chapter 48: endocrine disorder

Question 1

1. which type of diabetes is more prevalent in pediatrics
2. what are the manifestations of hyperglycemia and hypoglycemia
3. what are the diagnostic tests for DM
4. what assessments are to be done for a patient with DM
5. what are some nursing considerations for meds used in type 1 diabetes
6. what would you teach the parents of a child with new diagnosis of type 1 diabetes?

Answer 1

1. type 1

2.

Question 2

what are organs of endocrine system

Answer 2

1. hypothalamus
2. pituitary
3. thyroid
4. parathyroid
5. adrenal
6. gonads
7. islets in pancreas

Question 3

what are diagnostic tests used for endocrine

Answer 3

1. CT, MRI, Ultrasound used to determine lesion
2. Urinalysis for ketones
3. serum osmolarity
4. serum sodium
5. fluid deprivation tests and water deprivation study

Question 4

Pituitary

1. what hormones released in anterior
2. what hormones released in posterior

Answer 4

1. Prolactin, growth hormone, ACTH, LH, FSH, TSH

2. vasopressin and oxytocin

Question 5

Growth hormone deficiency

1. aka
2. maybe caused by
3. clinical manifestation
4. diagnosis
5. therapeutic technique
6. complication

Answer 5

1. hypopituitarism, dwarfism
2. tumors, trauma, hereditary, deficiancies in TSH ACTH
3. poor growth, short stature, delayed epiphyseal closure, increased insulin sensitivity, delayed dentation
4. hand xray, GH stimulation test, Growth aptterns, IGF binding proteins, CT scans
5. synthetic growth hormone ( stopped once child grows less than 1 inch a year ), thyroid, cortisone, testosterone, or estrogen, or progesterone.
6. altered fat metabolism, glucose intolerance, diabetes, leukemia, infection at injection site, sodium retention

Question 6

hyperpituitarism

1. symptoms
2. diagnosis
3. nursing considerations

Answer 6

1. height of 8 ft or more, increased muscle growth, acromegaly
2. elevated GH (failure to suppress this when oral glucose level test), bone xray
3. early identification, emotional support

Question 7

precocious puberty

1. patho
2. treatment
3. nursing considerations

Answer 7

1. sexual development before 8 in girls and 9 in boys. occurs more frequently in girls. also has accelerated growth.
2. Treat the cause if known, Lupron.
3. treatment is halted at age when pubertal changes are to resume, psychological support

Question 8

Diabetes insipidous

1. patho
2. symptoms
3. treatment
4. nursing management

Answer 8

1. disorder in posterior pituitary resulting in hyposecretion of antidiuretic hormone resulting in excess urination
2. polyuria and polydipsia. in infants, they become irritable relieved with water not milk
3. lifelong adherence: vasopressin,
4. Monitor I and O, assess fir fluid overload and dehydration, seizure precaution, administer ADH antagonizing meds

Question 9

SIADH
1. patho
2signs and symptoms

Answer 9

1. excessive release of ADH resulting in fluidoverload

2. fluid retention and hypotonicity, N/V anorexia, irritability

Question 10

juvenile hypothyroidism

1. is it common in us
2. symptoms
3. treatment

Answer 10

1. no
   2, decelerated growth, thick tongue, constipation, sleepiness, dry skin, sparse hair, periorbital edema
2. early treatment: hormone replacement therapy, adherence to treatment

Question 11

Goiter

1. AKA
2. results from?
3. what is this a risk for
4. nursing management

Answer 11

1. hypertrophy of thyroid gland
2. maternal ingestion of antithyroid drugs during pregnancy
3. airway obstruction
4. this is a lifelong disease, eduate about adherence

Question 12

lymphocytic thyroiditis

1. patho
2. symptoms
3. treatment?

Answer 12

1. lymphocytic infiltration of the thyroid gland
2. inflammation, hyperplasia, some symptoms of hyperthyroidism (goiter, large eyes, weight loss, heat intolerance
3. may resolve within 1 to 2 years, or thyroid hormone replacement which would decrease goiter

Question 13

Hyperthyroidism

1. which is most common in children
2. S and S
3. management

Answer 13

1. graves disease
2. develops gradually, over 6 to 12 months usually: enlarged thyroid, T4 and T3 are elevated and TSH decreased.
3. decrease rate of thyroid hormone secretion through: thyroidecetomy, radiologic iodine, or meds

Question 14

thyroidtoxicosis

1. aka
2. patho
3. S and S
4. treatment
5. nursing consideration

Answer 14

1. thyroid storm, a medical emergency
2. sudden release of thyroid hormone from discontinuation of antithyroid therapy, surgery
3. restlessness suddenly with irritability, fever, diaphoresis, severe tachycardia
4. antithyroid drugs, propranolol
5. identify early, quite environment with rest periods, help with coping, dietary requirements

Question 15

how is growth promoted for child with hypothyroidism

Answer 15

1. record growth at regular intervals
2. measure thyroid levels every 2 to 4 weeks until target range is reached
3. in first years of life, tests are to be done every 3 to 4 months, then changing to every 6 to 12 months during adolescence
4. monitor for signs of hypo or hyper thyroidism : Vital signs, temperature, activity.
5. rest periods

Question 16

what does parathyroid gland release

Answer 16

1. PTH - maintains serum calcium by increasing release of calcium and phosphate and promotes calcium absorption in GI

Question 17

Hypoparathyroidism

1. patho
2. S and S

Answer 17

1. could be deficient PTH, pseudoparathyroidism, or production of PTH but organs are unresponisve
2. hypocalcemia, dry scaly skin, brittle hair, thin nals, tatany, lockjaw, stridor, spasm, HD, seizure, chvostek (facial nerve stimulation) and trousseau (hand spasm from blood pressure)

Question 18

hyperparathyroidism

1. caused by
2. diagnosed through
3. treatment
4. nursing consideration:

Answer 18

1. congenital or tumor or anomalies in urinary tract
2. blood calcium and parathyroid levels
3. surgical removal or treat underlying cause
4. monitor vitals, ekg, renal stones, calcium and phosphate levels. Monitor I and O, fluids, diet low in calcium but high in phosphate (watch kidney levels closely)

Question 19

what are released in adrenal glands

Answer 19

glucocortocoids (cortisone and corticosterone), aldosteron, androgens, estrogens, pregestins

Question 20

acute adrenal inssuficiency

1. aka
2. s and s

Answer 20

1. adrenal crisis is a medical emergency
2. fatigue, orthostatic hypotension, hyperpigmentation, hyponatremia, hyperkalemia, hypoglycemia, hypovolemia, hyperkalemia
3. early identification, maintain blood pressure and tissue perfusion, IV therapy, adrenal hormone replacement, VS, cardiac rhythms, monitor I and O and fluid levels.

Question 21

chronic adrenal insufficiency

1. aka
2. patho
3. diagnosis
4. S and S

Answer 21

1. Addison disease
   2 not enough cortisol and aldosterone, occurs whne 90% of tissue is nonfunctional
2. corticosteroid and potassium levels
3. muscle weakness, fatigue, dizziness, dark skin, fast pulse, dark freckles, bluish discoloration in mucus membranes, salt craving, N/V and diarrhea, intolerance to cold
4. corticosteroid is taken lifelong treatment

Question 22

Cushing syndrome

1. patho
2. educate about stopping steroid
3. S and S
4. nursing consideration

Answer 22

1. excessive cortisol through use of steroids or excess production
2. don’t stop using steroid abruptly
3. moon face, red chicks, poor wound healing and easy bruising, increased hair growth
4. avoid injury, avoid infection, perp for surgery, encourage rest and moderate activity.

Question 23

congenital adrenal hyperplasia nursing consideration

2. what is this

Answer 23

1. treat parent anxiety and teach parents about about signs and symptoms of dehydration and focus on genetic counseling.
2. female genitelia is affected

Question 24

hyperaldosteronism

1. results in
2. treatment and management

Answer 24

1. hypertension, hypokalemia, polyuria
2. replace potassium, block effects of aldosterone through spironolactone, assess for signs and symptoms for hypo and hyperkalemia

Question 25

pheochromocytome 1. patho 2. therapeutic techniques

Answer 25

1. adrenal tumor that secrete catecholamines | 2. surgical removal, lifelong therapy

Question 26

pancreatic hormone function

Answer 26

1. alpha cells prduce glucagon, betacells produce insulin, delta cells produce somatostatin

Question 27

diabetes 1. patho 2. diagnosis

Answer 27

1. typ1 has destroyed beta cells, type 2 body doesn't react to insulin properly 2. - 8 hr fasting glucose ( positive if 126 or more) - random glucose of 200 or more with manifestation - oral glucose tolerance test of 200 or more - HbA1C >6

Question 28

hyperglycemia signs and symptoms

Answer 28

1. thirst, polyuria, N/V, abdominal pain 2. flushed skin 3. dry mucus membrane 4. confusion 5. weak pulse, poor healing 6. lethargy 7. rapid respirations 8. recurrent infection and delayed healing 9 > 250

Question 29

hypoglycemia signs and symtoms

Answer 29

1. hunger, lightheadedness, shakiness, HD, anxiety, irritability 2. pallor with cool skin 3. diaphoresis 4. irritability 5. tachycardia, palpitations 6. decreased LOC, blurred vision, seizures. 7. < 60

Question 30

complications of diabetes

Answer 30

1. retinopathy, nephropathy, neuropathy, dyslipidemia, celiac disease, hypothyroidism, and diabetic keto acidosis

Question 31

explain diabetic ketoacidosis 4. S and S 5. nursing actions

Answer 31

1. medical emergency 2. ketonuria and acetone breath 3. leads to ketoacedosis due to ketones released from breakdown of fat due to lack of glucose 4. anorexia, N/V, lethargy, stupor, altered LOC, kussmaul respiration, air hunger, decreased skin turgor, fruity breath, tachycardia. 5. monitor BUN, CBC, LOC, IV fluids

Question 32

nursing actions with insulin

Answer 32

1. dont mix lantus with any other insulin 2. offer instruction as needed 3. rotate injection site at 90 degree angle 4. draw up short acting then long acting when mixing.