Endocrine study questions Flashcards
Growth hormone deficiency definition
Decreased activity of the pituitary gland leading to inhibition of somatic growth
Hypopituitarism
GHD
Manifestations of GHD
Normal birth weight, but slowed growth (<5 cm/year), below 3rd percentile by age 1. Other signs: hypoglycemic seizures, jaundice, pale optic discs, micropenis
Causes of GHD
Hypothalamic dysfunction, tumors, sickle cell infarct, trauma, or chemotherapy
Diagnosis of GHD
GH plasma level (radioimmunoassay), hand x-rays, endocrine studies
Treatment of GHD
Daily biosynthetic GH injections at bedtime; may need other hormone replacements
Special considerations of GHD
Education on injection technique, support body image, cost awareness, monitor growth
Hypothyroidism labs
↑ TSH, ↓ T3/T4
Hyperthyroidism labs
↓ TSH, ↑ T3/T4
positive newborn screen for hypothyroidism
↑ t3/t4
Symptoms of hypothyroidism
hypotonia, thick tongue, constipation, large fontanelle, bradycardia, dry skin
Symptoms of hyperthyroidism
increased metabolism, tachycardia, weight loss
treatment of hypothyroidism
levothyroxine
treatment of hyperthyroidism
antithyroid meds or surgery
why screen for hypothyroidism
to prevent intellectual disabilities
Precocious puberty definition
Onset of puberty <8 in girls, <9 in boys
Treatment of precocious puberty
GnRH analog (Lupron) slows growth to normal rates
Concerns of precocious puberty
advanced bone age; stunted growth
Education of precocious puberty
positive body image, emotional support
Diabetes mellitus definition
hyperglycemia resulting from defects in insulin secretion, insulin action, or both
Type 1 DM
- body’s immune system mistakenly attacks beta cells in pancreas that produce insulin
- pancreas can no longer produce insulin
- more common in children
Type 2 DM
- insulin resistance occurs after prolonged exposure to elevated glucose levels
- can be controlled with diet and exercise
presentation of type 1 DM in children
- peaks around 4-6 years
- re-peaks around puberty
presentation of type 2 DM in children
- less common
- childhood obesity
S/S of type 1 DM
- classic triad
- polydipsia, polyphagia, polyuria
treatment of type 1
- insulin
- monitor glucose
- good nutrition
nursing management in type 1 DM
- blood sugar >200 should be checked for ketones in urine
- check blood sugar before meal and bedtime
- educate on carb counting
Unit/mL in insulin types
All types are 100 units/mL
Rapid acting insulin
- given within 15 minutes of meal
- check glucose close to meal time
Intermediate insulin
- cloudy
- not often used in children
Long acting insulin
- common in managing type 1 diabetes
- can’t be mixed in a syringe with any other insulins
Insulin absorption speeds (fastest to slowest)
Abdomen is fastest, then arm, and leg is the slowest
3 steps of insulin administration
- step 1 is determining how much you need for carbs
- step 2 is determining how much you need for glucose
- step 3 is adding those units together for total insulin delivered
Insulin to carb ratio
Amount of carbohydrate 1 unit of insulin will cover (different in everyone)
Example of I:C ratio
Pt orders 45g of carbs and I:C is 15. How many units should they receive?
3
common target blood sugar
150
Blood glucose correction
Blood sugar - target goal / correction factor = insulin units
Example of blood glucose correction
Blood sugar: 300
Goal blood sugar: 150
Correction factor: 50
How many units of insulin?
3
Total dose of insulin
- Last step in insulin administration
- Add the insulin needed for carbs and needed for glucose
Diabetic ketoacidosis defintion
state of insufficient insulin for body demands in a diabetic patient that results in the production of ketones resulting in a progressive metabolic acidosis
Labs of DKA
- Blood glucose >200
- Ketones in urine
- Acidosis = ph < 7.3, bicarb <15
concern of DKA
If not reversed -> dehydration, electrolyte imbalance, acidosis, coma, death
S/S of DKA
dehydration, flushed look, kussmaul respirations, fruity breath, altered LOC, hypotension
treatment of DKA
Fluids, insulin, electrolyte monitoring.
cause of DKA
Missed insulin, illness, stress
Addison’s disease definition
adrenal insufficiency resulting in fatigue, weakness, N/V, etc.
Addison’s disease diagnosis
↓ Cortisol, ↑ ACTH; ACTH stimulation test
Addison’s disease nursing considerations
Stress-dose steroids during illness/injury, educate about medication compliance, emergency hydrocortisone injection for crisis
Cushing’s disease definition
benign tumor in the pituitary gland that leads to excessive production of the hormone cortisol, resulting in symptoms like weight gain, high blood pressure, and fatigue
Cushing’s disease diagnosis
↑ Cortisol, may be from pituitary tumor. Diagnosed with dexamethasone suppression test or 24-hour urine cortisol.
Cushing’s disease nursing considerations
Monitor for infection, emotional support for body image changes, pre/post-op care if surgery is done
Klinefelter syndrome
- 47th chromosome is XXY (extra X)
- S/S include tall stature, gynecomastia, small testes, learning disabilities, delayed puberty
- treatment is testosterone therapy around age 11-12
