Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Fall - Pediatrics > Endocrine > Flashcards

Endocrine Flashcards

1
Q

How does the endocrine system affect water and electrolyte balance?

A

Water retention
ADH
Mineralocorticoids
ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does the endocrine system affect energy production and glucose homeostasis?

A

Insulin
Glucagon
Epinephrine
Cortisol
GH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does the endocrine system affect the metabolic rate?

A

Thyroid hormone
Leptin
Ghrelin
Restistin
Insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does the endocrine system affect growth and sexual maturity?

A

GH
Estrogen
Progesterone
Luteinizing hormone
Oxytocin
Prolactin
Testosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does the endocrine system affect the circulatory function?

A

Aldosterone
Epinephrine
Norepinephrine
Renin
Vasopressin
Cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Congenital adrenal hyperplasia is caused by which hormone?

A

ACTH
Cortisol
Aldosterone
Sex hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What hormones cause congenital hypothyroidism

A

TSH
T3
T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the concern r/t endocrine issues? What are the interventions?

A

Over/under production of a hormone –> alteration in growth and development

Intervene with hormone management to optimize growth and development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the patho of T1DM? What are the causes? Do they need insulin?

A

Autoimmune: destruction of the beta cells –> no insulin from pancreas so glucose accumulates in blood because can’t penetrate into cell w/o insulin

Genetic and CF

Insulin dependent (AKA juvenile-onset)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is T2DM? What causes it? Do they need insulin?

A

Insulin resistance

Lifestyle - increasingly diagnosed in kids and teens d/t obesity

Non-insulin dependent (adult onset)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the clinical manifestations of hyperglycemia? (9)

A

Polyphagia
Weight loss
Blurry vision
Polydipsia
Polyuria
Dry mouth
Frequent bed wetting
Stomach pain
Drowsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Are child or adult more at risk of developing ling term complications? Do child have short term complications?

A

Child have more long term complications

Child are likely to have short term complications such as hypoglycemia because they use more energy d/t high metabolic demands and growing (growth spurts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why are glucose goals higher in children?

A

Support growth patterns
Higher baseline metabolic demands
Safety - cannot report s/s of hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the glucose goals for non-diabetic child? Diabetic under 6? 6-12? over 13?

A

Non-diabetic: 70-110

Diabetic:
Under 6: 100-200
6-12: 90-180
Over 13: 90-130

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you diagnose diabetes?

A

Acute s/s and random glucose of 200 or above
Fasting glucose of 126 or above
2 hour glucose of 200 or above during OGTT
A1C of 6.5% or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the A1C goal for a child?

A

7.5%-8.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the patho of DKA?

A

Body can’t use glucose so believes it is in starvation mode even with excess glucose
Utilizes fat/protein for energy –> ketones from fat metabolism
Ketones –> metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why are kussmauls respirations in DKA?

A

Rapid and deep respirations to blow off excess acid form metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are early s/s of DKA?

A

Abdominal pain
N/V
Flu like s/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are later s/s of DKA? (8)

A

Dehydration - cracked lips
Altered LOC - difficult to arrouse
Kussmaul respirations
Increase UOP
Ketones in blood
Fruity breath
Labored breathing - retractions, nasal flaring, grunting
Metabolic acidosis (pH 6.9)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does an increase in glucose lead to for sodium and potassium?

A

Na is pushed into the cell
K is pushed out of the cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the normal bicarb in a chid?

A

Above 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are priority concerns for a patient with DKA?

A

Fluid resuscitation
Replace insulin
Stabilize and decrease blood glucose
Correct electrolyte imbalances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why do you need to replace fluids in DKA? What is the bolus? What will you see in UA?

A

there is a significant fluid volume deficit d/t excessive urination b/c the kidneys are trying to excrete glucose

20ml/kg over 5 minutes

UA: glucose and ketones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What do you need before replacing insulin?

A

Need fluids first!
Stabilize BP and perfusion before insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which electrolytes do you need to correct in DKA?

A

Glucose
Na
HCO3
K (decreased b/c insulin will force it into cell)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What should be monitored every 15 minutes during critical period in patient with DKA?

A

VS
Respiratory status
Neuro/LOC
ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How often should you get I&Os? Glucose level? Chem panel/ABG? Urine ketones?

A

I&O: hourly (foley)
Glucose level: hourly
Chem panel and ABG: every 2 hours
Urine ketones: every void

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why do patients with DKA need 3 lines?

A

Line for fluids (20 ml/kg bolus of NS)
Line for dextrose (to maintain stable glucose and electrolytes while decrease glucose)
Line for insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What insulin is used via IV in DKA? Why?

A

Regular insulin

Lower risk of hypoglycemia because it peaks fast and leave body fast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are some reasons for hyperglycemia?

A

No enough insulin
Larger food intake than usual
Less exercise than usual
Emotional stress
Physical stress like cold, flu, puberty, growth spurts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When do you start dextrose in DKA?

A

250-300mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Do you intubate a patient with DKA since they are having difficulty breathing?

A

NO respirations are compensating for acidosis so as that improves, breathing will improve as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a complication of DKA? When does it occur?

A

Cerebral edema

Typically in the first 24 hours of treatment

Reason for slow correction of glucose and electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the management for cerebral edema?

A

Immediate recognition and intervention
Neuro assessment
Reduce IVF and give mannitol and hypertonic (3%) saline
Advance airways placement with mechanical ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are short term complications with diabetes?

A

Hypoglycemia
DKA
Hyperglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are general insulin considerations for T1DM?

A

SubQ
Rotate sites
Time injections in relation to meals
Mix insulin clear to cloudy
Can be stored room temp for 30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What dose should insulin be given? What warrants an insulin adjustment?

A

Dose: 0.5-1 unit/kg/day, titrated to glucose goal

3-4 days of hyperglycemia warrants adjustment

39
Q

What insulin can be administered IV?

A

ONLY regular insulin

40
Q

What are general nursing interventions for a stable patient with DM?

A

Routine VS and PEWS
S/S for hypo/hyperglycemia
Strict I&Os
Lab monitoring (acid/base, electrolytes)
Monitor meals/adherence
Education

41
Q

When should you monitor glucose levels? What about with acute illness?

A

Before meals
Symptomatic

More frequently with acute illness

42
Q

When should you monitor urine ketones?

A

During illnesses with each void
Sustained hyperglycemia with blood glucose over 180mg/dL or random glucose over 250mg/dL

43
Q

What are ways to administer insulin?

A

syringes
insulin pens
insulin pumps

44
Q

What should the diet look like for children with T1DM?

A

No concentrated sweets
Stable complex CHO every meal based on calories/day
Consistent meal times - even with snacks

45
Q

What is the carbohydrate/insulin ratio?

A

Units of inulin/number of carbs grams

46
Q

What are the benefits of exercise management?

A

Helps body use glucose effectively
Increase HDL and lowers LDL cholesterol
Lower blood glucose levels
Increase bone mass and muscular strength
Relieves anxiety and stress
Increases self-esteem

47
Q

When should you avoid exercise? What should you do before exercise?

A

During insulin peak times because at risk for hypoglycemia

Give a snack before exercise with carbs
Carb load if more than 45-60 minutes

48
Q

Should insulin management change if the child is sick?

A

Illness increases insulin needs
Insulin should never be withheld

49
Q

Should diet management change if the child is sick? Hydration?

A

Clear liquids that contain carbs can be substituted for solids (popsicle instead of crackers)

Plenty of liquids b/c hydration is essential to offset diuresis

50
Q

What OTC medications are safe for a child with DM? If it contains carbs fo you need to count it in daily tally?

A

Alcohol free
Sugar free (flavoring)
Decongestants should be avoided/limited

Any CHO from meds need to be counted in daily tally

51
Q

What are the causes of hypoglycemia?

A

Too little food/glucose
Too much insulin
Extra or vigorous exercise

52
Q

What is the treatment for hypoglycemia if the patient has no IV access?

A

Oral carbs (simple, 15 grams)
Repeat if no improvement in 15 minutes
Glucagon IM or SQ
Follow with some protein and a complex carb

Test and monitor blood sugar once s/s subside

53
Q

What is the treatment for hypoglycemia if the patient has IV access?

A

IV dextrose at a dose of 0.25 g/kg with a max single dose of 25 g

Test and monitor blood sugar once s/s subside`

54
Q

What are the s/s of hypoglycemia? (8)

A

Sweating
Trembling
Dizziness
Mood changes
Hungar
HA
Blurred vision
Extreme tiredness and paleness

55
Q

What are developmental consideration for an infant with DM?

A

Rapid growth
Brain development
Erratic sleeping/eating habits

Avoid hypoglycemia

56
Q

What are developmental consideration for toddlers and preschoolers with DM?

A

Picky/inconsistent with eating habits
More regulated activity/sleep patterns
Can be difficult to decipher a low blood sugar from a normal temper tantrum

57
Q

What can you do to help make care easier for a toddler/preschooler with DM?

A

Choice of food between 2 options
Hold still for injections
Term for “feeling bad”

58
Q

What are developmental consideration for school age with DM?

A

Eating/sleeping more consistent
Increase activity and play so could get hypoglycemic
Peer issue can begin to develop

59
Q

What are developmental consideration for a early adolescent with DM?

A

Puberty –> erratic growth –> erratic glucose control –> affect insulin requirements
Concerned avocet body image
Greatly influences by friends
May challenge authority
Beginning to understand consequences

60
Q

What task can be done to care for DM in early adolescence?

A

Log glucose
Draw up insulin with supervision
Know meal plan

61
Q

What are developmental consideration for a mid-late adolescent with DM?

A

Increased time away from home
Risk taking behaviors including not taking insulin and not checking BG
Many social activités are unpredictable
Counseling about BC, alcohol, vaping, smoking
Have cognitive ability to manage disease but might not be emotionally mature enough

62
Q

What are the two types of congenital adrenal hyperplasia (CAH)?

A

Glucocorticoids (cortisol) not enough
Mineralcorticoids (aldosterone) not enough

63
Q

What are the actions of cortisol?

A

Regulates glucose
Responds to stress
Regulates metabolism
Immune function

64
Q

What are aldosterone actions?

A

Regulates Na/K
Regulates volume and BP

65
Q

Do you have to have both glucocorticoid CAH and mineralcorticoid CAH?

A

If you have CAH, you will always have not enough glucocorticoids but you won’t always have not enough mineralcorticoids

66
Q

What occurs d/t lack of cortisol?

A

Cannot meet metabolic demands of body
Especially worrisome if they have an acute illness
Cariogenic shock

67
Q

If cariogenic shock occurs d/t lack of cortisol?

A

Does not respond to IVF/inotropes
Need glucose (hydrocortisone IV and add dextrose)

68
Q

What occurs in the body d/t lack of aldosterone?

A

Excessive salt wasting
Hyponatremia
Volume depletion
Cant regulate BP
Hypotension
Hypovolemic shock

69
Q

What do infants rely on for CO?

A

Volume (sodium and water)
Glucose

70
Q

How do you test for a CAH crisis?

A

Early recognition
Life threatening so newborn screening and ACTH stimulation test to confirm diagnosis

71
Q

What are the early s/s of CAH adrenal crisis hypovolemic shock?

A

VS elevated
Weakness
Fatigue
N/V/D
Poor suck and hypotonia (not eating well)
Alteration in LOC
Seizure

72
Q

What are the late s/s of CAH adrenal crisis hypovolemic shock?

A

Hypotension
Poor perfusion

73
Q

How do you restore hydration/perfusion in CAH adrenal crisis hypovolemic shock acutely?

A

Remove stress
Nourish adrenals with adrenal supplements

74
Q

How do you manage CAH at home?

A

Daily glucocorticoid (hydrocortisone) in divided doses to mimic normal circadian rhythm
Salt additives for excess heat/humidity
Sick day management (stress does: 2-3x baseline)

75
Q

When would you come into the ED if have CAH and sick? What s/s?

A

When sick day management is not improving s/s

Weak, confused, dehydrated, decrease UOP

76
Q

What is the secondary issue in regards to CAH?

A

ACTH doesn’t shut off –> excessive stimulation –> hyperplasia of gland (trying to make up for decreased glucocorticoids) –> increased androgen (sex hormones) released

77
Q

How does CAH affect females?

A

Ambiguous genitalia at birth
Precocious puberty (excess muscle mass, advanced bone age, short stature, premature pubic hair, hirsutism)
Irregular menses
Delayed menses

78
Q

Can ambiguous genitalia be fixed?

A

Requires surgery

79
Q

What are alterations for GH deficiency

A

Abnormal newborn screening
Dysmorphic features in face
Muscle tone and activity level
Appears sick such as dehydration, exopthalmos, tachycardia, fatigue, lethargy, pallor, hypothermia, resp distress, weakness, wasting, vomitting

80
Q

What is a Kewpie doll appearance indicative of? What does a child with this look like?

A

GH deficiency

Exopthalmus

81
Q

When do you see congenital hypothyroidism?

A

1-2 months

82
Q

What are the clinical manifestations for congenital hypothyroidism? (10)

A

Large for gestational age
Puffy face, swollen tongue
Hoarse cry
Poor muscle tone
Cold extremities
Constipation (decrease metabolism)
Bloated abdomen
Lethargic and poor activity
Profound cognitive delays
Poor linear growth

83
Q

Do child with congenital hypothyroidism appear normal at birth? When do you want these children on medication by?

A

Often appear normal at birth - screening is vital d/t this

Diagnosed within 2 weeks so can be on medication within 1 month

84
Q

What are the nursing interventions associated with congenital hypothyroidism?

A

Confirmed newborn screening results
Monitor G&D
Parental education

85
Q

What parental education is necessary for a child with congenital hypothyroidism?

A

Need for lifelong thyroid hormone replacement therapy
Improvement in 7-21 days
Single dose in AM
Thyroid levels need to be monitored every 1-3 months

86
Q

What is PKU?

A

Absence or deficiency of an enzyme (essential to metabolism) that is made by the liver that breaks down phenylalanine (an essential amino acid)

Absence of enzyme can lead to toxic accumulation of phenylalanine

Phenylalanine accumulation –> poor CNS development, intellectual impairment and death if not detected

87
Q

How is PKU detected?

A

Newborn screening

Genetics for confirmation

88
Q

What is the lifelong treatment for PKU?

A

Dietary restriction of phenylalanine
Special formula for first 2 years of life
Low protein diet as child gets older

89
Q

What does the diet for PKU do for the patient? Can they ever go off the diet?

A

Avoids cognitive delays

Possibly able to go off diet after 6-8 years when neurologic development is complete

90
Q

What is precocious puberty for females?

A

before age 6-8

Appearance of secondary sexual characteristics, advanced growth rate, and bone maturation

91
Q

What is precocious puberty for males?

A

before age 9

Appearance of secondary sexual characteristics, advanced growth rate, and bone maturation

92
Q

What are major implications of precocious puberty?

A

Short stature as an adult d/t early closure of epiphyseal ends of long bones

93
Q

What tests should be done to rule out secondary reasons for precocious puberty? What is most common cause?

A

Hormone-secreting tumors
Brain injury caused by head trauma
Thyroid dysfunction
Ovarian dysfunction

Idiopathic most common - obesity

94
Q

What are you do to delay early puberty? When would this be discontinued?

A

GnRH blocker
Monthly lupin injections
Implantable devices

Discontinue when old enough to go through puberty

Fall - Pediatrics (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions