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Module 5 > Endocrine Dysfunction of The Child > Flashcards

Endocrine Dysfunction of The Child Flashcards

1
Q

diminished secretion of one or more pituitary hormones

A

hypopituitarism

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2
Q

what are the causes of hypopituitarism

A

tumors
genetic
r/t GH deficiency

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3
Q

over production of anterior pituitary hormone

A

hyperpituitarism

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4
Q

what are CM of hyperpituitarism

A

gigantism (excess growth hormone)
hyperthyroidism
hypercortisolism
precocious puberty

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5
Q

what are CM of growth hormone deficiency

A

normal growth during 1st year but slowed after
primary teeth appear at normal age but permanent teeth delayed
teeth over crowded
delayed sexual development

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6
Q

how is growth hormone deficiency dx

A 
family hx
physical exam
x-ray/MRI
endocrine studies
growth chart
genetic testing
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7
Q

what is the therapeutic treatment for GH deficiency

A

correct underlying disease or give GH replacement (expensive but 80% successful)

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8
Q

CM of GH EXCESS before closure of epiphyseal shafts

A

proportional overgrowth of the long bones
rapid/increased muscle development
weight increase in proportion with height
proportional head enlargement

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9
Q

CM of GH EXCESS after closure of epiphyseal shafts

A

acromegaly
increased facial hair
thickened skin
increase for hyperglycemia and DM

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10
Q

who is GH excess dx

A

hx of excess growth
increased levels of GH
enlargement of bones

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11
Q

what is the therapeutic mngmt of excess GH

A

removal of tumor/lesion if present
external radiation or radioactive implants
meds

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12
Q

hypo function of the posterior pituitary and under secretion of antidiuretic hormone

A

Diabetes Insipidus (DI)

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13
Q

____ is an early sign of some other ______ thing going on

A

DI; cerebral

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14
Q

what are the cardinal signs of diabetes insipidus

A

polyuria and polydipsia

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15
Q

what are CM of DI in older children

A

excessive urination accompanied by compensatory insatiable thirst (1st sign is bedwetting= enuresis)

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16
Q

what are CM of DI in infants

A

irritability relieved with feeding of WATER not milk

prone to dehydration

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17
Q

what is the therapeutic mngmt of DI

A

hormone replacement of desmopressin

* remember it is LIFELONG treatment

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18
Q

what is important teaching for DI

A 
DI is different form DM
tx is lifelong
correct admin of desmopressin
child should wear med alert ID
carry desmopressin nasal spray with them
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19
Q

hyper function of posterior pituitary and over secretion of antidiuretic hormone

A

syndrome of inappropriate antidiuretic hormone (SIADH)

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20
Q

SIADH results in _____ intoxication and ______

A

water; hyponatremia

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21
Q

what are CM of SIADH

A 
anorexia
nausea
vomiting
stomach cramps
irritability 
personality changes
progressive decrease in sodium (stupor, seizures)
serum sodium levels 120mEq/L
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22
Q

what is the therapeutic mngmt of SIADH

A 
fluid restriction (brain starts to swell from excess water)
correction of underlying disorder
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23
Q

what is the nursing care for SIADH

A 
early recognition of S/S
I&O
daily weight
watch for fluid overload
seizure precautions
educate regarding fluid restriction
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24
Q 
decrease levels of ADH
increase urine output
increase serum sodium
dehydrated
lose too much fluid
A

Diabetes Insipidus (DI)

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25
Q 
increase levels of ADH
decrease urine output
decrease serum sodium 
over hydrated
retain too much fluid
A

SIADH

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26
Q

acquired from partial/complete thyroidectomy
following radiation tx for malignancy
infectious process
dietary iodine deficiency

A

juvenile hypothyroidism

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27
Q

CM of juvenile hypothyroidism

A 
decelerated growth
myxedematous skin
constipation
sleepiness
lethargy
mental decline
delayed puberty
excessive weight gain
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28
Q

therapeutic tx for juvenile hypothyroidism

A

oral thyroid replacement
prompt tx in infants to help brain growth
*lifelong treatment

29
Q

juvenile autoimmune thyroiditis

A

hashimoto disease (Lymphocytic thyroiditis)

