Endocrine Flashcards
What is hypopituitarism?
p. 861-866
Deficient secretion of pituitary hormones which lead to retarded growth, gonadotropin deficiencies, thyroid and adrenal deficiencies depending on which hormones are deficient.
What is congenital hypothyroidism?
p. 869-870
Decrease in T3 and T4 which slows the metabolic rate. Usually an
embryonic autosomal recessive defect in the thyroid gland.
What is congenital adrenal hyperplasia?
p. 873-874
Family of genetic conditions affecting the adrenal glands that interferes with normal growth and development including normal development of the genitals due to decreased or absent cortisol synthesis
What is Turner syndrome?
p. 892
Chromosomal disorders interfering with normal growth processes; absence of X chromosomes: 45 XO karyotype
What is Klinefelter Syndrome?
p. 893
Chromosomal disorders interfering with normal growth processes;
excess of X chromosomes: 47 XXY karyotype
S/s of hypopituitarism
- Short stature
- Delayed bone age
- Infertility
- Intolerance to cold
- Fatigue
- Loss of hair
S/s of congenital hypothyroidism
- Pallor
- Decreased temperature
- Hypoactivity (sluggish)
- Decreased muscle tone
- and reflexes
- Large tongue
- Bradycardia
- Constipation
- Feeding difficulties
- Dry and cracked skin
- Edema at eyelids
S/s of congentital adrenal hyperplasia
- Salt wasting - which can be life threatening (shock)
- Hyponatremia
- Hyperkalemia
- Hypoglycemia
- Ambiguous genitalia
S/s of Turner Syndrome
- Edema to hands and feet
- Low posterior hairline/webbed neck
- Low set ears
- Short stature
- Delayed pubertal development
- Amenorrhea
- Normal growth until 3 years, then
- no growth spurts
- Infertile
- Kidney, thyroid, heart and other
- problems
- Learning difficulties
S/s of Klinefelter Syndrome
- Not detected until puberty
- Varying degrees of mental
- impairment
- Severity of intellectual disability
- increases with the additional #
- of X chromosomes
- Tall
- Hypogenitalism
- Gynecomastia
- Sterile
- Poor social interactions
Tx of hypopituitarism
- Replacement of Growth hormone every day until growth plates close (side effects: increase in blood glucose and gynecomastia)
Tx of congenital hypothyroidism
Thyroid hormone replacement
Tx of congenital adrenal hyperplasia
Steroid (hydrocortisone +/- fludrocortisone) replacement, Salt replacement
Tx of Turner Syndrome
Growth hormone Estrogen (beginning around 12 -13 years)
Tx of Klinefelter Syndrome
Testosterone replacement beginning at puberty
Nursing Implications of hypopituitarism
- Family teaching and support
- Child will reach normal adult height, but more slowly than others (takes 3-6 months to see changes)
- Wear a medical identification bracelet
Nursing Implications of Congenital Hypothyroidism
- Give med on empty stomach
- 30 minutes before food
- Separate from iron and calcium supplements by 4 hours
- Testing is done at newborn screening
Nursing Implications of Congenital Adrenal Hyperplasia
- Increased steroid doses during times of illness, injury and stress.
- Foster bonding between parent and child
- Educate parents about reconstructive surgery options
Nursing Implications of Turner Syndrome
- Educate about learning abilities and fertility
- In vitro fertilization can be effective
Nursing Implications of Klinefelter Syndrome
- Therapies (OT, PT, speech)
Causes of hypoglycemia
- Insulin dose too high for food eaten
- Insulin injection into muscle
- Too much exercise for insulin dose
- Too long between snacks/meals
- Too few carbohydrates eaten
- illness, stress
Clinical manifestations of hypoglycemia
- Rapid onset
- irritability, nervousness, tremors, shaky feeling, difficulty concentration or behavior change, confusion, repeating something over and over
- unconsciousness, seizure, shallow breathing, tachycardia
- pallor, sweating
- moist mucous membranes, hunger,
- headache, dizziness, blurred vision, double vision, photophobia
- Numb lips or mouth
Clinical therapy of hypoglycemia
- If conscious, give 15g of carbohydrate
- Wait 15 minutes and recheck blood glucose
- Give another 15g of carbohydrates if 70mg/dL or below
- Recheck the blood glucose in 15 mins
If unconscious, give glucagon by injection
Causes of hyperglycemia
- Insulin dose too low for food eaten
- illness or injury, stress
- too many carbohydrates eaten
- Meals/snacks too close together
- Insulin injected just under skin or into hypertrophied areas
- Decreased activity
Clinical manifestations of hyperglycemia
- Gradual onset
- Lethargy, sleepiness, slowed responses, or confusion
- Deep, rapid breathing
- flushed skin or dry skin
- dry mucous membranes, thirst, hunger, dehydration
- Weakness, fatigue
- Headache, abdominal pain, nausea, vomiting
- Blurred vision
- shock
Clinical Therapy of hyperglycemia
Give additional insulin at usual injection time
Give correction scale insulin doses for specific blood glucose levels when ill or injured
give extra injections if hyperglycemia and moderate to large ketones
increase fluids
Rapid Acting Insulin
- Humalog (Lispro),
- Glulisine, (Apidra),
- Aspart;
- Afrezza
Onset: 15-30 min (Afrezza <15min)
Peak: 30-90 min (Afrezza 10-20min)
Duration: <5 hours (Afrezza 2-3 hours)
Short Acting Insulin
Regular, Novolin
Onset: 30-60 min
Peak: 2-5 hours
Duration: 4-12 hours
Intermediate Insulin
NPH
Onset: 1-2 hours
Peak: 6-10 hours
Duration: 14-24 hours
Long-acting insulin
Glargine (Lantus, Toujeo) 3-6 hours/minimal/24 hours
Detemir (Levemir), 3-4 hours/3-9 hours/24 hours
Degludec (Tresiba) 1hour/9 hours/42 hours
Insulin condsiderations for puberty
Insulin resistance and fluctuations in glucose levels
- Insulin doses may need to increase
Insulin considerations for Adolescent Psychosocial development/Noncompliance
(impulsiveness, mood swings, struggle for independence)
- Care contracts, increased responsibilities, screen for depression, test glucose before driving, sex education and protection
Insulin considerations: Developmental Approaches – Toddlers
- Introduce the parents to other families with children with diabetes or find a support group.
- Offer toddler choices of snacks and injection sites
- Offer finger foods
Insulin considerations: Developmental Approaches – Pre-School
- Let child help choose foods, let child wipe skin for shots and glucose checks
- Needle play with dolls (with supervision)
- Play games to teach about hypoglycemia
Insulin considerations: Developmental Approaches – Elementary
- Play board and computer games about diabetes.
- Attend diabetes camps.
- Can follow a diet and help with management with close supervision.
- Help with meal planning and preparation.
- Can count carbohydrates.
- Can administer or begin assisting with administration of insulin (drawing up and injecting); performing fingersticks with supervision.
- **Does not fully comprehend how doing something now affects long-term outcomes (good diabetes control prevents complications later) **
- If the child has electronic devices (phone, tablet, etc.), can download and use diabetes and carbohydrate monitoring apps
Insulin considerations: Developmental Approaches – Young Adolescents
- Support groups, negotiate plans to allow increasing responsibility for management with supervision
- If the child has electronic devices; download diabetes management apps
- Impulsiveness, mood swings, struggle for independence and body image are key influencing factors and can lead to noncompliance issues: care contracts can be used to foster accountability and increase compliance
- Screen for depression, test glucose before driving, sex education and protection
Insulin considerations: Developmental Approaches – Older Adolescents
Should begin to be independent with care by about 16 years. May still need help with insulin dosing decisions.
Phenylkentonuria (PKU)
p. 893
- Autosomal recessive disorder of metabolism that affects the body’s ability to use protein.
