Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Peds Exam 2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is hypopituitarism?

Which hormones?

A

Not enough hormones from the pituitary

GH - main one
Gonadotropin
TSH
Corticotropin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In hypopituitarism, what are GH levels at first?

If GH is low, will this affect their growth?

A

Normal. They drop around 1 yr or at the growth curve.
- But they still are having this hormone. Just not enough

Yes - duh.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

In hypopituitarism, what can occur if Gonadotropin levels are low?

What type of issues can arise with low TSH & corticotropin?

A

Delayed sexual development
- difficulty reproducing

Developmental issues as well.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What will the bone age be in someone with a low GH level?

A

Bone age will be delayed

- growth plates will not be developed like they should be for age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When a child isn’t growing like expected & we think it is GH - how do we diagnosis this?

A
  • Check family history to see how other members grew. Combination between parents is typical.
  • Check for tumors that interfere with production
  • X rays to look at the bone age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

If GH is low - what things can stimulate GH production?

Explain the last one

A

Arginine, L-dopa, and Insulin (hypoglycemia will stimulate it).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Percent of GH cases that are successfully treated when the GH is replaced?

Type of injection used to replace GH?

What is a reason to stop administering the GH?

A

80% of GH cases
- this means they get “closer” to expected growth

SQ for 6-7 days a week

Stop GH if the bone plates are closing bc it is the maximum
- they will monitor for this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why do we test kids who have GH deficiency for other hormones?

A

Just incase they have other deficiencies & to get them those supplements.
- TSH, Gonadotropin especially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why is family support so important with GH therapy?

A

It is expensive. Need to make sure the family has the resources.
- help with insurance

Also, children can go through personality changes that the family may not be expecting.

Also help child feel accepted in society.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Diabetes Insipidus?

And what does this cause?

A

Undersecretion of Antidiuretic Hormone (ADH)

  • ADH will decrease if there is an excess of fluid and it will increase when there’s too little fluid.
  • Just think of the name.

Diabetes Insipidus. Since we don’t have enough ADH, you will have excessive urination and thus dehydrate yourself.
- and restricting fluid won’t help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to diagnose Diabetes insipidus (or too little ADH = dehydration)?

What can cause DI? How does this affect treatment?

A

Clinical manifestation of excessive urination

Tumor of or near the pituitary.
Trauma or infection.
- If one of these things are the cause, then we need to treat this first.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can vasopressin do for Diabetes insipidus?

What route is it given?

A

If vasopressin is given in then the urine excretion will stop.
It is sort of a definite sign or test that Diabetes insipidus is the problem in the first place.
- vasopressin is actually a synthetic ADH

Give vasopressin IV, orally, nasally
- DDAVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What if the cause of Diabetes Insipidus isn’t due to a tumor/infection that can be fixed? How will they be treated?

A

They’ll be given long term therapy for ADH replacement.

- maybe vasopressin long term?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Syndrome of Inappropriate Antidiuretic Hormone?

What electrolyte is affected?

What happens to urine osmolality?

A

SIADH is just an overproduction of ADH.
- meaning you won’t pee & you will retain fluid

Sodium (Na) will dilutionally decrease

Urine osmolality increases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Since SIADH causes a decrease in sodium, what can that cause?

How to manage this?

A

Can cause Neurological changes due to cerebral edema (can cause brain damage due to pressure restricting bloodflow)
- the more sodium decreases, more CNS issues arise

Fluid restriction to make sure it doesn’t make it worse.
Do electrolyte replacement to replace or even draw Na back in.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is hypoparathyroidism?

Which hormones?

A

Deficiency in hormones from parathyroid.

Parathyroid hormone (PTH) which help regulate serum calcium
-PTH, calcitonin, VIT D will
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What can cause hypoparathyroidism?

What is the PTH, Ca, phosphorus relationship

A

Congenital
Post thyroidectomy (for hypothyroidism or nodules) due to close proximity anatomy - leading to short term impact on PTH
Transient PTH deficiency from mom to neonate
- tremors & seizures due to low calcium

If not enough PTH - will see a decrease in serum Ca and increase in phosphorus
- just regulate and return these to norms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Calcium Levels

Newborn
24-48 hrs old
4-7 yrs old
Child

Ionized
Newborn
24-48 hrs old
Thereafter

A

Calcium Levels

Newborn 9-10.6
24-48 hrs old. 7-12.0
4-7 yrs old. 9-10.9
Child 8.8-10.8

Ionized.
Newborn. 4.3-5.1
24-48 hrs old. 4.0 -4.7
Thereafter 4.8-4.92

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How to recognize hypocalcemia?

How to treat hypocalcemia?

A

Tremors, seizures, or any changes in muscle functioning
EKG changes

Treat w calcium replacement IV (later on oral)
As well as replace vitamin D IV to help with calcium absorption
- stay away w scalp veins & monitor their EKGs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which diabetes is more common in children?

A

Type 1 since it is an autoimmune process with genetic predisposition.
- However, type 2 is growing since obesity is becoming more common.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

For type 1 diabetes to occur in a child, what needs to happen?

What is the patho?

A

Often need an environmental trigger of some sort like an infection or exposure to chemical. Not really known for sure. We just know its not just genes.
- one time they tried to use immunosuppresants in a study to stop it from happening but it didn’t work

Destruction of beta islet cells in the pancreas

  • insulin is produced in these & so then there is a lack of insulin since there’s no cells to make it
  • insulin resistance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

3 P’s associated with diabetes type 1?

A

Polyruia - increased urination
PolyDipsia - thirst
Polyphagia - hunger, leading to weight loss

  • we often bring someone into the doctors for a prolonged issue like this & they find they have elevated BG and then have diabetes.
  • may be DKA too
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Diabetic Keto acidosis?

How does this happen?

A

Type 1 diabetics can develop this.

  • Changes in breathing
  • Fruity smell
  • Change of consciousness

Well the 3 P’s kind of set this off due to BG. DKA is often the first finding that causes someone to know they have diabetes type 1.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Can a type 1 diabetes who is already diagnosed and treated develop DKA?

A

Yes.

Infection/Illness can cause the DKA
Poor diet control and BG climbing & thus burning fat cells (keto)
Stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Patho of Diabetic Keto Acidosis (DKA)

Glycogen

Glycogenesis

Gluconeogenesis

Explain how they work together

A

Normal: insulin allows glucose to come on in and feed the cell with energy
- carbs is usually the source of glucose for immediate use

Glycogen: stored carbs in liver in the form of glucose
Glycogenesis: creating the glycogen
Gluconeogenesis: stored proteins and fats as glycogen

Body will usually put carbs in the liver as glycogen. This process if called Glycogenesis. Gluconeogensis is when we put fats & protein into a form of stored glycogen also. (All this means is that we have energy stored away in liver, fat, and muscle. First one to get used up is in the liver)
If we aren’t getting enough glucose in the form of carbs to keep up with energy needs, we burn through all of the stored energy. IF it gets to the point we are using the fats and proteins as energy, our body will give off ketones. Once ketones reach our blood, then we become in a state of acidosis. And we aren’t made to be in an acidotic state & so our body will try to correct it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are symptoms of DKA…..

Fluids?

Cardiac?

Weight?

Breath?

What may someone mistake them as?

A

F&E imbalances
Dehydration
- due to wanting to pee out the acid so much

Tachycardia
Hypotension
- trying to compensate for less volume but eventually the tachy stops working to compensate
Kussmauls
- deep respirations trying to blow off CO2 (acid)

Weight loss
- not getting nutrients to cells & the polyphagia

Fruit/acetone breath
- due to ketones

Decreased senses and neuro
- someone might actually think they’re drunk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What can DKA progress to?

A

Coma & death

- emergency situation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Diabetic Keto Acidosis labs (DKA)

Potassium

Sodium

BUN

Chloride

Phosphurus

Ca & Mg

Co2

Blood sugar

WBC

Triglycerides

A

DKA

Potassium can be normal or low
- Low due to intracellular changes

Sodium serum level low
- due to diuresis or peeing

BUN increased
- dehydration

Chloride

  • normal, low , or high
  • saline resuscitation may reason for increased CL

Phosphurus is low
- diuresis

Ca & Mg decrease
- the decrease comes from phosphorus replacement

CO2 will be low now
- due to them trying hard to breath it off

Blood sugar
- elevated

WBC shift left is change is triggered by infection

Triglycerides are elevated

  • Very important to monitor these labs DURING treatment. Increased neuro problems with shifting fluid - even if intentional.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why and when do we want to monitor DKA labs so closely?

A

We want to monitor labs during treatment especially. This is because our treatment may include fluid shifts - and if this happens too fast, we can have some neuro issues due to cerebral edema. Even if it is intentional, the shift cannot be all of a sudden. It takes time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

If child comes in & they’re admitted for DKA - what are the first initial assessments we want to do?

A

First check their airway & respiratory needs to see if they’re breathing okay. Next assess for perfusion by checking extremities doing cap refill, checking pulses.
Next lets move to their level of consciousness. Do they seem well put together?

Also - was there a Diabetes type 1 trigger that led to the DKA?

31
Q

What is the goal if DKA treatment?

A

Getting them back to normal state really. And controlling their glucose levels.

32
Q

What type of fluid replacement is needed with DKA?

A

Isotonic fluids such as a normal saline usually. Could also see Lactated Ringers due to potassium formula without chloride.

  • If they have increased chloride essentially.
  • Could also use a less isotonic NS mix. Depends on initial lab values & electrolytes
33
Q

When giving fluids for DKA - what is the goal?

How quickly can we do this?

A

Need to give them their maintenance fluid needs but also for their losses. This will be a large amount.

Needs to be done over time so we don’t cause fluid shifting to be too fast and cause cerebral edema.

34
Q

Your patient is DKA. You are giving them NS first but when you see their blood glucose lower to 250, what fluid do you switch to? And why?

A

Dextrose
So we don’t lower their Blood Glucose too much to where they are hypoglycemic. The dextrose is a carb source and can fuel their cells just enough to keep you balanced.

35
Q

At what time do you begin giving insulin replacement?
What type of insulin will you use? What is the infusion rate?

Will we ever lower the infusion rate?

A

Same time as fluid replacement we will start a short acting insulin at 0.05U/kg/hr.

Yes, we will lower the infusion rate of insulin as glucose levels lower. Won’t go lower than 100mg/hr though due to possible fluid shift & edema.

36
Q

What does insulin have a strong affinity for? What does this mean for us?

A

Plastic so we need to prime the tubing we plan to use really well. Otherwise, the insulin will bind to plastic instead of going to patient.

37
Q

After the glucose levels have lowered and acidosis stage has passed we will then switch to giving the patient a SQ insulin. Does this mean we turn off the pump?

A

No - we will keep the pump going for about 30 min just to make sure the insulin has time to be effective.

38
Q

Since there’s overall depletion of potassium in the cells (there’s a complicated explanation here), when should we replace this?
What should we monitor for?

A

Replace Potassium as soon as urine output is established.

Make sure their serum potassium doesn’t drop tho since most of it will get eaten up by the cells.
Monitor for dysrhythmias.

39
Q

DKA causes low phosphate alterations.
What energy process needs phosphate?

How does it affect oxygenation?

In what form do we replace phosphate with?

A

ATP needs the phosphate.

Hemoglobin and oxygen binding mechanism to help with perfusion requires phosphate.

Replacement of phosphate is done with Potassium Phosphate.
- watch for hypocalcemia since the phosphate and calcium share inverse relationshipo

40
Q

Why is lab so important in DKA?

Initial assessment?

Why might we use an NG tube for DKA?

A

It makes sure treatment is going well. And that there’s no shifting too quickly.

Need to be able to do initial assessment quickly in order to get those IV’s started (NS/LR/Dex + Insulin)

NG tube to decompress stomach & prevent aspiration and vomiting

41
Q

Can DKA cause respiratory status problems?

