Caring for the Child with an Endocrinological or Metabolic Condition Flashcards
Exam 3
Endocrine System: What is it composed of? What does if involve?
Composed of glands, tissues, or clusters of cells that produce and release hormones in a negative feedback system involving the hypothalamus and nervous system.
Endocrine System: What does it influence?
Influences all physiologic processes
Endocrine System: Influences all physiologic processes like?
Growth and development.
Metabolic processes related to fluid and electrolyte balance and energy
production.
Sexual maturation and reproduction.
The body’s response to stress.
Maintenance of internal homeostasis.
Organs or Tissues of the Endocrine System include:
Pituitary gland and hypothalamus (“control centers”).
Thyroid gland.
Parathyroid glands.
Adrenal glands.
Gonads (ovaries and testes).
Islets of Langerhans located in the pancreas.
Health history: What questions should be included?
History should include questions related to family history or growth and development difficulties (late development of secondary sex characteristics)
Health history: What else should be included?
Diet and elimination patterns. Extreme thirst, excessive appetite, frequent voiding.
Common Medications for Endocrine Disorders
Hypoglycemics (oral, injectable)
Hormone therapy (supplemental)
Hormone suppression therapy
Corticosteroids and mineralocorticosteroids
Desmopressin acetate (DDAVP)
Laboratory and Diagnostic Testing for Endocrine Disorders
Newborn metabolic screening
Serum chemistry
Random and timed serum hormone testing
Growth hormone stimulation testing
Blood glucose (fasting, random and OGTT), HgA1C
Urine testing (ketone, glucose, 24 hour collections)
Genetic testing
Water deprivation study
Bone age radiographs
Imaging studies—CT, MRI, nuclear medicine, ultrasonography
Pituitary Disorders: What two hormones are involved?
Anterior hormones
Posterior hormones
Pituitary Disorders: Anterior hormones can cause?
Growth hormone deficiency
Hyperpituitarism
Precocious puberty
Pituitary Disorders: Posterior hormones can cause?
Diabetes insipidus
Syndrome of inappropriate antidiuretic hormone secretion
Complications of Growth Hormone Deficiency and Therapy
Altered carbohydrate, protein, and fat metabolism
Hypoglycemia
Glucose intolerance/diabetes
Slipped capital femoral epiphysis (SCFE)
Pseudotumor cerebri
Leukemia
Recurrence of CNS tumors
Infection at the injection site
Edema and sodium retention
Common Medical Treatments for Endocrine Disorders include:
Dietary interventions.
Glucose monitoring and insulin delivery via programmable pumps.
Irradiation/administration of radioactive iodine.
Surgery.
Goals of Nursing Management of Precocious or Delayed Puberty: What are you educating about?
Educating the child and family about the physical changes the child is experiencing.
Teaching how to correctly use the prescribed medications.
Goals of Nursing Management of Precocious or Delayed Puberty: What are you helping child with?
Helping the child to deal with self-esteem issues related to the differences in the rate of growth and development of secondary sexual characteristics compared to peers.
Goals of Nursing Management of Precocious or Delayed Puberty: What are you promoting?
Promoting age-appropriate physical development and pubertal progression.
Comparison of Diabetes Insipidus versus Syndrome of Inappropriate ADH (SIADH)
DI: level of water? urine? salt? serum osmolality? Urine specific gravity? Urine osmolality? Symptoms?
“High and dry”
Increased urine
Hypernatremia
High serum osmolality
Low urine specific gravity
Low urine osmolality
Dehydration and thirst
Comparison of Diabetes Insipidus versus Syndrome of Inappropriate ADH (SIADH)
SIADH: level of water? urine? salt? serum osmolality? Urine specific gravity? Urine osmolality? Symptoms?
“Low and wet”
Decreased urine output
Hyponatremia
Low serum osmolality
High urine specific gravity
High urine osmolality
Fluid retention, weight gain, Increased bp
Thyroid Disorders in Children:
Hyperthyroidism: How common is it in children?
rare in children
Thyroid Disorders in Children include:
Hyperthyroidism: rare in children
Hypothyroidism: can be congenital or acquired
Thyroid Disorders in Children:
Hypothyroidism: How can children get it?
can be congenital or acquired
Thyroid Disorders in Children:
Hyperthyroidism: How is it mostly seen?
mostly seen as Graves Disease.
Thyroid Disorders in Children:
Hyperthyroidism: How are levels present in this condition?
Excessive T3, T4, T3 resin uptake.
TSH usually low.
