Endocrine Dysfunction of The Child Flashcards
diminished secretion of one or more pituitary hormones
hypopituitarism
what are the causes of hypopituitarism
tumors
genetic
r/t GH deficiency
over production of anterior pituitary hormone
hyperpituitarism
what are CM of hyperpituitarism
gigantism (excess growth hormone)
hyperthyroidism
hypercortisolism
precocious puberty
what are CM of growth hormone deficiency
normal growth during 1st year but slowed after
primary teeth appear at normal age but permanent teeth delayed
teeth over crowded
delayed sexual development
how is growth hormone deficiency dx
family hx physical exam x-ray/MRI endocrine studies growth chart genetic testing
what is the therapeutic treatment for GH deficiency
correct underlying disease or give GH replacement (expensive but 80% successful)
CM of GH EXCESS before closure of epiphyseal shafts
proportional overgrowth of the long bones
rapid/increased muscle development
weight increase in proportion with height
proportional head enlargement
CM of GH EXCESS after closure of epiphyseal shafts
acromegaly
increased facial hair
thickened skin
increase for hyperglycemia and DM
who is GH excess dx
hx of excess growth
increased levels of GH
enlargement of bones
what is the therapeutic mngmt of excess GH
removal of tumor/lesion if present
external radiation or radioactive implants
meds
hypo function of the posterior pituitary and under secretion of antidiuretic hormone
Diabetes Insipidus (DI)
____ is an early sign of some other ______ thing going on
DI; cerebral
what are the cardinal signs of diabetes insipidus
polyuria and polydipsia
what are CM of DI in older children
excessive urination accompanied by compensatory insatiable thirst (1st sign is bedwetting= enuresis)
what are CM of DI in infants
irritability relieved with feeding of WATER not milk
prone to dehydration
what is the therapeutic mngmt of DI
hormone replacement of desmopressin
* remember it is LIFELONG treatment
what is important teaching for DI
DI is different form DM tx is lifelong correct admin of desmopressin child should wear med alert ID carry desmopressin nasal spray with them
hyper function of posterior pituitary and over secretion of antidiuretic hormone
syndrome of inappropriate antidiuretic hormone (SIADH)
SIADH results in _____ intoxication and ______
water; hyponatremia
what are CM of SIADH
anorexia nausea vomiting stomach cramps irritability personality changes progressive decrease in sodium (stupor, seizures) serum sodium levels 120mEq/L
what is the therapeutic mngmt of SIADH
fluid restriction (brain starts to swell from excess water) correction of underlying disorder
what is the nursing care for SIADH
early recognition of S/S I&O daily weight watch for fluid overload seizure precautions educate regarding fluid restriction
decrease levels of ADH increase urine output increase serum sodium dehydrated lose too much fluid
Diabetes Insipidus (DI)
increase levels of ADH decrease urine output decrease serum sodium over hydrated retain too much fluid
SIADH
acquired from partial/complete thyroidectomy
following radiation tx for malignancy
infectious process
dietary iodine deficiency
juvenile hypothyroidism
CM of juvenile hypothyroidism
decelerated growth myxedematous skin constipation sleepiness lethargy mental decline delayed puberty excessive weight gain
therapeutic tx for juvenile hypothyroidism
oral thyroid replacement
prompt tx in infants to help brain growth
*lifelong treatment
juvenile autoimmune thyroiditis
hashimoto disease (Lymphocytic thyroiditis)
CM of hashimoto’s
enlarged thyroid
some have symptoms of hypothyroid or hyperthyroid
how is hashimoto’s dx
normal thyroid function test
serum antibody titiers to thyroid antigents
what is the therapeutic mngmt of hashimoto’s
goiter regresses spontaneously within 1-2 years
oral thyroid hormone replacement
sx contraindicated
what is the nursing care for hashimoto’s
identify thyroid enlargment
reassure it may be temporary
therapy will be life long and take in the morning on an empty stomach (30 min before)
most common cause of HYPERthyroidism in children
graves disease
excessive motion gradual weightloss accelerated linear growth and bone age muscle weakness vomiting/frequent stool cardiac manifestations dyspnea warm, moist skin heat intolerance unusual fine hair exopthalmus
CM of graves disease
how is graves disease dx
increase t4 and t3
suppressed TSH
what is the therapeutic mnmgt of graves disease
when s/s are noted activity should be limited to classwork only
antithyroid drugs
subtotal thyroidectomy
ablation with radio iodine
what is important to tell children who take PTU or MTZ
monitor vital signs such as sore throat and fever because these accompany grave complications of leukopenia
characterized by hyperglycemia and insulin resistance
Diabetes Mellitus
what are the 3 cardinal signs of DM
polyuria
polydipsia
polyphagia
destruction of pancreatic beta cells that produce insulin
absolute insulin deficient
type 1 DM
relative insulin deficiency
insulin resistant
body fails to use insulin properly
type 2 DM
S/S of type 1 DM
3 p's hyperglycemia rapid weightloss dry skin irritability drowsiness abd discomfort ketoacidosis
S/S of type 2 DM
3p's fatigue blurred vision slow healing sores frequent infections areas of dark skin (acanthosis nigricans)
what is acanthosis nigricans
plaque due to increased insulin levels
what is the difference internment between type 1 and type 2 DM
type 1 uses insulin and type 2 uses oral medication (metforman and glucophage)
to dx DM what should the 8hr fasting BG level be
greater than or equal to 126mg/dl
to dx DM what should the random BG be
greater than or equal to 200 mg/dl with classic s/s of diabetes
to dx DM what should the oral glucose tolerance test be
greater than or equal to 200mg/dl in the 2 hr sample
to dx DM what should the hemoglobin A1C be
greater than or equal to 6.5%
what insulin should you give within 15 minutes of a meal
rapid
this insulin is cloudy
intermediate
cannot be mixed in a syringe with any other insulin
long acting (Lantus)
this insulin is given 30min before a meal
short acting
what insulins can be mixed together
rapid/short with NPH
what are the 5 insulin injection sites
outer arm
abd
hip area
thigh
why is it important to rotate insulin injection sites
to prevent lipoatrophy (pitting)
and lipohyperthrophy (build up of subQ)
-thes both can affect absorption of insulin
what are the drawbacks of insulin pumps
they can malfunction and are not cheap
when can absorption of insulin be altered
during exercise and an illness so self monitoring is a must
what is the goal of BG
80-120 mg/dl
what are s/s of hypoglycemia
shaky hungry pale HA confusion disoriented lethargy change in behavior
what is the tx for hypoglycemia
simple carb then follow with complex carbohydrate, then protein
what are simple carbs
OJ, apple juice, soda
what are complex carbs
PB crackers, meat and cheese sandwich
what happens if a pt is unconscious, seizes, or cannot swallow and they are hypoglycemic
give glucagon
IM/SQ
hypoglycemia followed by rebound hyperglycemia (more common for type 1)
somogyi effect
what is the treatment for smoggy effect
reduce bedtime insulin to prevent early a.m. hypoglycemia
during illness how should DM be managed
monitor BG every 3 hrs
monitor urine ketones every 3 hrs or when glucose is > 240
*still have to give insulin even when they are sick
how should we manage diabetic ketoacidosis
rapid assessment adequate insulin fluids for dehydration electrolyte replacement (K) *slowly bring BG down to prevent cerebral edema