What if the infection was the DKA trigger?

How big of a needle are we going to use for IV? And how many sites?

A

Yes respiratory is a big concern here. They may have loss of consciousness combined with altered breathing and may need to be ventilated.

For infection - we may go ahead and start IV antibiotics too along with fluids and insulin.

As big of a needle as the vein can handle. Two IV sites preferred (usually antecubital)

42
Q

Why do we monitor urine in DKA?

A

Check glucose and ketones spilling

43
Q

What frequent check should we do in a DKA situation?

Labs to check frequently?

A

Neuro Checks
Vital signs every 1-2 hr

EKG due to cardiac function
Metabolic profile
Blood glucose hourly
I&O - if patient is unconscious will have to use foley catheter to measure

44
Q

After being treated for DKA what do we need to educate patient on?

A

If they had DKA that means they likely are Diabetic. We will have to do teaching on Diabetes on new diagnosis.

Even if it is someone who was already diagnosed, follow up and make sure their insulin dose is appropriate for them incase it wasn’t.

45
Q

How often should you check for signs of cerebral edema from DKA fluid shift ?
What signs are there?

A

Check Hourly

They may complain of headache. Start to seem a little off or decreased consciousness due to decreasing sensorium.

Check the eyes for papilla edema or optic nerve swelling.
Check for pupil changes.

Cardiac may look like bradycardia & hypertension.

Diabetes insipidus due to pressure from edema altering pituitary functioning.

46
Q

Why might we use sodium bicarb?

A

To correct pH if acidosis is severe enough. Less than 7.0 only
- This always needs to be diluted for administration

47
Q

Desired lab outcomes

BUN

CBC

ABGS

Serum Co2

A

BUN to decrease as we give them fluids

CBC not look suspicious due to infection treatment

ABGS so ph, co2 will go back to normal levels

Serum co2 should rise back up due to the blood being able to buffer

48
Q

Requirements needed for us to switch from IV insulin to SQ and thus patient is able to treat themselves?

A

Acidosis is treated so no ketones spilling into urine either
They must be able to tolerate PO feedings
Blood glucose must be below 180

49
Q

Other hormones affected by DKA?

A

Glucagon , adrenaline, cortisol, GH

50
Q

If an insulin is a mix between short and long acting, what should you be super cautious of?

A

Do not contaminate the long acting with short acting.

- draw up short acting first .

51
Q

Dawn Phenomena

Somogyi effect? What is it caused by?

A

Dawn Phenomena is when their blood sugar is high in the morning beginning 3 or 4
- need longer or intermediate insulin to get them through the night

Somogyi effect is when there is elevated glucose closer to bedtime & then it drops off during the night
- caused by epi, GH, and corticosteroid hormones

52
Q

T/F

BG changes are worse in smaller children than bigger children

A

True. Decreased size always means things go to shit quicker

53
Q

What is a technique used to keep pediatric patients glucose levels more stable?

A

Insulin Pump - this helps bc a childs small body is a little more dangerous for experiencing hypoglycemia but we don’t want to permit them to have hyperglycemia in response.

54
Q

What can cause hypoglycemia?

A

Increase of activity without increasing calories

Not eating enough

Poor absorption of nutrients

Too much insulin

55
Q

What two main concerns go on with hypoglycemia?

A

Adrenergic activity & impaired brain functioning

56
Q

Adrenergic activity signs of Hypoglycemia

A 
Tachycardia
Tremors
Sweating
Irritability
Aggression
Hunger

Adrenergic activity = think of someone who has been out in the wilderness surviving with no food, water , and is in survival mode

57
Q

Impaired Brain functioning due to Hypoglycemia

A 
Drowsy
Personality change
Confusion
Loss of coordination
Seizures
Coma

Think of someone being drunk or tweeking out due to brain cells not functioning bc of low glucose

58
Q

Quick carb sources for someone who is hypoglycemic:

60-100

Below 60

What if you treat it and it rises above 60 now?