Thyroid Disorders in Children:
Hyperthyroidism: How is it treated?
Treated by destruction of thyroid gland.
Thyroid Disorders in Children:
Hypothyroidism: What populations are at risk?
Certain populations at risk (Downs, maternal hypothyroidism).
Thyroid Disorders in Children:
Hypothyroidism: What are hormone levels?
Decreased thyroid hormones.
Decreased T3, T4, T3 resin uptake.
TSH usually elevated.
Thyroid Disorders in Children:
Hypothyroidism: What is needed to treat this?
Lifelong thyroid supplementation.
Hypothyroidism Versus Hyperthyroidism
Hyperthyroidism symptoms:
Nervousness
Diarrhea
Heat intolerance
Weight loss
Smooth, velvety skin
Hypothyroidism Versus Hyperthyroidism
Hypothyroidism symptoms:
Tiredness/fatigue
Constipation
Cold intolerance
Weight gain
Dry, thick skin,
Edema of face, eyes and hands
Decreased growth
Promoting Growth for a Child With Congenital Hypothyroidism:
What should be measured and recorded?
Measure and record growth at regular intervals.
Promoting Growth for a Child With Congenital Hypothyroidism:
How are thyroid levels measured?
Measure thyroid levels every 2 to 4 weeks until the target range is reached on a stabilized dose of medication.
Promoting Growth for a Child With Congenital Hypothyroidism:
When should testing be done?
Obtain tests every 3 to 4 months for the first several years of life, changing to every 6 to 12 months during adolescence.
Promoting Growth for a Child With Congenital Hypothyroidism:
What should you monitor for signs of?
Monitor for signs of hypo- or hyperfunction, including changes in vital signs, thermoregulation, and activity level.
Promoting Growth for a Child With Congenital Hypothyroidism:
What should you provide?
Provide adequate rest periods and meet thermoregulation needs.
Signs of Thyroid Storm
Sudden onset of severe restlessness and irritability
Fever
Diaphoresis
Severe tachycardia
Disorders of parathyroid gland:
What does the parathyroid gland secrete?
The parathyroid gland secretes parathyroid hormone (PTH).
Disorders of parathyroid gland:
What regulates calcium and phosphate homeosstasis?
PTH + Vitamin D + calcitonin –> regulates calcium/phosphate homeostasis
Disorders of parathyroid gland:
What are the two disorders?
HYPOparathyroid:
HYPERparathyroid:
Disorders of parathyroid gland:
HYPOparathyroid:
Deficiency of PTH;
Disorders of parathyroid gland:
HYPOparathyroid: What can lead to a deficiency of PTH? What can deficiency lead to?
aplasia/hypoplasia, or accidental removal or trauma –> decreased Ca, increased Phosphorus
Disorders of parathyroid gland:
HYPERparathyroid:
Hypersecretion of PTH ;
Disorders of parathyroid gland:
HYPERparathyroid: What can cause a hypersecretion of PTH?
parathyroid adenoma;
Secondary hyperparathyroid d/t renal failure
Disorders of adrenal gland include:
Addison Disease:
Cushing syndrome:
CAH
Disorders of adrenal gland:
Addison Disease: What is it?
Deficiency in adrenal steroids, glucocorticoids (cortisol), and mineralocorticoids (aldosterone)
Disorders of adrenal gland:
Addison Disease: What can cause it?
Damage or destruction of adrenals by infection, dysfunction of hypothalamus, autoimmune or familial
Disorders of adrenal gland:
Addison Disease: What are symptoms of it?
Hyperpigmentation of skin
Hypoglycemia, hypotension, hyponatremia, hyperkalemia, dehydration
Disorders of adrenal gland:
Addison Disease: What is a severe form of it?
Adrenal crisis
Disorders of adrenal gland:
Cushing syndrome: What is it?
Excess levels of one or all of the hormones
Disorders of adrenal gland:
Cushing syndrome: What is it caused by?
Caused by small ACTH pituitary adenoma, but most common cause is excessive corticosteroid therapy.
Disorders of adrenal gland:
Congenital Adrenal Hyperplasia (CAH): What is it?
CAH is a group of autosomal recessive disorders in which there is insufficient supply of the enzymes required for synthesis of cortisol and aldosterone.
Disorders of adrenal gland:
CAH: What is a symptom?
Ambiguous genitalia
Polycystic ovarian syndrome:
What is it?
Functional ovarian hyperandrogenism or ovarian androgen excess
Testosterone production in ovaries is excessive
Polycystic ovarian syndrome:
What does it cause?
Causes hirsuitism, balding, acne, increased muscle mass, decreased breast size
Polycystic ovarian syndrome:
Complications include:
Complications include insulin resistance, infertility, CVD
Classification of Diabetes
What are the types of Diabetes?
Type 1:
Type 2:
Diabetes secondary to certain conditions
Gestational diabetes (diabetes during pregnancy).
Classification of Diabetes
What is Type 1 diabetes caused by:
Type 1: caused by a deficiency of insulin secretion due to pancreatic β-cell damage.
Classification of Diabetes
What is Type 2 diabetes caused by:
Type 2: consequence of insulin resistance that occurs at the level of skeletal muscle, liver, and adipose tissue with different degrees of β-cell impairment.
Classification of Diabetes
Diabetes can occur secondary to certain conditions like what?
Diabetes secondary to certain conditions such as cystic fibrosis, glucocorticoid use (as in Cushing syndrome), and certain genetic syndromes such as Down syndrome, Klinefelter syndrome, and Turner syndrome .
Classification of Diabetes
What is gestational diabetes?
Gestational diabetes (diabetes during pregnancy).
Examples of Nursing Diagnoses for Endocrine Disorders
Delayed growth and development.
Disturbed body image.
Deficient knowledge (specify).
Interrupted family processes.
Imbalanced nutrition: less than or more than body requirements.
Deficient or excess fluid volume.
Noncompliance.
Insulin Type, Action, and Duration:
What are the types of insulin?
Rapid Acting
Short Acting
Intermediate acting
Long acting
Insulin Type, Action, and Duration:
Rapid Acting insulin includes:
Lispro
Aspart
Glulisinc
Insulin Type, Action, and Duration:
Rapid Acting insulin (LAG) onset is:
Within 15 minutes
Insulin Type, Action, and Duration:
Rapid Acting insulin (LAG) peak is?
30-90 minutes
Insulin Type, Action, and Duration:
Rapid Acting insulin (LAG) duration is?
3-5 hours
Insulin Type, Action, and Duration:
Short acting insulin includes?
Regular insulin
Insulin Type, Action, and Duration:
Short acting insulin onset is?
30-60 minutes
Insulin Type, Action, and Duration:
Short acting insulin peak is?
2-4 hours
Insulin Type, Action, and Duration:
Short acting insulin duration is?
5-8 hours
Insulin Type, Action, and Duration:
Intermediate acting includes:
NPH
Insulin Type, Action, and Duration:
Intermediate acting onset is?
1–3 hours
Insulin Type, Action, and Duration:
Intermediate acting peak is?
4-10 hours
Insulin Type, Action, and Duration:
Intermediate acting duration is?
10-16 hours
Insulin Type, Action, and Duration:
Long acting insulin includes:
Glargine
Determir
Insulin Type, Action, and Duration:
Long acting insulin onset is?
1-2 hours
Insulin Type, Action, and Duration:
Long acting insulin peak is?
No clear peak, offer continuously steady coverage
Insulin Type, Action, and Duration:
Long acting insulin duration is?
6-24 hours
Complications of Diabetes Mellitus
Retinopathy
Nephropathy
Dyslipidemia
Hypertension
Celiac disease
Hypothyroidism
Signs and Symptoms of Diabetic Ketoacidosis
Anorexia, nausea and vomiting.
Lethargy, stupor, altered level of consciousness, confusion.
Decreased skin turgor.
Abdominal pain.
Kussmaul respirations and air hunger.
Fruity (sweet-smelling) or acetone breath odor.
Presence of ketones in urine and blood.
Tachycardia, and if left untreated, coma and death.
Goals of Therapeutic Management of Diabetes Mellitus
Achieving normal growth and development.
Goals of Therapeutic Management of Diabetes Mellitus:
What do you want to promote?
Promoting optimal serum glucose control, including fluid and electrolyte levels and near-normal hemoglobin A1C or glycosylated hemoglobin levels.
Promoting positive adjustment to the disease, with ability to self-manage in the home.
Goals of Therapeutic Management of Diabetes Mellitus:
What do you want to prevent?
Preventing complications.
Teaching Points for Diabetes Management
Self-measurement of blood glucose.
Urine ketone testing.
Medication use.
Signs and symptoms and treatment of hypoglycemia and hyperglycemia.
Monitoring for and managing complications.
Sick-day instructions.
Laboratory testing and follow-up care.
Diet and exercise as part of DM management.
