Chapter 28 Review: Endocrine Dysfunction Flashcards
What is hypopituitarism?
growth hormone deficiency where growth of all cells in the body is inhibited proportionately (shorter stature with proportional H&W)
How is hypopituitarism diagnosed?
3 diagnoses
- observation of familial growth patterns for comparison
– look at H&W growth trends – these children tend to fall off growth charts - definitive diagnosis = absence of or subnormal reserves of pituitary GH
- skeletal survey in children < 3 y.o. – look for ossification of bones
How is hypopituitarism treated?
2 treatments
- biosynthetic growth hormone injections
- other hormone replacements as needed
What are some nursing considerations for hypopituitarism?
5 considerations
- early identification is key – better chance that treatments will help them mimic normal growth pathways
- familial growth trends compared to child’s growth trends
- child’s body image
- daily injections
- expensive treatment
What is syndrome of inappropriate antidiuretic hormone secretion (SIADH)?
hypersecretion of posterior pituitary, resulting in excessive ADH production
How do children with SIADH usually present?
9 manifestations
- fluid retention, usually in belly
- hypotonicity
- anorexia d/t feeling full
- N/V
- irritability
- personality changes
- peripheral edema
- coarse breath sounds
- low urine output less than 1 mL/kg/hr – low volume, high concentration (high specific gravity)
How is SIADH managed?
4 treatments
- I&Os
- observe for signs of fluid overload
- seizure precautions – d/t build-up of toxins in body
- ADH-antagonizing medications
What s/s is common in both DI and SIADH?
excessive thirst
What do the 3 cells of the pancreas produce?
- alpha cells – glucagon
- beta cells – insulin
- delta cells – somatostatin
What is diabetes mellitus?
- total or partial deficiency of insulin
- most common endocrine disorder of childhood
- peak incidence is early adolescence – 10 - 15 y.o.
What is type 1 diabetes?
destruction of beta cells, causing an absolute insulin deficiency
What is type 2 diabetes?
arises d/t insulin resistance
What is ketoacidosis?
- when glucose is unavailable for cellular metabolism, the body begins to break down alternate sources for energy
- breakdown of protein creates ketones
- excess ketones are elimintated in the urine or by respiratrion
- ketones are strong acids and lower blood pH –> ketoacidosis
What are Kussmal respirations?
hyperventilation characteristic of metabolic acidosis – it is the body’s attempt to eliminate excess CO2
What is diabetic ketoacidosis?
- progressive deterioration with dehydration, electrolyte imbalance, acidosis, and coma
- may cause death
- pediatric emergency
How is diabetic ketoacidosis treated?
6 treatments
- administer fluids first – blood is viscous, so fluids dilute it down; 20 mL/kg
- administer insulin – don’t want to change blood sugar too rapidly; no more than 100 mg/dL/hr
- administer glucose and other electrolytes (K+ mostly)
- glucose monitoring – goal = less than 126 mg/dL
- urine test for ketones
- labs for A1c
What are some education topics for children with type 1 DM?
- nutrition
- exercise
- management of hypoglycemic episodes
- illness management
- management of DKA
- glucose monitoring
What are the types of rapid acting insulin, when do they start working, and what is their peak?
– Novolog & Humalog
* starts working in 15 min
* peak = 30 - 90 min
* take immediately prior to meals – make sure sugar/meal is in front of pt prior to administering
What are the types of intermediate acting insulin, when should it be administered, and when does it peak?
– NPH & Humalin
* administer in the AM
* peak = 6 - 8 hours
What is the name for long acting insulin, when should it be taken, and when does it peak?
– Lantus
* administer at dinner
* peak = no peak
