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Peds Ex. 3 Study Material > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What are some characteristics of Growth Hormone Deficiency?

A
  • Associated with deficient secretion of GH
  • Caused by a variety of conditions
  • Inhibits somatic growth = the length of them
  • Treated more frequently in boys
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2
Q

What are some assessment findings seen with growth hormone deficiency?

A
  • Short stature
  • Skeletal proportions are normal
    • Get them diagnosed as early as possible, they start deviating after 1 years old.
  • Sexual development usually is delayed
  • Usually normal intelligence
  • Premature aging common in later life
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3
Q

How would you manage a child with growth hormone deficency?

A
  • Correct underlying disease process
  • Replace GH
  • Replace of hormone deficiencies if needed

Assist in establishing diagnosis

  • Provide emotional support
  • Education
    • Daily SQ injections - Daily injections AT NIGHT because this is when the endogenous hormone would be released
    • Self-management during school-age
  • Prepare caregivers for financial impact
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4
Q

What are some assessment findings seen with precocious puberty in girls?

A
  • breast development, body hair, adult body odor, onset of menstrual periods
  • Occurs before the age of 8 for girls
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5
Q

What are some assessment findings seen with precocious puberty in boys?

A
  • genital enlargement, body hair, adult body odor, acne, deepening voice
  • Occurs under 9 years old
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6
Q

How would you diagnose precocious puberty?

A
  • GnRH stimulation test
  • Bone age X-rays
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7
Q

How do you manage children with precocious puberty?

A
  • Administering GnRH analog, Lupron injection Q3-4 weeks
  • Educate family about socialization and dressing the child appropriate for age and not physical maturation age
  • Heterosexual/romantic interest is not advance for chronologic age
  • Provide emotional support
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8
Q

What is diabetes insipidus?

A
  • Disorder of posterior pituitary hypofunction
  • Known as neurogenic DI or central DI
  • Hyposecretion of antidiuretic hormone (ADH), or vasopressin
  • Produces a state of uncontrolled diuresis
  • Causes: familial or unknown; or secondary
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9
Q

What are some Laboratory and Diagnostic Tests for Diabetes Insipidus?

A

Radiographic studies such as CT scan, MRI, or ultrasound of the skull and kidneys will determine if a lesion or tumor is present.

Urinalysis: urine is dilute, osmolarity is less than 3,000 mOsm/L, specific gravity is less than 1.005, sodium is decreased.

Serum osmolarity is greater than 300 mOsm/L. = Serum sodium is elevated.

Fluid deprivation test measures vasopressin release from the pituitary in response to water deprivation.

•Normal results will show decreased urine output, increased urine specific gravity, and no change in serum sodium.

**If they do have DI they will continue to have an increased urine output, decreased specific gravity. **

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10
Q

How would manage children with Diabetes inspidus?

A

Drugs:

  • Daily hormone replacement (usually)
  • Drug of choice: desmopressin acetate (DDAVP)
    • Nasal, Oral, Injectable

Nursing:

  • Initial objective: identify disorder
  • Educate family and child
  • Encouraged child to assume responsibility
  • Monitor BP
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11
Q

What are some characteristics of SIADH?

A
  • Disorder of posterior pituitary hyperfunction
  • Hypersecretion of ADH (vasopressin)
  • Observed in variety of conditions
  • Manifestations directly related to fluid retention and hypotonicity
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12
Q

How would you manage a child with SIADH?

A
  • Immediate management: restrict fluids
  • Implement safety precaution (seizures)
    • Serum sodium levels are low -> at risk for seizures
  • Help child cope with fluid restriction
  • Educate family
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13
Q

Compare DI to SIADH

A

DI

  • High sodium lvls & low lvls of water
  • Increased urination
  • Hypernatremia
  • Serum osmolality > 300
  • Urine specific gravity <1.005
  • Decreased urine osmolality
  • Dehydration, thirst

SIADH

  • Low serum lvls & increased amount of h20 retention
  • Decreased urination
  • Hyponatremia (dilutional)
  • Urine specific gravity > 1.030
  • Increased urine osmolality
  • Fluid retention, weight gain, hypertension
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14
Q

What are some characteristics of Precocious Puberty?

A
  • Characterized by the early sexual development
  • Occurs more frequently in girls
  • Unknown cause in 80% of girls
  • CNS insult or injury is more common in boys
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15
Q

What are some characteristics of hypothyroidism?