30
Q

CM of hashimoto’s

A

enlarged thyroid

some have symptoms of hypothyroid or hyperthyroid

31
Q

how is hashimoto’s dx

A

normal thyroid function test

serum antibody titiers to thyroid antigents

32
Q

what is the therapeutic mngmt of hashimoto’s

A

goiter regresses spontaneously within 1-2 years
oral thyroid hormone replacement
sx contraindicated

33
Q

what is the nursing care for hashimoto’s

A

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)

34
Q

most common cause of HYPERthyroidism in children

A

graves disease

35
Q 
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
A

CM of graves disease

36
Q

how is graves disease dx

A

increase t4 and t3

suppressed TSH

37
Q

what is the therapeutic mnmgt of graves disease

A

when s/s are noted activity should be limited to classwork only
antithyroid drugs
subtotal thyroidectomy
ablation with radio iodine

38
Q

what is important to tell children who take PTU or MTZ

A

monitor vital signs such as sore throat and fever because these accompany grave complications of leukopenia

39
Q

characterized by hyperglycemia and insulin resistance

A

Diabetes Mellitus

40
Q

what are the 3 cardinal signs of DM

A

polyuria
polydipsia
polyphagia

41
Q

destruction of pancreatic beta cells that produce insulin

absolute insulin deficient

A

type 1 DM

42
Q

relative insulin deficiency
insulin resistant
body fails to use insulin properly

A

type 2 DM

43
Q

S/S of type 1 DM

A 
3 p's
hyperglycemia
rapid weightloss
dry skin
irritability
drowsiness
abd discomfort
ketoacidosis
44
Q

S/S of type 2 DM

A 
3p's
fatigue
blurred vision
slow healing sores
frequent infections
areas of dark skin (acanthosis nigricans)
45
Q

what is acanthosis nigricans

A

plaque due to increased insulin levels

46
Q

what is the difference internment between type 1 and type 2 DM

A

type 1 uses insulin and type 2 uses oral medication (metforman and glucophage)

47
Q

to dx DM what should the 8hr fasting BG level be

A

greater than or equal to 126mg/dl

48
Q

to dx DM what should the random BG be

A

greater than or equal to 200 mg/dl with classic s/s of diabetes

49
Q

to dx DM what should the oral glucose tolerance test be

A

greater than or equal to 200mg/dl in the 2 hr sample

50
Q

to dx DM what should the hemoglobin A1C be

A

greater than or equal to 6.5%

51
Q

what insulin should you give within 15 minutes of a meal

A

rapid

52
Q

this insulin is cloudy

A

intermediate

53
Q

cannot be mixed in a syringe with any other insulin

A

long acting (Lantus)

54
Q

this insulin is given 30min before a meal

A

short acting

55
Q

what insulins can be mixed together

A

rapid/short with NPH

56
Q

what are the 5 insulin injection sites

A

outer arm
abd
hip area
thigh

57
Q

why is it important to rotate insulin injection sites

A

to prevent lipoatrophy (pitting)
and lipohyperthrophy (build up of subQ)
-thes both can affect absorption of insulin

58
Q

what are the drawbacks of insulin pumps

A

they can malfunction and are not cheap

59
Q

when can absorption of insulin be altered

A

during exercise and an illness so self monitoring is a must

60
Q

what is the goal of BG

A

80-120 mg/dl

61
Q

what are s/s of hypoglycemia

A 
shaky
hungry
pale
HA
confusion
disoriented 
lethargy
change in behavior
62
Q

what is the tx for hypoglycemia

A

simple carb then follow with complex carbohydrate, then protein

63
Q

what are simple carbs

A

OJ, apple juice, soda

64
Q

what are complex carbs

A

PB crackers, meat and cheese sandwich

65
Q

what happens if a pt is unconscious, seizes, or cannot swallow and they are hypoglycemic

A

give glucagon

IM/SQ

66
Q

hypoglycemia followed by rebound hyperglycemia (more common for type 1)

A

somogyi effect

67
Q

what is the treatment for smoggy effect

A

reduce bedtime insulin to prevent early a.m. hypoglycemia

68
Q

during illness how should DM be managed

A

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

69
Q

how should we manage diabetic ketoacidosis

A 
rapid assessment
adequate insulin
fluids for dehydration
electrolyte replacement (K)
*slowly bring BG down to prevent cerebral edema

Module 5 (18 decks)

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