A

OJ or 1/2 glass of milk for 60-100

Glucose gel or OJ too if below 60

Make sure to recheck the BG in 15 minutes. And if it is still below 60, try again.

If this is your second snack treat then give a protein source with the carbs.

59
Q

When is glucagon given? How long does it take? Route?

Why use it?

A

Given IM when someone is hypoglycemic. But it takes at least 15 min to stimulate liver to release glycogen

It is a sustained response but it isn’t rapid

60
Q

What type of glucose do want to give if the patient is having severe hypoglycemia as in below 40?

A

Give IV glucose 25-50% with sterile water (dilution helps enter into bloodstream)

Like if they’re unconscious btw.

61
Q

What do you need to do if you give a hypoglycemic patient glucose gel in buccal pouch?
Why would you want to do this?

A

Need to monitor them and their airway

It can be helpful bc buccal route absorbs fairly quickly

62
Q

How do you fix hypoglycemia at night time?

A

Give glucose gel or OJ if less than 80.
And do 15 min rule

If the BG rises up to 60 or so then do the protein and carb combo

63
Q

Main concern here with type 1?

How are infants treated?

A

Avoid hypoglycemia - especially in infants when treating hyperglycemia.

Infants do oral intake in response to treat hypoglycemia. But we allow hunger to drive thier calorie intake and adjust insulin based off that. Obviously avoid concentrated sweets but include breast milk and formula

64
Q

Explain needs of sick plan for type 1 diabetic children and infants

A

Stress of illness increases BS so may need to switch to regular insulin, take bs more frequently, urine checks for ketones of DKA (to treat early), and maintain diet as much as possible

65
Q

Should we just educate the parents about diabetes?

What to keep in mind w small doses?

Can we make the care less traumatic?

Can kids learn to do their own BS?

What are we trying to reduce?

A

No educate child too.

Small doses need to be more carefully measured and use the appropriate syringe

It is our job to make care as easy as possible

Yes kids can be taught to do own BS

Try to reduce spikes & falls but also reduce long term effects

66
Q

Is type 2 diabetes in children that much different than in adults?

What is the patho of type 2?

When does type 2 onset occur?
What other rt occurences happen?

A

No. It’s essentially the same thing. We just normally don’t think of kids having type 2 but society is shifting to be that way.

Insulin resistance > beta cell defect > prediabetes > type 2 Diabetes

Onset is puberty due to hormones
- obesity, Hypertension, hyperlipidemia

67
Q

What is the main reason why type 2 diabetes is more prevalent in children

And in which sex is this most common in? What else can this sex develop

A

Sedentary lifestyle

Females 2: 1 males
- can develop polysystic ovary syndrome too

68
Q

What cultures/ethnicity is higher risk of diabetes?

A 
African Americans
Native Americans
Hispanic Americans
Asian 
Pacific islanders

(Basically not white people)

69
Q

Can diabetes type 2 be genetic?

A

Yes it can

70
Q

Mean age for type 2 diabetes diagnose

Avg BMI?

Percent in minority groups

A

12-14

Average BMI is in 85th percentile

94%

71
Q

Fasting glucose for type 2 goal

PP goal

Bedtime goal

A1c

A

Fasting : between 80-100

PP : 100-160

Bed : 100-160

A1c below 7

  • But we need to make sure we are not overtreating
72
Q

Can losing weight help with type 2 diabetes

A

Yes but will look at diet and cardiovascular risks too

- Body image is a very important factor so try to avoid focusing on obesity but encourage health overall

73
Q

If someone has a BG over 250 what is treatment?

At what A1c can we wean off insulin of type 2 and just add metformin ?

A

If above 250, will just give insulin, diet , and exercise

Below 7%

74
Q

What if someone’s BG is elevated and no symptoms?

A

Start with diet and exercise to see if it improves

Follow up a1c every 3 months. If below 7 then good

Then we can add metformin

Next, do insulin, TZD, Suflon

Lastly add 3rd med

Peds Exam 2 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions