Chapter 31: the child w/ endocrine dysfxn

Question 1

Endocrine system

Answer 1

-Metabolic processes
-Influences growth and development, electrolyte balance, energy production, sexual maturation and reproduction, body’s response to stress (internal homeostasis

Question 2

pituitary gland fxn

Answer 2

-aka hypophysis
-regulates other glands
-anterior gland is master gland and controlled by hypothalamus

Question 3

hypopituitarism: growth hormone deficiency

Answer 3

-gh also called somatropin
-causes poor growth and short stature
-dx: skeletal survey in child < 3 y, hand x-ray, endocrine studies
-tx: biosynthetic gh injections, thyroid extract, cortisone, testosterone or estrogen or progesterone
-mgmt: consider body image and finances of daily injections
-growth rate of 3.5-4 cm/yr before tx to 8-9 cm/yr after tx

Question 4

pituitary hyperfxn

Answer 4

-excessive gh
-excess gh before epiphyseal closure = gigantism
-excess gh after epiphyseal closure = acromegaly
-gigantism: height of 8 ft+, vertical growth and increased muscle
-acromegaly: brow furrow, enlargement of base of nose, thickening of lips and nasolabial sulcus, teeth separation, enlargement of hands, increased facial hair, thickened skin
-major cause is tumor
-tx: surgery to remove tumor, radiation and radioactive implants, hormone replacement therapy after surgery
-mgmt: consider body image

Question 5

precocious puberty

Answer 5

-sexual development before age 9 in boys and age 8 in girls
-more common in girls
types: central,peripheral, incomplete
-tx: central treated w/ leuprolide acetate and discontinued at age normal puberty would occur
-mgmt: consider body image

Question 6

precocious puberty types

Answer 6

-central: premature production of gnrh (produces sex hormones), may produce ova and sperm
-peripheral: no secretion of gnrh, early overproduction of sex hormones causing breast and pubic hair growth
-incomplete: premature thelarche (breasts) and adrenarche (androgens) but delayed puberty

Question 7

diabetes insipidus (di)

Answer 7

-principal disorder of posterior pituitary
-results from hyposecretion of adh
-s/s: polyuria, polydipsia, low water and high salt in body, diluted urine, hypotension, dry skin
-1st sign is enuresis (involuntary urination at night) accompanied by insatiable thirst
-risk for hypovolemia d/t dehydration
-fluid restrictions have no effect on urine production
tx: daily hormone replacement of vasopressin, ddavp (nasal spray or im or sq) for life, seizure precautions

Question 8

syndrome of inappropriate antidiuretic hormone (siadh)

Answer 8

-hypersecretion of adh
-s/s: fluid retention (edema), high water and low salt (< 120) in body, seizures, small amounts of dark sticky urine, personality changes

Question 9

thyroid fxn

Answer 9

-regulates basal metabolic rate (growth and development)
-secretes thyroid hormone (combo of thyroxine (t4) and triiodothyronine (t3)) and thyrocalcitonin

Question 10

juvenile hypothryoidism

Answer 10

-congenital: untreated will lead to intellectual disability, growth failure, delayed physical maturation
-acquired: thyroidectomy for ca or thyrotoxicosis, following radiation for hodgkin
-rarely from dietary insufficiency
-s/s: slowed growth, constipation, sleepiness, myxedematous skin (dry skin, sparse hair, periorbital edema)
-tx: oral thyroid hormone replacement, tx for brain growth in infant, increasing amts over 4-8 weeks to reach euthyroidism

Question 11

juvenile hyperthyroidism

Answer 11

-common cause is graves disease (autoimmune response to tsh receptors)
-enlarged thyroid gland and exophthalmos
-peaks at 12-14 yrs
-s/s: develop over 6-12 m, exophthalmos eyes, excessive motion, irritability, hyperactivity, short attention span, tremors, insomnia, emotional lability, gi hyperactivity, pounding pulse when sleeping, cardiomegaly, skin is warm flushed and moist, heat intolerance w/ diaphoresis, losing weight w/ good appetite, oligomenorrhea
-tx: antithyroid drugs (ptu and methimazole), subtotal thyroidectomy, ablation w/ radioiodine

Question 12

thyrotoxicosis

Answer 12

-thyroid crisis or storm
-sudden release of hormone
-unusual in children but life threatening
-precipitated by infection, surgery or discontinuation of antithyroid therapy
tx: antithyroid drugs, propranolol

Question 13

thyroid nursing mgmt

Answer 13

-quiet environment, rest periods
-help family cope w/ emotional lability
-dietary requirements to meet child’s increased metabolic rate

Question 14

parathyroid gland fxn

Answer 14

-secretes parathormone (pth)
-maintain serum calcium

Question 15

hypoparathyroidism

Answer 15

-autoimmune condition
-decreased ca and increased p
-dx: kidney fxn test, increased bone density and suppressed growth
-pseudohypoparathyroidism: production of pth is increased but end organs are unresponsive to hormone, x-linked dominant trait
-s/s: dry, scaly skin w/ eruptions, brittle hair, thin nails, tetany, neuro changes, chvostek or trousseau sign
-tx: vitamin d, oral ca

Question 16

hyperparathyroidism

Answer 16

-primary: adenoma of gland
-secondary: chronic renal disease, congenital anomaly of urinary tract
-common factor is hypercalcemia
-rare in children
-dx: ultrasound, mri
-tx: surgery or treat underlying cause

Question 17

diabetes mellitus (dm)

Answer 17

-deficiency of insulin
-most common endocrine disorder of childhood
-peaks in adolescence
-s/s: polyuria, polydipsia, polyphagia, hgb a1c > 6.5%, random glucose > 200, 8 hr fasting glucose > 126, oral glucose tolerance test > 200
-types: type 1, type 2, maturity-onset diabetes of the young (mody)

Question 18

dm: types

Answer 18

-type 1: destruction of beta cells, absolute insulin deficiency, majority of diabetes in children, believed to be autoimmune (hereditary)
-type 2: insulin resistance, onset after age 40, native american, hispanic, african american at increased risk, require insulin injections

Question 19

diabetic ketoacidosis (dka)

Answer 19

-acute and life threatening
-hyperglycemia > 300, acidosis ph 7.3 and bicarb 15, ketones in blood, urines and lungs, kussmaul respirations and acetone (fruity) breath
-caused by acute stress or poor mgmt
-admitted to picu
-tx: rapid isotonic fluid replacement, add glucose to ivf when sugar per protocol, monitor glucose hourly, admin regular insulin

Question 20

long-term complications of dm

Answer 20

-failure to grow or delayed puberty
-retinopathy
-hypothyroidism
-poor wound healing
-recurrent infections
-neuropathy
-vascular complications

Question 21

type 1 dm mgmt

Answer 21

-2 or more insulin injections a day or continuous via iv pump
-goal insulin range 80-100
-q3h urine ketone testing during illness and whenever glucose is > 240 when illness isn’t present

Question 22

insulin pumps

Answer 22

-device gives rapid-acting insulin continuously (novolog, humalog, apidra)
-attaches to body
-insulin deliver can be after meal
-must count carbs and monitor glucose

Question 23

types of insulin

Answer 23

-rapid acting: insulin lispro
-short acting: regular insulin
-intermediate acting: nph insulin
-long acting: insulin glargine u-100

Question 24

type 1 dm mgmt

Answer 24

-oral meds if can’t be controlled by diet and exercise
-nsg: admin w/ food, warn some otc drugs may increase hypoglycemic effect
-adverse effects of oral agents: headache, dizziness, flatulence, gi distress, edema, increased liver enzymes
-insulin injections 2nd choice afte oral agents

Question 25

dm nursing mgmt for each age group

Answer 25

-infant: support for caregivers
-toddlers: establish routines, rituals, discipline
-preschoolers: use play therapy and encourage participation
-school age: practice injection on dolls
-adolescents: slowly turn over care to adolescent, assess for risk taking behaviors, promote identity/independence