A
  • Known as cretinism
  • Results from failure of the thyroid gland to migrate during fetal development
  • Leads to low concentrations of circulating T3 and T4
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16
Q

What are some complications of hypothyroidism and how would you manage it?

A
  • Complications: include mental retardation, short stature, growth failure, and delayed physical maturation and development
  • Therapeutic management: TH replacement
    • Give the med every day AT NIGHT, on an empty stomach (2 hrs before and 2hrs after), for LIFE
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17
Q

What are some assessment findings seen in a child with hypothyroidism?

A

Health history

  • Maternal history—connection to hypothyroidism
  • Infant sensitivity to cold, constipation, feeding problems, or lethargy

Physical examination

  • Lethargic or hypoactivity
  • Persistent open posterior fontanel
  • Enlarged tongue

Laboratory and diagnostic tests

  • Mandatory newborn screening
  • Radioimmunoassy
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18
Q

What are some nursing interventions for children with hypothyroidism?

A

Promote appropriate growth:

  • Measure and record growth at regular interval
  • Measure TH levels at recommended intervals
  • Assist with trail off medication
  • Monitor for signs of hypo- and hyperfunction
  • Provide periods of rest
  • Implement safety measures

Educate and support the family:

  • Developmental screening
  • Medication therapy
  • Genetic counseling
19
Q

What are some characteristics of acquired hypothyroidism?

A
  • Commonly results from an autoimmune chronic lymphocytic thyroiditis
  • Genetic condition, antibodies develop against the thyroid gland
  • More common in girls, seen during childhood and adolescence
  • Therapeutic management is same as congenital hypothyroidism
20
Q

What are some characteristics of hyperthyroidism?

A
  • Hyperfunction of thyroid gland
  • Uncommon in children, peak incidence occurs in adolescence as a result of Graves disease
  • Therapeutic management aimed at decreasing TH level
21
Q

What are some symptoms associated with hyperthyroidism?

A
  • Nervousness / anxiety
  • Diarrhea
  • Heat intolerance
  • Weight loss
  • Smooth, velvety skin
22
Q

What are some symptoms associated with hyorthyroidism?

A
  • tiredness / fatigue
  • Constipation
  • Cold intolerance
  • Weight gain
  • Dry, thick skin; edema of face, eyes, and hands
  • Decreased growth
23
Q

What are the manifestations of a hyperthyroid crisis?

A
  • Excessive stress triggers this to occur
  • Hyperthermia
  • Tachycardia
  • High-output heart failure
  • Agitation or delirium
  • Nausea/vomiting/diarrhea —> Fluid depletion
24
Q

What is the treatment for a hyperthyroid crisis?

A
  1. Use of drugs that block TH synthesis (methimazole, propylthiouracil)
  2. Use of beta-blockers for control of cardiovascular system
  3. Administration of corticosteroids
  4. Administration of iodine (To inhibit thyroid hormone sysnthesis)
  5. Supportive care
25
Q

What are some characteristics of Cushing syndrome?

A
  • Disorder of adrenal gland hyperfunction
  • Most common cause in older children is prolonged or excessive use of corticosteroid therapy
  • Management depends on cause
  • Goal: to restore hormone balance and reverse Cushing syndrome
26
Q

What are the clinical manifestations of Cushing syndrome/disease?

A
  • Bone effects
  • Weight gain
  • Glucose intolerance
  • Protein wasting
27
Q

Describe the effects of cushing’s disease/syndrome on weight

A

Weight gain – fat deposition & transient Na+ & H2O
retention (from mineralcorticoid effects of high cortisol)
 Facial (moon face)
 Cervical (buffalo hump)
 Truncal (central obesity)

28
Q

Describe the glucose intolerance associated with cushing’s disease/syndrome

A
  • Cortisol-induced insulin resistance
  • ↑ gluconeogenesis & glycogen storage by liver
29
Q

Describe the protein wasting associated with cushing’s disease/syndrome

A

Catabolic effects of high cortisol on peripheral tissues leads to muscle wasting

30
Q

What are the complications associated with cushings disease/syndrome?

A
  • ↑ cortisol → ↑ vascular sensitivity to catecholamines → vasoconstriction/↑ BP
  • Metabolic syndrome (central obesity, hypertension, glucose intolerance, dyslipidemias)
  • Infections from immune system suppression
  • Altered mental status (irritability, depression, psychiatric disorders) from cortisol effects on hippocampal neurons
  • Hyperglycemia, glycosuria, hypokalemia, metabolic alkalosis
31
Q

What is the treatment for cushings disease/cushings syndrome?

A
  • 50% mortality within 5 years if untreated
  • Treatment options include medication, radiation, and/or surgery
32
Q

What are some characteristics of congenital adrenal hyperplasia?

A
  • Results from genetic defect
  • Breakdown in steroid synthesis and overproduction of androgens
  • Can lead to ambiguous genitalia in females
33
Q

What causes Type 1 Diabetes?

A
  • Peak age of diagnosis = 12 years
  • Autoimmune loss of β cells
    • Gene-environment trigger cell-mediated destruction of pancreatic cells
    • Slowly progressive, T-cell-mediated Lymphocyte & macrophage infiltration → inflammation → β cell death
    • Autoantibodies produced against islet cells, insulin, other cytoplasmic proteins
       T helper lymphocytes → IL-4 → B lymphocyte proliferation & antibody production, IL-2 → T cytotoxic (CD8) cells, and IFNγ → macrophage activation
  • Altered β & α cells → excess glucagon → hyperglycemia
  • Non-immune is a secondary result of other diseases (pancreatitis)
34
Q

What causes Type 2 diabetes?

A
  1. insulin resistance (relative insulin deficiency) → pancreatic β cell dysfunction → absolute insulin deficiency
  2. insulin secretory defect with insulin resistance
35
Q

How would you manage a child in DKA?

A
  • Rapid assessment
  • Monitor BGL Q1h
    • Goal: drop 50-100 dL/h
  • Correct fluid deficit
    • Over 24-48 hr
    • NS 10-20 mL/kg•Give regular insulin IV
  • Correct electrolyte imbalance
    • Potassium (high lvls in serum)
    • Sodium (pee’d out)
  • Prevent complications - Complications can develop if you drop the glucose level too fast
    • Hypoglycemia – give dextrose
    • Cerebral edema – control replacement of fluids
36
Q

How would you care for a child with diabetes that is sick?

A
  • Monitor BGL and urine ketones more frequently - Blood glucose levels increase when they are sick
  • Insulin should not be omitted
  • Notify primary care provider
    • Vomits more than one time
    • BGL remain above 240 mg/dl
    • Urinary ketones remain high
  • Provide extra oral fluids
37
Q

Describe the insulin dosage schedule for children

A
  • Administer insulin as directed before meals.
  • Increase insulin dose or activity level when extra food is eaten.
  • Decrease insulin dose during periods of strenuous activity.
38
Q

How would you involve children in their diabetes management?

A

Children under age 3 can choose which finger to stick for blood sugar tests or which place to use for the insulin injection

Children 4 to 7 years old can help with monitoring blood sugar and with injections.

•Regular reassurance that DM is not a punishment for this age group

39
Q

What is the classic triad for DKA?

A
  • Hyperglycemia - blood glucose greater than 200 mg/dL
  • Ketosis - ketones present in blood and/or urine
  • Acidosis - pH less than 7.3 and/or bicarbonate less than 15 mmol/L
40
Q

What are the clinical manifestations of DKA?

A

•Dehydration
•Rapid, deep, sighing (Kussmaul respiration)
• Nausea, vomiting, and abdominal pain mimicking an acute abdomen (doesn’t occur with HHNKS)
•Progressive obtundation and loss of consciousness
•Increased leukocyte count with left shift
• Non-specific elevation of serum amylase
Fever only when infection is present

41
Q

What are the 3 classifications of DKA?

A
  1. Mild
    • Venous pH <7.3
    • HCO3 <15
    • Use sub q insulin
  2. Moderate
    • Venous pH <7.2
    • HCO3 <10
    • use IV insulin
  3. Severe
    • Venous pH <7.1
    • HCO3 <5
    • use IV insulin
42
Q

What causes hypoglycemia?

A
  • Too much insulin
  • Too little food
  • Too much exercise without food
  • Missing or delayed meals/snacks
  • Stress/overexcitement in young children

Blood glucose < 60 mg/dL

43
Q

What causes hyperglycemia?

A
  • Insufficient insulin
  • Missed insulin dose(s)
  • Infections/illness
  • Stress response

Blood glucose > 200mg/dL

Peds Ex. 3 Study Material (5 decks)

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