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peds 331 > endo > Flashcards

endo Flashcards

1
Q

PKU management

A

breast feed or Phe free formula forever (for protein), no meat or dairy, limited fruits and veggies, limit grains
meet nutritional needs for optimum growth, maintain Phe 2-6

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2
Q

PKU cm: untreated - kids

A

decreased height and weight, musty odor (urine and sweat), hypopigmentation (fair skin, blue eyes, bland hair, eczema), v, irritable, seizure, hyperactive, retardation

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3
Q

PKU cm: untreated - adults

A

short attention, poor short term memory, vision, decreased motor coordination, mood disorders, decreased grey matter
on diet for life!

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4
Q

PKU nc

A

test, teach (normal vaccine), refer for genetic counseling, support, flex feeding schedule, no extra developmental assessment, encourage early treatment

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5
Q

galactosemia cm

A

v, weight loss, jaundice, lethargy, hypotonia, cataracts
long term: learning disability, decreased IQ, short attention, behavior problems

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6
Q

galactosemia tm

A

lactose free, dont breast feed unless mom is dairy free, soy formula, Ca supplement, med caution - sensitive to penicillin and other meds that contain galactose

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7
Q

hypothyroid s/s

A

everything slows down
fatigue, exercise intolerance, slower reaction time, weight gain, constipation, sparse, coarse, dry hair and skin, slow pulse, cold intolerance, muscle cramps, sides of eyebrows thin or fall out, dull facial expression, hoarse voice, slow speech, droopy eyelids, puffy and swollen face, enlarged thyroid (goiter), increased menstrual flow and cramping in younger, hypotherm, large protruding tongue, short thick neck, delayed dentition, hypotonia, poor feed, mental defects if delayed diagnosis

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8
Q

hypothyroid nc

A

recognize early, compliance and periodic monitoring, med amin - teach to avoid heat, dont mix with soy, check interactions, not liquid

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9
Q

goiter nc

A

airway, noticeable with rapid growth (puberty), large are obvious and small must palpate (swallow)

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10
Q

goiter tm

A

oral hormone replacement, prompt treatment (brain growth), may admin in increasing amounts over 4-8 weeks to reach euthryroidism, compliance!! with meds for life

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11
Q

hyperthyroidism s/s

A

everything speeds up
enlarged thyroid (goiter), increased heart rate and BP, slight tremor, lighter and less frequent menstrual, irritated and bulging eyes with redness or visible blood vessles on white part, pain when moving eyes, inability to fully open eyelid, increased activity, restless, poor sleep, fatigue, increased appetite, increased BM, heat intolerance, decreased school performance, difficulty concentrating, lump in throat

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12
Q

hyperthyroidism tm

A

diagnose with T3 and T4 levels with decreased TSH
drugs (PTU) can cause agranulocytosis: toxic reaction that decreased wbc, if they have sore throat or fever they need to stop and isolate and call hcp to start abx and steroids (they are immunocompromised)

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13
Q

hyperthyroidism nc

A

identify, limit activity and demands, counsel fam and teachers (low stress), high cal and nutritious diet, meds (SE)

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14
Q

thyrotoxicosis

A

crisis or storm, can be life threatening
from sudden release of hormone, precipitated by infection, Sx, discont of antithyroid therapy

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15
Q

thyrotoxicosis tm

A

antithyroid drugs and propanolol

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16
Q

hypopituitarism - gh cm

A

absences or regression of secondary sex characteristics, normal h and w at birth and progressively deviate, distinguish from - constitutional delay, familial short stature, or genetic disorder (turners syndrome)
<3rd %, w normal-heavy, skeletal proportions normal, retarded bone age, appear younger, delayed perm teeth erupt, emotional issues because so small

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17
Q

hypopituitarism - gh tm

A

diagnose with history, assessment, x ray, low serum gh (stim test - q 30 min after insulin)
daily SQ GH injection until adult height (growth plate close around 14 or 18), may continue because of effect on bone and muscle, replace other hormones prn
very expensive and painful

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18
Q

hypopituitarism - gh nc

A

fam support - realistic expectation, response varies
body image
daily injection at bed, 5-7 times/wk
usually school aged
expensive
identify (plot on growth chart), assist with test, emotional support, teach, promote realistic expectation

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19
Q

precoscious puberty

A

before 9 or 8

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20
Q

precoscious puberty tm

A

treat cause, lupron (monthly IM) until they are supposed to start puberty, psych support

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21
Q

precoscious puberty - true/complete/central

A

lurpon
normal P, just happens early

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22
Q

precoscious puberty - premature therlarche

A

breast, dont treat, resolves on own

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23
Q

precoscious puberty - prematurue pubarche

A

hair, not a problem

24
Q

precoscious puberty - premature menarche

A

period without other development

25
Q

CAH cm

A

cortisol down, sex hormones up (androgens)
decreased stress response, hypogly, increased inflam response, hypotension, compromised immune, hyponatremic dehydration s/s
males: precoscious puberty
females: ambiguous genitalia - enlarged clit, fused labia, internal intact
diagnose with untralsound, chromosome

26
Q

CAH tm

A

confirm diagnosis, cortisone to decreased ACTH (rest of life), reconstructive sx

27
Q

CAH nc

A

parental anxiety, teach parents s/s of dehydration and Na loss crises - injectable hydrocortisone, genetic counseling

28
Q

DM 1 cm

A

3Ps, weight decrease, enuresis (urinalysis), irritable, fatigue, abdominal pain
children, insulin dependent, autoimmune Beta cells, rarely overweight or fam history

29
Q

DM 2 cm

A

overweight, fatigue, freq infection, acanthosis nigricans (skin folds)
adults, not insulin dependent, body cant produce and use insulin, overweight, fam hx

