CPN Exam Endocrine/Metabolic Flashcards
Hypothyroidism
Thyroid gland secretes too little thyroid hormone
Congenital/Acquired
Hypothyroid Assessment
Impaired growth and development
Constipation
Sleepiness
Hypotonia
Hypothermia
Weight gain
Hypothyroid Management
Thyroid Hormone (TH) replacement– Prompt treatment is required for the infant to reduce neurologic impairment
Monitor progress of growth and development which should resolve with adequate treatment
Routine monitoring of serum TH levels
Hyperthyroidism (Grave Disease)
Thyroid gland over secretes thyroid hormone
Hyperthyroidism Assessment
Irritability and emotional lability
Short attention span
Weight loss despite voracious appetite Accelerated linear growth and bone age Hyperactivity of GI Tract
Hyperactivity
Tremors
Insomnia
Tachycardia
Tachycardia, bounding pulse
Hyperthyroidism Treatment
Drug therapy
Propylthiouracil (PTU)
Methimazole (MTZ, Tapazole)
Subtotal thyroidectomy
Ablation with radioiodine
Thyrotoxicosis Thyroid Storm
Sudden symptoms such as rapid heart rate, blood pressure and increased body temperature (manifested as fever)– Requires immediate medical attention (give an anti-thyroid drug)
Cushing Syndrome
A cluster of clinical abnormalities resulting from excessive levels of adrenocortical hormones.
Cushing Syndrome Etiologies
(1.) Adrenocortical tumor (infants and young children)
(2.) Excessive or prolonged steroid therapy (older children)
Cushing Syndrome Assessment
Central Obesity
Moon face
Susceptibility to infection/wound healing
Hypertension
Osteoporosis
Hirsutism
Mood disorder
Cushing Syndrome Management
Gradual discontinuation of exogenous steroids
Surgical removal of tumor
Steroid replacement therapy
Diabetes Insipidus (DI)
Hi and dry” = hi sodium (Na) and dehydration
Posterior pituitary hypofunction resulting in a hyposecretion of antidiuretic hormone (ADH) also called vasopressin
DI Assessment
Large volumes of urine and diuresis (i.e. polyuria)
Intense polydipsia (thirst)
DI Management
Hydrate
– Oral administration of water
– IV fluids
Drug therapy (oral or nasal)– DDAVP (exogenous vasopressin)
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
syndrome of hyponatremia and hypoosmolality that results from the excessive production or release of antidiuretic hormone (ADH) also called vasopressin which causes diminished water elimination.
SIADH
Opposite of DI is “low and too much H20” = low sodium (Na) and over volumized– Low Na is a risk for cerebral edema
SIADH Assessment
Decreased urine, fluid retention, weight gain, hyponatremia, muscle weakness, lethargy, confusion, seizures
Serum Laboratory Tests:
-Osmolality is low = means there is ↑ fluid volume and ↓ solute volume
-Blood Urea Nitrogen (BUN) is low = due to total body water dilution
SIADH Management
Correct hyponatremia with neurologic monitoring
Drug therapy: vasopressin receptor antagonists; diuretics
Fluid restrictions and fluid monitoring
Neuro checks and seizure precautions
Type I Diabetes
Most common endocrine disease in children
Autoimmune disorder causing destruction of the pancreatic beta cells
No insulin is produced so cells cannot utilize glucose
Hyperglycemia
Polyuria
Polydypsia
Polyphasia
“Warm and Dry - Sugar High”
Acetone breath
Pre-Diabetes
Fasting Glucose: 100-125
Normal <99
Hypoglycemia
Glucose <70
Sweaty, Shaky, Tachycardia, behavior changes
“Cold and clammy, need some candy”
HgbA1c
<7% for Type I
Type I Diabetes Management
Monitor blood glucose frequently
– Before meals and snacks
– Before and mid-way point when starting new physical activities
Carbohydrate, fat, and protein counting
Administration of insulin
Promote regular exercise and a healthy weight
Diabetes and Exercise
↓ blood glucose and ↓ insulin needs
– Either ↓ insulin dose or add 1-2 “uncovered snack(s)”
Diabetes and Sick Day/Illness
↑ blood glucose and ↑ insulin needs
– “Sick day rules” with more frequent blood glucose monitoring and insulin “touch ups
Hyperglycemia Management
Give rapid-acting insulin
Give fluids without sugar to flush out ketones (This includes IV fluid.)
Hypoglycemia Management
Give fast-acting carbohydrate (1/2-cup orange juice or soda)
-Avoid complex carbohydrates such as a candy bar
– Give glucagon for unconscious child
Place on side to prevent aspiration with vomiting (i.e. side effect of glucagon)
Insulin
Lispro/Humalog (Rapid Acting)
– Onset: 10-15 minutes
– Peaks: 30-90 minutes
NPH (Intermediate Acting)
– Onset: 2-4 hours
– Peaks: 8 hours
Lantus (Long Acting)
– Basal needs; no peaks; not related to meals
Type II Diabetes
Insulin resistance (varying degrees) with some insulin deficiency
Type II Diabetes Symptoms
Overweight/obesity Sleep apnea
– Hypertension Hyperlipidemia
– Acanthosis Nigricans (90% of kids with type 2 DM)
-Cutaneous thickening and hyperpigmentation
Bones in Pediatric Patients
Bone lengthening happens in epiphyseal plates
Damage to plates can impact growth
Healing is faster in kids - 1 week for every year of age up to 10
Most common fracture in peds
Clavicular
Greenstick
Clavicular Fracture
Occur during vaginal birth due to width of shoulders
Greenstick
Occur in long bones due to flexibility of growing bones
Spiral
associated with a twisting force; more closely associated with child abuse than other fractures but also seen in sports injuries like skiing
Compound
Bone breaks skin
Comminuted
Bone breaks into pieces
Casts
Plaster casts: less common; less expensive
Fiberglass casts: more common, lighter, better air flow, better X-ray visualization; more expensive
Fracture Assessment
Assess Circulation:
-Color
-Pulses
-Sensation
-Movement
-Temperature
-Edema
-Wiggle toes/fingers without tingling/numbness
Cast Management
Elevate extremity 24-72 hours after placement (reduces swelling and tightness)
Antihistamines for itching
Nothing inside the cast
Regularly assess circulation
Check for pressure as child grows
Cover cast when bathing/in water
Compartment Syndrome
Complication of a fracture causing swelling or bleeding occurs within a compartment leading to increased pressure and disruption of blood flow to muscles and nerves
– Can lead to tissue death and permanent disability
Neurovascular Assessment
Pallor - lack of profusion
Pain - most important finding, more intense than expected
Pulse - weak or absent
Paralysis - inability to wiggle toes or fingers
Paresthesia - tingling/Numbness
Traction
Designed to decrease muscle spasms and realign and position bone ends
Skin Traction
uses adhesive, moleskin, elastic bandage to pull indirectly on the skeleton
Skeletal Traction
Uses pins and tongs to pull on skeleton directly
Traction Assessment
Assess skin at site of pin insertion
Neurovascular assessment of extremity (pulses, warmth, brisk cap refill)
Assure that weights hang freely
Use pressure reducing surfaces
Prevent constipation (fluids, fiber, stool softeners)
Manage pain
Provide developmental stimulation
Spica Cast
Extends from mid-chest to legs
Legs are abducted with a bar between them (never lift using bar)
Spica Cast Care
Place disposable diaper under edges to prevent cast from getting soiled
Elevate head of bed so urine and stool drain downward
Reposition frequently to reduce pressure; check for pressure as the child grows
Development Dysplasia of Hip
Abnormal development of the hip socket– Head of the femur comes out of the hip socket
Present at birth
Can affect one or both hips
Etiology of DDH
Breech Delivery
Fetal position in utero
genetic predisposition
DDH Assessment
Ortolani/Barlow Sign or Click
Shortened limb on the affected side (telescoping) Asymmetrical skin folds in gluteus and thighs from telescoping and dislocation
DDH Treatment
Treated with Pavlik harness continuously for 6-12 weeks
– Effective in 95% of cases
Surgical reduction with hip-spica casting (for those not responsive to Pavlik harness
Osteogenesis Imperfecta
Genetic disorder characterized by bones that break easily due to a collagen defect– Classified from less to more severe (e.g. from a few to hundreds of fractures in a lifetime)
OI Assessment
Bones fracture easily, sclera is a blue tint, brittle teeth, thin skin, small stature, spinal curvature
OI Intervention
No cure exists, maximize bone mass and muscle strength through exercise (e.g. swimming and walking, if able
Osteomyelitis
An infection in a bone spreading from the bloodstream, adjacent tissue, or bone injury
Osteomyelitis organism
most commonly staphylococcus bacteria commonly found on skin and in nose of even healthy individuals
Osteomyelitis Assessment
More common in long bones in kids* Fever, pain, swelling, warmth, redness in affected region
Osteomyelitis Management
4 to 6-week course of antibiotics
May require surgical removal of infected or necrotic tissue
Scoliosis
A lateral curvature of the spine that may occur in the thoracic, lumbar, or thoracolumbar spinal segment
Scoliosis Complications
Impaired growth and development
– Impaired mobility
– Debilitating pain
– Respiratory compromise
Non-Structural Scoliosis
Unequal leg lengths
Abnormal posture
C-shaped curvature of spine
– Curve disappears when child bends at the waist to touch the toes (Adams-Bend test)
Scoliosis Management
Shoe lifts (if unequal leg lengths the cause)
– Postural exercises (if poor posture is the cause)
Structural Scoliosis
An S-shaped curvature of the spine
– Asymmetry of hips, ribs, shoulders, scapula
– Curve does NOT disappear when the child bends at the waist to touch the toes (Adams-Bend test)
Structural Scoliosis Diagnosis
Diagnostic tests
– X-rays of the spine (definitive diagnosis)
Structural Scoliosis Management
For mild to moderate curvatures < 40 degreeso Prolonged bracing
Tight t-shirt underneath
Keep skin beneath the brace clean and dry
Wear the brace as ordered (16-23 hours per day)
Provide psychological support
Traction
Electrical stimulation
