Endocrine Flashcards
1
Q
Functions of the Endocrine System
A
- regulates body metabolism through release of hormones
- maintain optimal hormone levels
- maintain homeostasis
2
Q
A/P Pediatric Endocrine Differences
A
- endocrine system responsible for sexual differentiation during fetal development
- hormones regulate growth and development
- stimulate reproductive system and regulates puberty
3
Q
Negative Feedback
A
- hypothalamus-Pituitary Axis produce releasing and inhibiting hormones
- hypothalamus synthesizes hormones
- pituitary stimulates release of hormones when needed
- secretion inhibited when target cells have received adequate hormone
- secretion resumes when levels of hormones are low
4
Q
Puberty
A
-hypothalamus stimulates pituitary to release hormones LH and FSH
5
Q
Girls Puberty
A
- LH and FSH –> ova maturation and ovulation
- mean onset 10.2 yrs (white) and 9.6 years (black)
6
Q
Boys Puberty
A
- LH –> testosterone production
- FSH –> sperm production
- enlargement of testes
- scrotal changes
- Mean onset 11.5 years
7
Q
Thelarche
A
breast buds
8
Q
Adrenarche
A
growth of pubic hair
9
Q
menarche
A
initial presence of menses
10
Q
Amenorrhea
A
primary: absence of menarche by age 16 -due to hormonal imbalance, structural defect
secondary: skip 3 menstrual periods in a row–due to pregnancy, extreme exercise without eating
11
Q
Tx of Amenorrhea
A
depends on cause
- BCPs with estrogen and progesterone
- Balanced meals, high calorie for athletes
12
Q
When is puberty delay considered in boys…
A
if no changes by 13.5 to 14 years old
13
Q
Gynecomastia
A
- breast enlargement in boys during puberty
- common and benign; self limiting
- ratio of estrogen to testosterone is greater than usual
- important b/c adolescents concerned with body image
14
Q
Tanner Stages
A
- used to classify stage of puberty
- 5 stages
1: no secondary sex characteristics
2: first signs of puberty
3 and 4: progressive puberty
5: puberty completed
15
Q
Ethnic Differences in Puberty
A
US: boys developing secondary sexual characteristics and achieving testicular enlargement 6 months to 2 years earlier than norms
AA: boys entering Tanner stages 2 to 4 earlier than white or hispanic boys
16
Q
Normal growth patterns in puberty
A
- final 20-25% of height attained during puberty
- girls: growth spurt age 10-14 yrs
- boys: growth spurt 11-16 years
- growth ceases age 16-20
- seem to grow from feet up. first shoes, slacks, then shirts get too small
17
Q
Constitutional Growth Delay
A
- delayed linear growth
- sexual and skeletal maturation behind peers
- may have fam hx of late bloomers
- delayed bone age
- experience puberty and growth spurt later
- achieve normal heigh without tx
- different from familial short stature, short due to genetic potential
18
Q
GHD
A
Growth Hormone Deficiency
- hypopituitarism
- caused by decreased activity of pituitary gland
- GH stimulates bone growth and density, tissue growth, protein synthesis
- released by anterior pituitary, controlled by hypothalamus
- problems with pituitary can affect GH release
19
Q
Clinical Manifestations of GHD
A
- birth length/weight usually WNL
- fall below 3rd percentile after age 1 year
- grow 2 inches per year
- may have hyponatremia, seizures, micropenis, or undescended testicles (severe cases)
- youthful facial features, decreased muscle mass
- delayed dentition, bone growth, and puberty
- low IGF-1
20
Q
Clinical Therapy of GHD
A
- bone age xray
- MRI brain
- provacative GH testing to stimulate release of GH
- Positive test? GH replacement therapy
- GH SQ daily injections, increased growth velocity initially, then maintains growth
21
Q
GnRH analogue
A
delay puberty
with GH, maximizes growth
should not be given routinely except for precocious puberty
22
Q
Nursing Management of GHD
A
- accurate height and weight, 2x for accuracy
- teaching about disorder, SQ injections
- GH expensive, not always covered
- may have learning disabilities if GHD is due to head trauma or tumor
- social prejudice and teasing common
- tx in age appropriate manner
- individual sports
- focus on strengths
23
Q
PP
A
Precocious Puberty
-secondary sexual characteristics before age
7 - white girls
6 - black girls
9 - boys
- central or true PP occurs when hypothalamus is activated to secrete GnRH
- may start out tall for their age, have advanced bone age
- growth stops early as hormones stimulate closure of epiphyseal plate
24
Q
what confirms dx for PP
A
-provocative testing
25
What is given to stop puberty in PP
GnRH analogue
- lupron IM monthly or synarel intranasal BID
- tx stops at normal age of puberty
***some children may only have careful growth monitoring
26
Nursing Management: PP
- teaching, emotional support, medications
- kids want to hear they are normal
- dress in age-appropriate clothes
- may have mood swings
27
DSDs
Disorders of Sexual Differentiation
- female with ambiguous or male-looking genitals (CAH)
- female with normal external genitals but some internal male structures
- male chromosomes, may be insensitive to androgens
- testes remain inside, no womb
-mixture of male and female organs, usually have female chromosomes
28
PKU
Phenylketonuria
- autosomal recessive disorder of amino acid metabolism
- enzyme missing to convert phenylalanine to tyrosine
- results in build ip of phenylalanine in blood
- leads to mental retardation, seizures, death
29
PKU: Screening and tx
- screening in all 50 states by law
- after 48 hours of birth
- positive test needs to be repeated
- 2 positive tests? referral
- tx by diet: special formula, low protein and low aspartame foods, elemental medical foods, low phenylalanine diet for life
30
PKU Nursing Management
-mainly supportive
-education of parents:
phenylalanine sources of food, strict adherence to diet to avoid decline in IQ, negotiations with insurance companies to pay for medical food
-genetic counseling
31
T2DM
- impaired insulin action (insulin resistance)
- visceral fat produces TNF--insulin receptors are desensitixed
- impaired insulin secretion: hyperinsulinemia, eventually decrease in insulin release
- leads to hyperglycemia, impaired glucose tolerance, diabetes
32
RF for T2DM
- obesity
- low physical activity
- low SES
- Race
- family h/o DM
33
T2DM Nursing Management
- assess child with BMI at 85 percentile or above for signs of insulin resistance
- acanthosis, nigicans, HTN, dyslipidemia
- family h/o diabetes in overweight child
- Hgb A1C levels
34
T2DM Education
- disease and lifestyle, BG testing
- weight loss or maintenance if going through growth spurt
- annual screening for potential complication
- BP, lipids, eye exam, neuro exam of extremities, liver, and renal fx
35
DM Type 1
- pancreatic islet cells fail to produce insulin
| - autoimmune, genetic predisposition
36
Clinical manifestations of DM type 1
- polyuria
- polydipsia
- polyphagia
- weight loss
- fatigue
- lethargy
- candida vaginitis
- DKA
37
Clinical therapy for DM type 1
- monitor BG
- insulin
- CHO balancing
- exercise
38
Nursing Manangement T1DM
- physiologic assessment
- VS, LOC
- hydration status
- labs, blood gas, glucose, electrolytes
- caloric intake
39
Toddler Development considerations
- picky eaters
| - need to consume enough calories
40
Preschoolers Development considerations
- allow choices with food
| - which finger to test BG
41
Schoolage Development considerations
- learn to obtain BG and admin insulin
| - can be taught food management
42
Adolescents Development considerations
- compliance can become an issue
- may skip insulin doses
- may eat like their peer
- alcohol
43
Sick Day Guidelines
- be seen for fever or infection
- monitor BG freq
- test urine for ketones
- don't skip insulin
- may need to up insulin
- maintain hydration
- drinks with CHOs if eating less
44
Nursing Management for T1DM
- good foot care
- rotate injection site
- medical alert ID
- school health plan
- carry rapid sugar product
- hypoglycemia tx
- vaccinations
- balance food and insulin dosage with activity
- summer camp: more active, need more food
45
Hypoglycemia tx
- pallor
- HA
- sweating
- tremors
- dizzy
- ALOC
- irritability
- Test BG, if less than or equal to 70:
- give half cup of juice or soda, small box of raisins or 3-4 glucose tabs
- Wait 15 minutes and retest BG, repeat if BG 70 or less and repeat BG
- 80: give substantial snack
- unconscious: admin IM glucagon or glucose paste on gums
