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Fall - Pediatrics > Endocrine > Flashcards

Endocrine Flashcards

1
Q

How does the endocrine system affect water and electrolyte balance?

A

Water retention
ADH
Mineralocorticoids
ACTH

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2
Q

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

A

Insulin
Glucagon
Epinephrine
Cortisol
GH

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3
Q

How does the endocrine system affect the metabolic rate?

A

Thyroid hormone
Leptin
Ghrelin
Restistin
Insulin

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4
Q

How does the endocrine system affect growth and sexual maturity?

A

GH
Estrogen
Progesterone
Luteinizing hormone
Oxytocin
Prolactin
Testosterone

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5
Q

How does the endocrine system affect the circulatory function?

A

Aldosterone
Epinephrine
Norepinephrine
Renin
Vasopressin
Cortisol

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6
Q

Congenital adrenal hyperplasia is caused by which hormone?

A

ACTH
Cortisol
Aldosterone
Sex hormones

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7
Q

What hormones cause congenital hypothyroidism

A

TSH
T3
T4

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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

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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)

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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)

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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

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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)

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13
Q

Why are glucose goals higher in children?

A

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

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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

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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

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16
Q

What is the A1C goal for a child?

A

7.5%-8.5%

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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

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18
Q

Why are kussmauls respirations in DKA?

A

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

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19
Q

What are early s/s of DKA?

A

Abdominal pain
N/V
Flu like s/s

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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)

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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

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22
Q

What is the normal bicarb in a chid?

A

Above 20

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23
Q

What are priority concerns for a patient with DKA?

A

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

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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

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25
What do you need before replacing insulin?
Need fluids first! Stabilize BP and perfusion before insulin
26
Which electrolytes do you need to correct in DKA?
Glucose Na HCO3 K (decreased b/c insulin will force it into cell)
27
What should be monitored every 15 minutes during critical period in patient with DKA?
VS Respiratory status Neuro/LOC ECG
28
How often should you get I&Os? Glucose level? Chem panel/ABG? Urine ketones?
I&O: hourly (foley) Glucose level: hourly Chem panel and ABG: every 2 hours Urine ketones: every void
29
Why do patients with DKA need 3 lines?
Line for fluids (20 ml/kg bolus of NS) Line for dextrose (to maintain stable glucose and electrolytes while decrease glucose) Line for insulin
30
What insulin is used via IV in DKA? Why?
Regular insulin Lower risk of hypoglycemia because it peaks fast and leave body fast
31
What are some reasons for hyperglycemia?
No enough insulin Larger food intake than usual Less exercise than usual Emotional stress Physical stress like cold, flu, puberty, growth spurts
32
When do you start dextrose in DKA?
250-300mg/dL
33
Do you intubate a patient with DKA since they are having difficulty breathing?
NO respirations are compensating for acidosis so as that improves, breathing will improve as well
34
What is a complication of DKA? When does it occur?
Cerebral edema Typically in the first 24 hours of treatment Reason for slow correction of glucose and electrolytes
35
What is the management for cerebral edema?
Immediate recognition and intervention Neuro assessment Reduce IVF and give mannitol and hypertonic (3%) saline Advance airways placement with mechanical ventilation
36
What are short term complications with diabetes?
Hypoglycemia DKA Hyperglycemia
37
What are general insulin considerations for T1DM?
SubQ Rotate sites Time injections in relation to meals Mix insulin clear to cloudy Can be stored room temp for 30 days
38
What dose should insulin be given? What warrants an insulin adjustment?
Dose: 0.5-1 unit/kg/day, titrated to glucose goal 3-4 days of hyperglycemia warrants adjustment
39
What insulin can be administered IV?
ONLY regular insulin
40
What are general nursing interventions for a stable patient with DM?
Routine VS and PEWS S/S for hypo/hyperglycemia Strict I&Os Lab monitoring (acid/base, electrolytes) Monitor meals/adherence Education
41
When should you monitor glucose levels? What about with acute illness?
Before meals Symptomatic More frequently with acute illness
42
When should you monitor urine ketones?
During illnesses with each void Sustained hyperglycemia with blood glucose over 180mg/dL or random glucose over 250mg/dL
43
What are ways to administer insulin?
syringes insulin pens insulin pumps
44
What should the diet look like for children with T1DM?
No concentrated sweets Stable complex CHO every meal based on calories/day Consistent meal times - even with snacks
45
What is the carbohydrate/insulin ratio?
Units of inulin/number of carbs grams
46
What are the benefits of exercise management?
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
When should you avoid exercise? What should you do before exercise?
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
Should insulin management change if the child is sick?
Illness increases insulin needs Insulin should never be withheld
49
Should diet management change if the child is sick? Hydration?
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
What OTC medications are safe for a child with DM? If it contains carbs fo you need to count it in daily tally?
Alcohol free Sugar free (flavoring) Decongestants should be avoided/limited Any CHO from meds need to be counted in daily tally
51
What are the causes of hypoglycemia?
Too little food/glucose Too much insulin Extra or vigorous exercise
52
What is the treatment for hypoglycemia if the patient has no IV access?
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
What is the treatment for hypoglycemia if the patient has IV access?
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
What are the s/s of hypoglycemia? (8)
Sweating Trembling Dizziness Mood changes Hungar HA Blurred vision Extreme tiredness and paleness
55
What are developmental consideration for an infant with DM?
Rapid growth Brain development Erratic sleeping/eating habits Avoid hypoglycemia
56
What are developmental consideration for toddlers and preschoolers with DM?
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
What can you do to help make care easier for a toddler/preschooler with DM?
Choice of food between 2 options Hold still for injections Term for "feeling bad"
58
What are developmental consideration for school age with DM?
Eating/sleeping more consistent Increase activity and play so could get hypoglycemic Peer issue can begin to develop
59
What are developmental consideration for a early adolescent with DM?
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
What task can be done to care for DM in early adolescence?
Log glucose Draw up insulin with supervision Know meal plan
61
What are developmental consideration for a mid-late adolescent with DM?
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
What are the two types of congenital adrenal hyperplasia (CAH)?
Glucocorticoids (cortisol) not enough Mineralcorticoids (aldosterone) not enough
63
What are the actions of cortisol?
Regulates glucose Responds to stress Regulates metabolism Immune function
64
What are aldosterone actions?
Regulates Na/K Regulates volume and BP
65
Do you have to have both glucocorticoid CAH and mineralcorticoid CAH?
If you have CAH, you will always have not enough glucocorticoids but you won't always have not enough mineralcorticoids
66
What occurs d/t lack of cortisol?
Cannot meet metabolic demands of body Especially worrisome if they have an acute illness Cariogenic shock
67
If cariogenic shock occurs d/t lack of cortisol?
Does not respond to IVF/inotropes Need glucose (hydrocortisone IV and add dextrose)
68
What occurs in the body d/t lack of aldosterone?
Excessive salt wasting Hyponatremia Volume depletion Cant regulate BP Hypotension Hypovolemic shock
69
What do infants rely on for CO?
Volume (sodium and water) Glucose
70
How do you test for a CAH crisis?
Early recognition Life threatening so newborn screening and ACTH stimulation test to confirm diagnosis
71
What are the early s/s of CAH adrenal crisis hypovolemic shock?
VS elevated Weakness Fatigue N/V/D Poor suck and hypotonia (not eating well) Alteration in LOC Seizure
72
What are the late s/s of CAH adrenal crisis hypovolemic shock?
Hypotension Poor perfusion
73
How do you restore hydration/perfusion in CAH adrenal crisis hypovolemic shock acutely?
Remove stress Nourish adrenals with adrenal supplements
74
How do you manage CAH at home?
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
When would you come into the ED if have CAH and sick? What s/s?
When sick day management is not improving s/s Weak, confused, dehydrated, decrease UOP
76
What is the secondary issue in regards to CAH?
ACTH doesn't shut off --> excessive stimulation --> hyperplasia of gland (trying to make up for decreased glucocorticoids) --> increased androgen (sex hormones) released
77
How does CAH affect females?
Ambiguous genitalia at birth Precocious puberty (excess muscle mass, advanced bone age, short stature, premature pubic hair, hirsutism) Irregular menses Delayed menses
78
Can ambiguous genitalia be fixed?
Requires surgery
79
What are alterations for GH deficiency
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
What is a Kewpie doll appearance indicative of? What does a child with this look like?
GH deficiency Exopthalmus
81
When do you see congenital hypothyroidism?
1-2 months
82
What are the clinical manifestations for congenital hypothyroidism? (10)
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
Do child with congenital hypothyroidism appear normal at birth? When do you want these children on medication by?
Often appear normal at birth - screening is vital d/t this Diagnosed within 2 weeks so can be on medication within 1 month
84
What are the nursing interventions associated with congenital hypothyroidism?
Confirmed newborn screening results Monitor G&D Parental education
85
What parental education is necessary for a child with congenital hypothyroidism?
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
What is PKU?
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
How is PKU detected?
Newborn screening Genetics for confirmation
88
What is the lifelong treatment for PKU?
Dietary restriction of phenylalanine Special formula for first 2 years of life Low protein diet as child gets older
89
What does the diet for PKU do for the patient? Can they ever go off the diet?
Avoids cognitive delays Possibly able to go off diet after 6-8 years when neurologic development is complete
90
What is precocious puberty for females?
before age 6-8 Appearance of secondary sexual characteristics, advanced growth rate, and bone maturation
91
What is precocious puberty for males?
before age 9 Appearance of secondary sexual characteristics, advanced growth rate, and bone maturation
92
What are major implications of precocious puberty?
Short stature as an adult d/t early closure of epiphyseal ends of long bones
93
What tests should be done to rule out secondary reasons for precocious puberty? What is most common cause?
Hormone-secreting tumors Brain injury caused by head trauma Thyroid dysfunction Ovarian dysfunction Idiopathic most common - obesity
94
What are you do to delay early puberty? When would this be discontinued?
GnRH blocker Monthly lupin injections Implantable devices Discontinue when old enough to go through puberty

Fall - Pediatrics (15 decks)

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