ENDO & MS CLASS MATERIALS Flashcards
What do the different glands control?
Thyroid - metabolism
Pituitary - growth
Hypothalomus - everything
Adrenal - stress hormones –> remember that SALT and CORTISOL affect each other. Cortisol regulates salt.
What is important to remember about Pavlik harness?
- need to prevent skin breakdown (clothing worn underneath)
- worn 23-24 hours a day, remove less than 1 hr per day for bathing purposes
- brachial plexus palsy if the clothing is worn too tight
Discuss neurovascular assessment
So movement, sensation & (1 more) is neurovascular assessment according to lecture video
BUT: pain is also a part of this, it’s just not the most important part
You can also think of it as the 5Ps:
pain, pulselessness, pallor, paresthesias, paralysis
What would you do first post-op spinal surgery?
A) give pain medication
B) Make sure pt is able to move
B) Movement before pain medicatoin
If you assess a pt and suspect compartment syndrome…
numbness, pain, swelling, color changes (blue, purple black if really bad) - elevation might help, but need doctor to split the cast
Nurse cannot split the cast!! In real compartment syndrome, elevation will not fix the problem, but it’s something the nurse can do initially.
Type of diet with PKU
low protein, NO aspartame, no artificial sweeteners, Stevia is ok
What are we most worried about (serious complication of CAH)?
Shock - low fluid hyponatremic, hypovolemic type shock, initial tx involves giving a bolus. You will give normal saline (remember salt and cortisol deficiency)
What is your primary tx of JIA?
anti-inflammatory meds, but you also can use non-pharmacological methods such as warm baths/showers and low impact exercise such as swimming
What is traction?
different types: it’s to stretch out or hold in place where bone should be, ex) bucks traction in femur fracture, weight is counterbalance
What is Circumferential compartment syndrome?
This is caused by a burn - swelling cuts off around extremity
Considerations for CAH
salt wasting, water follows salt, so can lead to shock, outside of hospital– will take salt tab, NaCl fluid, BOLUS first (any type of shock), bolus to address perfusion issue. 20/kg bolus,
What are some considerations for DKA?
shock & poor perfusion - delayed cap refill (shock), give a bolus
You need to address fluid issues first. You can’t give glucose with hypovolemia because your brain will take all the glucose and it could result in brain damage.
20/kg bolus or sometimes 2 boluses. They will have metabolic acidosis. They will be getting an insulin drip and the goal is to bring blood glucose down SLOWLY. no more than 100 pts per hour If you go too fast, you will end up with an electrolyte imbalance
When you get down to 250 blood glucose. Expect the type of fluid and drip to CHANGE. most endocrinologists will change the fluid to add glucose at this point, but they might mess with the drip too.
pediatric hopsitals use “diabetic solution” - it’s a fluid w/electrolytes, not NS.
DKA pts are “busy pts”
What differentiates a DKA pt that can go on the floor rather than ICU is LOC. Decr. LOC will be in PICU.
A DKA pt on drips on the floor will be a ratio of 3:1.
Most diabetic pts will have insulin coverage for meals and snacks. They will have a sliding scale and then coverage based on how many carbs they eat. They try to eat the same amount of carbs at each meal. They typically have a carb goal that helps them stay at the same blood sugar level every day.
Insulin high-risk so verify with another nurse
Blood sugar usually goes up when pts are sick.
Developmental considerations for diabetic pts.
Developmental considerations - toddler: pick finger, clean finger
School-ager - poke their finger to check. Maybe not drawing insulin yet and checking number
Adolescent - drawing their own insulin, checking number and administering. Regulating pumps, won’t place until they know how to manage the disease on their own
hypopituitarism
Main issue - growth hormone - you will grow to full height but slower than other children. Can still reach but might take longer than normal. Allow child to play activities bc of self-esteem.
