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Peds Exam 2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Functions of the Endocrine System

A
  • regulates body metabolism through release of hormones
  • maintain optimal hormone levels
  • maintain homeostasis
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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
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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
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4
Q

Puberty

A

-hypothalamus stimulates pituitary to release hormones LH and FSH

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5
Q

Girls Puberty

A
  • LH and FSH –> ova maturation and ovulation

- mean onset 10.2 yrs (white) and 9.6 years (black)

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6
Q

Boys Puberty

A
  • LH –> testosterone production
  • FSH –> sperm production
  • enlargement of testes
  • scrotal changes
  • Mean onset 11.5 years
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7
Q

Thelarche

A

breast buds

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8
Q

Adrenarche

A

growth of pubic hair

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9
Q

menarche

A

initial presence of menses

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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

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11
Q

Tx of Amenorrhea

A

depends on cause

  • BCPs with estrogen and progesterone
  • Balanced meals, high calorie for athletes
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12
Q

When is puberty delay considered in boys…

A

if no changes by 13.5 to 14 years old

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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
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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

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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

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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
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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
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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
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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
Q

What is given to stop puberty in PP

A

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
Q

Nursing Management: PP

A
  • teaching, emotional support, medications
  • kids want to hear they are normal
  • dress in age-appropriate clothes
  • may have mood swings
27
Q

DSDs

A

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
Q

PKU

A

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
Q

PKU: Screening and tx

A
  • 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
Q

PKU Nursing Management

A

-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
Q

T2DM

A
  • 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
Q

RF for T2DM

A
  • obesity
  • low physical activity
  • low SES
  • Race
  • family h/o DM
33
Q

T2DM Nursing Management

A
  • 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
Q

T2DM Education

A
  • 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
Q

DM Type 1

A
  • pancreatic islet cells fail to produce insulin

- autoimmune, genetic predisposition

36
Q

Clinical manifestations of DM type 1

A
  • polyuria
  • polydipsia
  • polyphagia
  • weight loss
  • fatigue
  • lethargy
  • candida vaginitis
  • DKA
37
Q

Clinical therapy for DM type 1

A
  • monitor BG
  • insulin
  • CHO balancing
  • exercise
38
Q

Nursing Manangement T1DM

A
  • physiologic assessment
  • VS, LOC
  • hydration status
  • labs, blood gas, glucose, electrolytes
  • caloric intake
39
Q

Toddler Development considerations

A
  • picky eaters

- need to consume enough calories

40
Q

Preschoolers Development considerations

A
  • allow choices with food

- which finger to test BG

41
Q

Schoolage Development considerations

A
  • learn to obtain BG and admin insulin

- can be taught food management

42
Q

Adolescents Development considerations

A
  • compliance can become an issue
  • may skip insulin doses
  • may eat like their peer
  • alcohol
43
Q

Sick Day Guidelines

A
  • 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
Q

Nursing Management for T1DM

A
  • 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
Q

Hypoglycemia tx

A
  • 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

Peds Exam 2 (5 decks)

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