hypotension with lying and standing blood pressures 
if you suspect adrenal insufficiency. 
Examine the eyes in all thyroid patients for external inflammation, proptosis, diplopia 
and visual function. Assess visual acuities and fields in patients with suspected 
pituitary tumors, to detect bitemporal hemianopia due to compression of the optic 
chiasm. Examine the fundi for optic atrophy in patients with longstanding optic 
pathway compression.
Examine the patient face and note any hirsutism (Hirsutism results in excessive 
amounts of stiff and pigmented hair on body areas where men typically grow 
hair, including the face, chest and back, Hirsutism can result from excess male 
hormones, called androgens. 
Examine the neck for goiter. If this is present, record its size, surface and consistency. 

Look for gynaecomastia (enlargement of a men’s breasts, usually due to hormone 

imbalance or hormone therapy) and for evidence of milk production in a man or non
breastfeeding woman (galactorrhoea). Inspect the axillae for acanthosisnigricans 
or loss of axillary hair 
Examine the male external genitalia. Inspect the amount of pubic hair and make 
a pubertal staging of all adolescents. Record testicular consistency and volume. 
Inspect the legs for evidence of pretibial myxoedema (Graves’ disease), proximal 

muscle wasting and weakness (Cushing’s syndrome and hyperthyroidism).

Self-assessment 2.4 

1) Hypertension is a feature of several endocrine conditions
a. True
b. False
2) The initial greeting of a patient suffering from endocrine system may 
suggest a diagnosis. 
a. True
b. False

3) Differentiate hirsutism from gynecomastia

2.5. Identification of client problem

Learning activity 2.5

Common endocrine disorders are: diabetes mellitus (a disease in which the 
body’s ability to produce or respond to the hormone insulin is impaired, resulting 
in abnormal metabolism of carbohydrates and elevated levels of glucose in the 
blood),acromegaly(overproduction of growth hormone), addison’s disease 
(decreased production of hormones by the adrenal glands), cushing’s syndrome 
(high cortisol levels for extended periods of time), graves’ disease (type of 
hyperthyroidism resulting in excessive thyroid hormone production), hashimoto’s 
thyroiditis (autoimmune disease resulting in hypothyroidism and low production 
of thyroid hormone), hyperthyroidism (overactive thyroid), hypothyroidism 
(underactive thyroid), prolactinoma(overproduction of prolactin by the pituitary 
gland). The Treatments depend on the specific disorder but frequently focus on 

regulating hormone balance using synthetic hormones.

Serious symptoms that might indicate a life-threatening condition

In some cases, endocrine disorders can be life threatening. The patient can have 
symptoms/signs like: confusion or loss of consciousness for even a brief moment, 
dangerously low blood pressure (extreme hypotension), dangerously slow heart 
rate, dehydration, depression or anxiety, difficulty breathing, eye problems, including 
dryness, irritation, pressure, pain or bulging severe fatigue or weakness, severe, 
unexplained headache, severe vomiting and diarrhea, sleep disturbances.

Self-assessment 2.5
1) Define the term acromegaly
2) Outline five Serious symptoms that might indicate a life-threatening 

endocrine condition

2.6. Nursing intervention based on client problem

Learning activity 2.6

A 35 years old patient, was admitted in medical word complaining of 
generalized body weakness, increased sensitivity to cold, constipation, dry 
skin, weight gain, puffy face, hoarseness, muscle weakness, pain, stiffness 
or swelling in joints, slowed heart rate, depression, impaired memory and 
enlarged thyroid gland (goiter).
1) What is the suspected diagnosis (problem) for this patient?

2.6.1. Interventions

Nursing intervention in endocrine system depends the client disorder. 
For diabetic patient, Monitor the patient’s signs of hyperglycemia and 
hypoglycemia and intervene accordingly. Monitor the patient weight to avoid 
obesity and help assess the adequacy of nutritional intake and vitals signs 
monitoring 
Education the importance of physical activity. Education on how to self inject insulin 
if any and how to take other medications. Physical activity helps lower blood glucose 
levels. Regular exercise is a core part of diabetes management and reduces the 

risk for cardiovascular complications.

Monitor patient for evidence of excess physical and emotional fatigue because 
hyperthyroidism results in protein catabolism, over activity, and increased 
metabolism leading to exhaustion.
Monitor cardiorespiratory response to activity (e.g., tachycardia, other dysrhythmias, 
dyspnea, diaphoresis, pallor, blood pressure [BP], and respiratory rate) because 
decompensation of cardiopulmonary function can occur with hypermetabolism.
Assist with regular physical activities (e.g., ambulation, transfers, turning, and 
personal care) to make certain patient’s daily needs are met.
Assist the patient to understand energy conservation principles (e.g., the requirement 
for restricted activity or bed rest) to avoid fatiguing patient.
Assist the patient to schedule rest periods and avoid care activities during scheduled 

rest periods to promote adequate rest.