30
Q

DM 2 tm

A

weight loss, exercise, oral meds, insulin

31
Q

DM 1 tm - mnt

A

fingerstick, eat whatever, count CHO based on what they ate
avoid high sugar habits
fat increases bg later, dont restrict carbs
extra snack before activity, increase insulin with more food

32
Q

DM 1 tm - insulin

A

rapid (15, 1, 3-4)
long acting (4-6, 8-24, all day)
intensive: basal/bolus - give based on fingerstick and how much they eat; pens, meters, sq ports changed q 7-10 days, extra batteries and back up kit, strips, alcohol, bandaids; fingerstick before meal and bedtime, count c post meal, sliding scale, combine, admin (rapid)
blood glucose monitor (4x - meal and bedtime) and feel or display s/s and before phys activity

33
Q

DM 1 tm - urine ketones

A

> 240, not enough insulin, when ill, on pump + >240

34
Q

DM 1 dev - toddler

A

differentiate misbehavior from hypogly, report funny feeling, expect food jags, give choices (injection site, food choices)

35
Q

DM 1 dev - preschooler

A

reassure not punishment, encourage participation, teach to report lows, teach what to eat when low

36
Q

DM 1 dev - schoolager

A

educate school personel, age appropriate independence (supervise!), extracuricular, injection

37
Q

DM 1 dev - adolescence

A

self care, meal plan and adjust, injection, risk takers (sleep late, skip breakfast, OH decreases BG so need to eat), parental involvement and support, menstruation and eating disorder

38
Q

DM 1 tm - sick day

A

test urine ketones
still give insulin and check more frequently

39
Q

hypogly s/s

A

<60
low bg, hunger, HA, confusion, shaky, dizzy, sweat
check BS

40
Q

hypogly tm

A

check, 15 g rule (1/2c juice or soft drink, 1c milk, glucose tab, cake icing, honey > 1 yr, NO CHOCOLATE), follow with meal/snack (protein)
severe - no swallow: glucagon emergency (expires), IM/SQ, on side bc v, feed when awake

41
Q

hypergly s/s

A

> 180
high BG, glucose in urine, polyuria, increased thirst

42
Q

hypergly tm

A

check ketones, call hcp, increase fluids w/o caffeine (FIRST), no activity

43
Q

ketosis and acidosis s/s

A

ketosis: 0.3 - 7.0 mmol/L
acidosis when >7.0, pH <7.3
s/s: rapid breathing and deep, confusion, lethargy, abd pain

44
Q

ketosis and acidosis tm

A

A/V BG, electrolytes, AG (low = low bicarb; high = met acidosis)

45
Q

dka cm

A

deep and rapid breathing (kussmal, resp distress w/o lung patho), v dry mouth (dehyd with excessive UOP), , fruity breath, n/v (w/o d), lethargy, drowsy
cerebral edema, hypergly, hypovolemia
insulin deficiency with countereg to enhance gluconeogenesis, glycogenolysis, lipolysis
hyper/hypoK: K loss from shift to extra to exchange with excess H+ in extra, out in urine
dehyd: increased serum osmolarity, h2o shift extra, dilutional hypoNa - out in urine

46
Q

dka tm

A

correct dehyd, acidosis and reverse ketosis, restore normal BG, avoid complications

47
Q

DKA tm - fluid

A

NS at 10-20 mL/kg/hr, replace fluid deficit evenly ove 48 hr
confirm DKA with labs

48
Q

DKA tm - insulin

A

separate IV, prime with insulin, not given in first hour bc r/o cerebral edema, d/c any bodily insulin pump
0.1 U/kg/hr, continue until acidosis clears
this will turn off ketone production, decrease blood sugar, check glucose q1hr
low dose to decrease hypogly or hypok, dont drop more than 50-100 mg/dL/hr (cerebral edema)
dont d/c based only on BG - pH >7.3 and HCO3 > 15 and serum ketones clear
before admin: neuro, VS, BG
continuous IV infusion, regular, high alert, dont give as bolus
once BG 250 - 300, maintain insulin and give dextrose (acidosis takes longer to fix)

49
Q

DKA tm - K

A

hour 2 if urinated
start with insulin, consult pharm
monitor! usually significant K deficit
continue throughout IV therapy
max rate is institution specific

50
Q

DKA tm - dextrose

A

maintain BG 150 - 250, prevent hypogly
add to IV when BG 250 - 300, change to 5% with .45 NaCl at rate to complete rehydration in 48 hr, check BG q1hr, electrolytes q2-4hr
SQ insulin after DKA resolves

51
Q

DKA tm - bicarbonate

A

contraindicated in peds bc cerebreal edema (consult)
severe acidemia, life threatening hyperK

52
Q

DKA nc - monitor q1

A

VS, neuro, I+O, poc BG, K
cardiac - continuous

53
Q

DKA nc - monitor q2

A

urine ketones, serum beta OH, serum glucose, electrolytes, BUN, Ca, Mg, P, hct, ABG

54
Q

DKA tm - extra

A

may need O2, airway, suction, cath (no urine)
need peripheral IV for sampling and insulin drip
altered mental or LOC: airway, NG suction, bladder cath

55
Q

DKA tm - high risk

A

icu: <7.1 or 7.2 + young, altered LOC, <5 yr, increased risk of cerebral edema
prep for intubation
caution with meds that alter LOC

56
Q

DKA tm - transition off IV insulin

A

pH > 7.3 and HCO3 > 15 -18, AG < 12, eat
SQ, d/c IV, IV dextrose, feed
known DM pt: prior dosing
new DM pt: .7-1 U/kg/day

peds 331 (28 decks)

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