Endocrine System
Key Points
- Endocrine glands release hormones that regulate metabolism, growth, reproduction, and energy use.
- Pancreatic insulin is central to blood-glucose control and is a major focus of clinical monitoring.
- Uncontrolled diabetes can damage cardiovascular, renal, neurologic, and visual systems over time.
Pathophysiology
The endocrine system coordinates organ function through hormone signaling transported by blood. Major glands include pituitary, thyroid, parathyroid, adrenals, pancreas, gonads, thymus, and pineal structures, each contributing to homeostasis.
In diabetes, insulin production or insulin responsiveness is impaired, causing chronic hyperglycemia. Persistent glucose elevation injures blood vessels and nerves, increasing risk of falls, infection, kidney disease, cardiovascular events, and vision loss.
Classification
- Type 1 diabetes: Pancreas cannot produce adequate insulin.
- Type 2 diabetes: Insulin resistance reduces cellular glucose uptake.
- Glycemic emergency patterns: Hypoglycemia from excess insulin/low intake and hyperglycemia from insufficient insulin relative to intake.
Nursing Assessment
NCLEX Focus
Priority items test recognition of hypoglycemia versus hyperglycemia and immediate reporting/escalation actions.
- Observe for hypoglycemia symptoms: confusion, irritability, shakiness, clammy skin, sweating, hunger, and anxiety.
- Observe for hyperglycemia symptoms: polyuria, polydipsia, polyphagia, fruity breath, warm dry skin, and deep rapid breathing.
- Monitor skin and feet for neuropathy-related injury risk and delayed wound recognition.
- Report acute mental-status changes, respiratory pattern changes, or severe glycemic-symptom clusters immediately.
Nursing Interventions
- Reinforce nutrition patterns that reduce glycemic extremes (whole grains, nonstarchy vegetables, lower refined sugar intake).
- Encourage safe activity as tolerated to support glucose management and cardiovascular health.
- Support prescribed glucose-monitoring workflow and escalate abnormal symptoms rapidly.
- Perform daily foot-skin surveillance and protect skin from pressure/friction injury.
Glycemic Crisis Risk
Severe untreated hypoglycemia or hyperglycemia can progress to coma and requires immediate nursing escalation.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| insulin | Basal and rapid-acting insulin contexts | Timing with carbohydrate intake is critical to avoid dangerous glucose swings. |
| oral-antidiabetic-agents | Type 2 diabetes management context | Monitor trends and report persistent out-of-range symptoms despite therapy. |
Clinical Judgment Application
Clinical Scenario
A resident with diabetes becomes shaky, confused, and diaphoretic shortly before a meal.
Recognize Cues: Classic low-blood-glucose symptom cluster. Analyze Cues: Glycemic imbalance may be progressing rapidly toward severe neuroglycopenia. Prioritize Hypotheses: Immediate priority is urgent nurse intervention for suspected hypoglycemia. Generate Solutions: Report immediately, support safety, and prepare for ordered glucose-correction pathway. Take Action: Stay with resident and assist rapid escalation workflow. Evaluate Outcomes: Symptoms resolve and follow-up prevention plan is reinforced.
Related Concepts
- diabetes-mellitus - Core endocrine disorder requiring continuous self-management support.
- hypoglycemia - Acute low-glucose emergency pattern.
- hyperglycemia - Acute high-glucose pattern linked to dehydration and metabolic risk.
- cardiovascular-system - Diabetes significantly increases vascular-complication burden.
- foot-care-in-diabetes - Neuropathy-related injury prevention reduces amputation risk.
Self-Check
- Which findings most reliably distinguish hypoglycemia from hyperglycemia?
- Why does chronic hyperglycemia increase fall and infection risk?
- Which daily interventions best protect skin and foot integrity in diabetes care?