2.6.2. Nutrition Management
Determine, in collaboration with the dietitian, the number of calories and type of 
nutrients needed to meet nutrition requirements.
Ascertain patient’s food preferences to determine extent of the problem and plan 
appropriate interventions.
Provide patient with high-protein, high-calorie, nutritious finger foods and drinks 
that can be readily consumed because hyperthyroidism increases metabolic rate 
with resulting need to prevent muscle breakdown and weight loss.
Offer snacks (e.g., frequent drinks, fresh fruits/juice) to maintain adequate caloric 
intake.
Monitor recorded intake for nutritional content and calories to evaluate nutritional 
status.
Weigh patient at appropriate intervals to evaluate effectiveness of nutritional plan.
Provide appropriate information about nutritional needs and how to meet them to 

promote self-care.

Assist the patient in receiving help from appropriate community nutritional programs.

2.6.3. Weight Management
Discuss with individual the medical conditions that may affect weight to reassure 
patient that optimal weight can be maintained with treatment of hypothyroidism.
Discuss with individual the relationship between food intake, exercise, weight gain, 
and weight loss to promote understanding of weight management.
Determine the individual’s ideal body weight to plan weekly weight loss goals.
Assist in developing well-balanced meal plans consistent with level of energy 
expenditure.
Develop with the individual a method to keep a daily record of intake, exercise 
sessions, and/or changes in body weight to promote progress toward final goal.
2.6.4. Constipation/Impaction Management
Encourage increased fluid intake (e.g., 2-3 L of fluids per day) to maintain soft stool.
Instruct patient/family on high-fiber diet to increase knowledge of how to increase 
fecal mass.
Monitor bowel movements, including frequency, consistency, shape, volume, and 
color, to plan appropriate interventions.
Suggest use of laxatives/stool softeners to stimulate bowel evacuation.
Teach patient/caregivers about timeframe for resolution of constipation because 
elimination patterns will improve with treatment of hypothyroidism.
2.6.5. Reality Orientation
Monitor for changes in orientation, cognitive and behavioral functioning, and quality 
of life to determine appropriate interventions.
Inform patient of person, place, and time to decrease confusion.
Provide a low-stimulation environment for patient in whom disorientation is increased 
by overstimulation.
Speak to patient in slow, distinct manner with appropriate volume to allow patient 
to understand.
Avoid requests that exceed the patient’s capacity (e.g., abstract thinking when 
patient can think only in concrete terms, decision making beyond preference or 
capacity) to decrease frustration and loss of self-esteem.

Use environmental cues (e.g., signs, pictures, clocks, calendars) to maintain 

orientation to time and day.

2.6.6. Infection Protection
Monitor for systemic and localized signs and symptoms of infection so infection can 
be detected early and treatment initiated promptly.
Provide private room.
Maintain asepsis for patient at risk.
Screen all visitors for communicable diseases to reduce the risk of infection 
exposure.
Monitor absolute granulocyte count, WBC count, and differential results to detect 
infection and plan treatment.
Obtain cultures as indicated to identify and treat infectious organisms.
Inspect skin and mucous membranes for redness, extreme warmth, or drainage 
because other signs and symptoms of infection may be minimal or absent.
Teach patient and family members how to avoid infections (e.g., hand washing).
Teach the patient and family about signs and symptoms of infection and when to 
report them to the health care provider.
2.6.7. Self-Esteem Enhancement
Encourage patient to identify strengths to promote awareness of capabilities.
Reinforce the personal strengths that patient identifies.
Make positive statements about the patient to boost morale by providing positive 
feedback.
Encourage increased responsibility for self to improve patient’s appearance and 
self-esteem.
2.6.8. Teaching: Disease Process
Provide reassurance about patient’s condition (e.g., explaining physical and 
emotional changes will resolve with hormonal balance) to increase their 
understanding and assist with coping.
2.6.9. Skin Surveillance
Observe extremities for color, warmth, swelling, pulses, texture, edema, and 
ulcerations for early detection of skin impairment.
Monitor for sources of pressure and friction to prevent injury to easily traumatized 
tissue.
Monitor skin for rashes and abrasions to promote early treatment.
Monitor skin and mucous membranes for areas of discoloration, bruising, and 
breakdown to provide early treatment.
Document skin or mucous membrane changes to provide early intervention.
2.6.10.Skin Care: Topical Treatments
Provide support to edematous areas to promote circulation to edematous areas.

Use devices on the bed (e.g., sheepskin) that protect the patient.

Self-assessment 2.6

1) Outline 5 action of nurse in prevention of infection for the patient with 
endocrine disorders.
2) The nurse should ensure skin Surveillance in order to 
a. Maintain skin color
b. Detect early signs of skin impairment.

c. Keep the skin clean

End unit assessment 2

1) Explain the hormones produced by each gland in the diagram above and 
its role in human body.
2) What is the result of overproduction and hypo production of each gland 
shown in this diagram in human body?
3) Explain the component of history taking in endocrine assessment

4) Observe the table below and match a disease with its cause