Endocrine Flashcards
When do most endocrine glands develop?
During the first trimester
Growth Hormone Deficiency
Also known as hypopituitarism or dwarfism, is characterized by poor growth and short stature
S/Sx of Growth Hormone Deficiency
- Prominent subcutaneous deposits of abdominal fat
- Child-like face with a large, prominent forehead
- High-pitched voice
- Delayed sexual maturation
- Delayed dentition
- Delayed skeletal maturation
- Decreased muscle mass
When does a Growth Hormone Deficiency becomes apparent?
May start with a normal birth weight and length but is less than 3% on the growth chart by 3 years of age
Causes of Growth Hormone Deficiency
- Tumor
- Infection
- Infarction
- Irradiation in utero
- Trauma during or after birth
- Genetics
- Idiopathic
- Emotional or nutritional deprivation which suppresses the production of pituitary hormones (but this is reversible)
Growth Hormone Deficiency Diagnostics
- Bone age test
- CT/MRI to rule out tumors
- Pituitary function test
Growth Hormone Deficiency Treatment
- Tumor removal (if applicable)
2. Supplemental GH
When do we stop administering supplemental GH to a patient with growth hormone deficiency?
When the growth plates fuse
Growth Hormone Deficiency Nursing Management
- F/U appointments with endocrinologist every 3-6 months
- Growth plotting every 3-6 months
- Assessing adequate nutrition
- Evaluate for learning problems
- Communicate in an age appropriate manner
- Medication compliance
- Encourage participation in sports that are not height dependent
- Support groups
Precocious Puberty
In precocious puberty, the child develops sexual characteristics before the usual age of pubertal onset.
S/Sx of Precocious Puberty
- Acne
- Adult body odor
- Accelerated rate of growth
- Breast development
- Pubic hair
- Advanced genitalia maturation, but does not typically display sexual behavior
- Emotional lability
- Aggressive behavior
- Mood swings
When does precocious puberty typically present?
In girls: 6-7 years
In boys: younger than 9
Precocious Puberty Causes
- Tumor
- Radiation
- Infection
Why is it necessary to treat precocious puberty?
Because without treatment, the child may become fertile (girls will start menstruation)
Precocious Puberty Diagnostics
- Pelvic ultrasound
- Serum hormone values
- CT/MRI
Precocious Puberty Treatment
Aimed at determining and treating the cause and halting sexual development
- GnRH analog: suppresses gonadotropin release
- Medroxyprogesterone (depo-provera) prevents menstruation
Precocious Puberty Nursing Interventions
- Medication compliance
- F/U appointments every 6 months
- Monitor for behavior changes
- Provide sexual education at discontinuation of treatment or if sexual behavior is suspected
- Communicate with child at age-appropriate level
- Counseling
Delayed Puberty
- Characterized by delayed secondary sexual development
- These children usually end up developing normally, just at a later age
Delayed Puberty (Boys)
- No testicular enlargement by 14
- Pubic hair by 15
Delayed Puberty (Girls)
- No breast development by age 12
- No pubic hair by 14
- No menarche by 15
Delayed Puberty Diagnostics
- Physical assessment
- Genetic testing
- Serum hormone level
- Growth plotting
- MRI/CT to assess for tumors
Delayed Puberty Treatment
Treating cause and/or Testosterone (males) and Estradiol (females)
Delayed Puberty Nursing Intervention
Emotional support for possible infertility depending on the cause
Polycystic Ovary Syndrome (PCOS)
Characterized by excessive testosterone production by the ovaries
S/Sx of Polycystic Ovary Syndrome
- Hirsutism (facial hair growth)
- Balding
- Acne
- Increased muscle mass
- Decreased breast size
Potential Complications of Polycystic Ovary Syndrome
- Infertility
- Insulin resistance
- Hyperinsulinemia (DM)
- Increased risk for endometrial carcinoma and CVD
Cause of Polycystic Ovary Syndrome
Unknown
Polycystic Ovary Syndrome Diagnostics
- Physical assessment
- Serum glucose and insulin levels (high insulin level in relation to glucose level)
- Serum hormone levels
Polycystic Ovary Syndrome Treatment
- Early recognition!!!
- Oral contraceptives
- Insulin sensitizing medications (metformin)
Polycystic Ovary Syndrome Nursing Management
- Encourage diet and exercise
- Medication compliance
- Monitor blood pressure
- Support groups
Childhood Obesity Nursing Interventions
- BMI and growth chart plotting
- Food exposure
- Exercise and/or sports of interest
- Positive support group/peers
- Assess environmental/financial concerns
Type 1 DM
Caused by a deficiency of insulin secretion
** Children can have both types of DM
Type 2 DM
Caused by insulin resistance
** Children can have both types of DM
S/Sx of Diabetes Mellitus (hyperglycemia)
- Weakness
- Fatigue
- Mood changes
- Polydipsia
- Polyuria
- Polyphagia
- Blurred vision
- Bed wetting
- Headaches
Diabetes Mellitus Diagnostics
- HbA1C (greater than 6.5%)
- Random glucose (greater than 200)
- Fasting glucose (greater than 120)
- 2-hour plasma glucose (greater than 200)
Long Term Complications of Diabetes Mellitus
- Failure to grow
- Delayed sexual maturation
- Poor wound healing
- Recurrent infections
- Retinopathy
- Neuropathy
- Vascular complications
- Nephropathy
- Cerebrovascular disease
- PVD
- CVD
S/Sx of DKA
- Anorexia
- N/V
- Lethargy
- Stupor
- Altered LOC
- Confusion
- Decreased skin turgor
- Abdominal pain
- Kussmaul respirations
- Fruity breath
- Ketones in urine and blood
- Tachycardia
- Coma and death (if untreated)
Type 1 Glycemic Control
Glucose checks with meals and at bedtime
Type 2 Glycemic Control
Glucose checks less often when on oral diabetic medications
- May also need insulin which increases the frequency of glucose checks
Insulins
- Rapid Acting (aspart)
- Short Acting (regular)
- Intermediate Acting (NPH)
- Long Acting (glargine)
Diabetes Mellitus Nursing Management
- Carb Counting (carb goals)
- Diet and Exercise
- Educate the patient and the family!
Managing Complication of Diabetes Mellitus
- Routine eye exams (monitor for retinopathy)
- Annual microalbuminuria testing (monitor for nephropathy)
- Periodic lipid profile (monitor for dyslipidemia)
- Every 1-2 years children should be screened for celiac disease and hypothyroidism
Hypoglycemia Treatment
Severe: glucagon SQ or IM OR dextrose IV
Mild: glucose paste or tablets, or simple carb such as OJ followed by a complex carb such as PB and crackers
CFRD
Cystic Fibrosis-Related Diabetes
- Thick mucus causes scarring of the pancreas that prevents the pancreas from producing normal amounts of insulin
S/Sx of CFRD
- May be asymptomatic
- Polyuria
- Polydipsia
- Fatigue
- Weight loss
- Unexplained decline in lung function
Treatment for CFRD
Treated with insulin
- Must maintain a high calorie, high protein, high fat diet
- Must count carbs and give insulin accordingly
- Glucose checks 4 times a day and increased exercise just like Type 1 diabetics