- Must be detected early (is screened in newborn screenings), because if untreated it can lead to brain damage and developmental delay; autism spectrum-like behaviors
- Diet low in phenylalanine; proteins and aspartame (artificial sweeteners)
** Fruits and vegetables are good, Lofenalac formula, carbs
See the “Target” diet below for best options of acceptable foods
Precocious Puberty
p. 868-869
Precocious puberty is when a child’s body begins puberty too soon, and is considered to begin before age 8 in girls and age 9 in boys. Administer hormone to stop puberty until they reach appropriate puberty time.
Developmental effects of endocrine disorders
Hypothyroidism: if
undertreated leads to delayed
growth and intellectual
disability (treat with thyroid
replacement)
Turner Syndrome: learning
disabilities
Klinefelter Syndrome: delayed
milestones, low verbal IQ
Effects of endocrine disorders on heart and lungs.
Hypothyroidism: bradycardia
CAH: dehydration/shock; hyponatremia
(treat with glucocorticoids,
mineralocorticoids, salt)
Turner Syndrome: congenital heart
defects
Effects of endocrine disorders on the reproductive system.
Hypothyroidism: altered puberty
CAH: virilization; ambiguous genitalia
(females); premature sexual development
Turner Syndrome: infertility; delayed
puberty
Klinefelter Syndrome: infertility; delayed
puberty; decreased hair growth; small
testes; gynecomastia (treat with
testosterone)
Effects of endocrine disorders on the skin.
Hypothyroidism: dry, cool skin;
sensitivity to cold
Effects of endocrine disorders - psychosocial
Turner Syndrome: Body image, self-
esteem
Klinefleter Syndrome: school difficulty;
difficult socialization
Effects of endocrine disorders - head and neck
Hypothyroidism: thick tongue; thin
hair
Turner Syndrome: webbed neck;
low hairline; small jaw; low set ears;
hearing loss
Effects of endocrine disorders - GI/GU
Hypothyroidism: constipation
Turner Syndrome: kidney
abnormalities
Effects of endocrine disorders - musculoskeletal
Hypopituitarism: short stature, growth
stops/slows at 1 year (treat with growth
hormone); decreased bone ossification; risk for
slipped capital femoral epiphysis (evaluate for
hip and knee pain and limp)
Hypothyroidism: delayed bone age; poor
muscle tone
CAH: early closure of epiphyseal plate; short
adult stature
Turner Syndrome: short stature and features
(treat with growth hormone); osteoporosis
(treat with estrogen and progesterone)
Klinefelter Syndrome: tall stature
describe the patho of different endocrine disorders
- Hypothyroidism (congenital): spontaneous gene mutation
- Turner Syndrome: missing X chromosome
- Klinefelter Syndrome: extra X chromosome
- Congenital Adrenal Hyperplasia: autosomal recessive
- PKU: autosomal recessive
- Diabetes Mellitus: genetic predisposition; runs in families (no
direct heredity)
Anterior and Posterior pituitary hormones
FLAT PeG
These are follicle stimulating hormone (FSH), luteinizing hormone (LH), adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), prolactin, endorphins, and growth hormone (GH)
What do the hormones of the pituitary gland control/affect
FSH - testes of male, ovaries of female (inhibin, testosterone, progesterone, estrogen) kleinfelter
LH - testes of male, ovaries of female (inhibin, testosterone, progesterone, estrogen) kleinfelter
ACTH - adrenal glands (epi, norepi) CAH
TSH - thyroid gland, thyroid hormones (TS3, TS4) hypothyroidism
PRL - mammary glands
GH - liver, bone, muscle tissues hypopituitarism
What gland control metabolism (primarily)?
Thyroid
A Pavlik harness has to be worn how long (hours/day)?
23-24 hrs/day
8-12 weeks
What gland primarily affects growth?
pituitary gland
What is associated with the 45 XO karyotype?
Turner Syndrome
What is the primary method for reducing swelling while wearing a cast?
elevation
What type of diet is appropriate for a child with PKU
low protein, fruits & veggies
What is the tx for osteomyelitis?
long-term abx
Most serious complication for CAH?
shock
Tx for JIA?
anti inflmmatories
DMARDs (methotrexate)
