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NURS 406 > Exam 2: Endocrine Disorders > Flashcards

Exam 2: Endocrine Disorders Flashcards

1
Q

Endocrine system functions to control and regulate metabolism including

A
  • Energy production
  • Growth
  • Fluid and electrolyte balance
  • Stress response
  • Sexual development
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2
Q

Pediatric Differences in the Endocrine System

A
  • Less developed at birth
  • Hormonal control is lacking until about 12-18 months: more difficulty regulating fluid and electrolytes, amino acids and glucose
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3
Q

Diabetes Insipidus

A
  • Inability to concentrate urine
  • Deficiency of vasopressin (ADH)
  • Not common
  • Inherited or acquired
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4
Q

What are clinical manifestations of diabetes insipidus?

A
  • Increased urination
  • Excessive thirst
  • Nocturia
  • Dehydration
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5
Q

How is Diabetes Insipidus evaluated?

A
  • Low urine specific gravity (absence of hyperglycemia)

- Urine restriction

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6
Q

Diabetes Insipidus: To confirm diagnosis

A

-Water deprivation test: continues to have large amounts of dilute urine; serum sodium level increases

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7
Q

Diabetes Insipidus Management

A
  • Maintain fluid balance: allow free access to water and toilet facilities
  • Monitor urine specific gravity
  • Administer DDAVP
  • Monitor for signs of dehydration
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8
Q

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

A
  • Excessive production or release of ADH or vasopressin
  • Rare in childhood
  • Usually related to underlying cause
  • Usually transient and resolves when underlying condition is corrected
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9
Q

What are clinical manifestations of SIADH?

A
  • Hyponatremia
  • Decreased urine output
  • Fluid retention
  • Weight gain
  • Increased urine specific gravity
  • Increased urine osmolarity
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10
Q

SIADH Evaluation

A
  • Consider in children with CNS involvement: infections, head trauma
  • Decreased urine output with adequate intake
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11
Q

SIADH: Labs

A
  • Hyponatremia
  • Hypochloremia
  • Low serum osmolarity
  • Urine specific gravity >1.030
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12
Q

Management of SIADH

A
  • Correct underlying cause
  • Monitor neurologic status q2-4 hours
  • Monitor for seizures
  • Monitor F&E balance
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13
Q

Pathophysiology of SIADH

A
  • Excessive ADH -> kidney reabsorbing too much water -> decreased output of concentrated urine
  • Excess water -> dilution of sodium levels
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14
Q

SIADH: If Na falls below <125 mEq/L, what symptoms would you expect to see?

A
  • Nausea
  • Anorexia
  • Weakness
  • Confusion
  • Irritability
  • Seizures
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15
Q

Take a look at comparison of DI and SIADH on slide 8 of PowerPoint

A

…

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16
Q

Sexual Maturation: Tanner Staging

A

See pag 450-453

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17
Q

Sexual Maturation: Female

A

Typically begins between age 8-13:

  • Breast buds show sign of ovarian function
  • Pubic hair
  • Adult body odor
  • Contour.
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18
Q

When does female menarche usually begin?

A

Between ages 10-15

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19
Q

When does ovulation usually occur?

A

6-14 months after menarche

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20
Q

When is a female growth height reached?

A

2-2 1/2 years after menarche

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21
Q

Sexual Maturation: Male

A
  1. Typically begins between 9-14:
    - Testicular enlargement
    - Penile enlargement
    - Pubic hair
  2. Reproductive maturity usually later than girls
  3. Gynecomastia
  4. Deepening of voice
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22
Q

When does growth spurt occur in males?

A

10-16 years of age

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23
Q

How long does a male continue to grow for?

A

Continues to grow until about age 20

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24
Q

Precocious Puberty

A
  • Premature appearance of secondary sexual characteristics, accelerated growth rate and advanced bone maturation.
  • Aka early onset of puberty
25
Q

Precocious Puberty usually occurs when?

A
  • Before age 8 in girls

- Before age 9 in boys

26
Q

What is a major consequence of precocious puberty?

A

Rapid bone growth which causes early growth plate fusion and shorter stature.

27
Q

What are clinical manifestations of precocious puberty in girls?

A
  • Breast Development
  • Pubic and axillary hair
  • Enlargement of vagina, uterus and ovaries
  • Growth spurt
  • Acne
  • Adult body odor
  • Onset of menstrual periods
  • Moodiness
28
Q

What are clinical manifestations of precocious puberty in boys?

A
  • Testicular enlargement
  • Penile enlargement
  • Pubic hair
  • Facial hair
  • Acne
  • Adult body odor
  • Deepening of voice
  • Moodiness
29
Q

Precocious Puberty: Evaluation

A
  • History: onset of secondary sexual characteristics
  • Physical exam
  • Gonadotropin-releasing Hormone Stimulation Test: differentiates between central and peripheral cause
  • Radiographs of wrists: determines bone age and maturation; predicts adult height
  • Abdominal ultrasound: diagnoses adrenal and ovarian tumors or cysts
30
Q

Precocious Puberty: Treatment is aimed to

A
  • Correct underlying cause
  • Stop or reverse the development of secondary sexual characteristics
  • Maximize adult height
31
Q

Precocious Puberty Management

A

Administration of GnRH agonist or blocker (slows/reverses sexual development)

32
Q

What are complications of precocious puberty?

A

-Growth plates fused earlier and bone age earlier -> higher risk of osteoporosis

33
Q

Diabetes Mellitus

A

Chronic disorder of metabolism characterized by hyperglycemia and insulin resistance.

34
Q

Type I Diabetes Mellitus

A
  • Most common in childhood
  • Pancreas is unable to produce and secrete an adequate amount of insulin
  • No prevention or cure is available
35
Q

Type I DM in Children

A

Prone to develop other autoimmune conditions such as Graves’ disease, Hashimoto thyroiditis and Celiac disease

36
Q

What are clinical manifestations of DM?

A
  • 3 P’s: Polyuria, polydipsia and polyphagia
  • Weight loss
  • Increased food intake
  • Fatigue
  • Blurred vision
37
Q

Signs of DKA

A
  • N/V
  • Abdominal pain
  • Acetone (fruity) odor to breath
  • