Chapter 48 Nursing Care of the Child with an Alteration in Metabolism/Endocrine Disorder

Question 1

Metabolism

Answer 1

Refers to all physical and chemical reactions occurring in the body’s cells that are necessary to maintain and sustain life

Question 2

Hormones

Answer 2

Chemical messengers that stimulate and/or regulate the actions of other tissues, organs, or other endocrine glands that have specific receptors to a hormone

Question 3

Impact of the Endocrine System on the Human Body

Answer 3

Influences all physiologic effects such as:
- Growth and development
- Metabolic processes related to fluid and electrolyte balance and energy production
- Sexual maturation and reproduction
- Body’s response to stress

Question 4

Hypofunction

Answer 4

Deficiency of specific hormone

Question 5

Hyperfunction

Answer 5

Excess of specific hormone

Question 6

Consequences of Undiagnosed/ Late Treatment of Endocrine Disorders

Answer 6

Delayed growth and development, cognitive impairments, or death may result

Question 7

Anterior Pituitary Disorders

Answer 7

Growth hormone deficiency & precocious puberty

Question 8

Growth Hormone Deficiency

Answer 8

Poor Growth

Short Stature

Complications include altered carbohydrate, protein, and fat metabolism; hypoglycemia, glucose intolerance

Treatment: supplemental growth hormone

Identify the common medications and treatment modalities used for palliation of endocrine disorders in children

Question 9

Complications of Growth Hormone Deficiency

Answer 9

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

Question 10

Precocious Puberty

Answer 10

Development of sexual characteristics before the usual age of puberty

Treatment: Education, medications to slow secondary sexual development, promote psychosocial well-being

Question 11

Nursing Management Goals for Precious or Delayed Puberty

Answer 11

Educating the child and family about the physical changes the child is experiencing

Teaching how to correctly use the prescribed medications

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

Promoting age-appropriate physical development and pubertal progression

Question 12

Posterior Pituitary Disorders

Question 13

Diabetes Insipidus

Answer 13

“High & Dry”

Deficiency of ADH

Characterized by:
- Polydipsia (excessive thirst)
- Polyuria (excessive urination)

Kidneys lose high amounts of water and retains sodium in the serum

Serum osmolarity > 300 mOsm/L

Treatment: Low sodium/protein diet, DDAVP

Question 14

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Answer 14

“Low & Wet”

Excess of ADH

Characterized by:
- Water retention

Low serum sodium osmolality

Treatment: Correct underlying disorder, fluid restriction, IV sodium chloride

Question 15

Hyperthyroidism

Answer 15

Hyperfunction of the thyroid gland (elevated T3 and T4)

Peaks during adolescence as a result of Graves disease.

Signs & Symptoms:
- Nervousness/Anxiety
- Diarrhea
- Heat intolerance
- Weight loss
- Smooth, velvety skin

TSH is usually low.

At risk for thyroid storm

Treatment: Antithyroid medications, radioactive iodine therapy, or thyroidectomy

Question 16

Hypothyroidism

Answer 16

Malfunction of the thyroid gland

Insufficient production of thyroid hormones (low levels of T3 and T4).

Signs & Symptoms:
- Tiredness/fatigue
- Constipation
- Cold intolerance
- Weight gain
- Dry, thick skin
- Edema of face, eyes, & hands
- Decreased growth

TSH is usually high

Complications include intellectual disability, short stature, growth failure, delayed physical maturation

Treatment: thyroid replacement therapy (example: Synthroid)

Question 17

Thyroid Storm

Answer 17

Sudden onset of severe restlessness and irritability
Fever
Diaphoresis
Severe tachycardia

Question 18

Diabetes Type I

Answer 18

Deficiency of insulin secretion due to pancreatic B-cell damage
- Autoimmune in nature

Onset usually in younger children

DKA more likely in Type 1

Sometimes has a genetic predisposition

Affects all ethnic groups

Question 19

Signs & Symptoms of Diabetes Type I

Answer 19

Polyuria
Polydipsia
Polyphagia
Weight loss
Abdominal cramping/nausea/vomiting
Headache/fatigue/blurred vision

Question 20

Diagnostic Findings Related to Diabetes Type I

Answer 20

Glucosuria
Ketonuria
Hemoglobin A1C
Serum Glucose > 200mg/dL

Laboratory criteria for the diagnosis of DM:
- A fasting glucose level greater than or equal to 126mg/dL
- A 2hour plasma glucose level greater than or equal to 200mg/dL during an oral glucose tolerance test
- A random glucose level greater than or equal to 200mg/dL accompanied by typical symptoms of diabetes

A hemoglobin A1C greater than 6.5%

Question 21

Diabetic Ketoacidosis

Answer 21

Diagnostic Values for DKA:
- Hyperglycemia (>300 mg/dl, but usually 400-800)
- Acidosis (pH < 7.3, HCO3- < 15 mEq/L)

Question 22

Signs & Symptoms of DKA

Answer 22

MEDICAL EMERGENCY!!

Anorexia

N+V

Altered LOC/ Confusion

Kussmaul respirations

Tachycardia & Tachypnea

Fruity/Acetone breath

Ketonuria / Glucosuria

Alterations in K+

Metabolic Acidosis

Severe insulin deficiency

Serum glucose >300

Question 23

Management of Diabetic Ketoacidosis (DKA)

Answer 23

Fluid Therapy

Initial 20ml/kg bolus 0.9% normal saline over 1-2 hours

Continuous IV fluid replacement

EKG monitoring*

Frequent VS and physical assessment

Urine output

Frequent blood sugars, potassium, and sodium levels

Continuous insulin drip

Don’t drop blood glucose too fast!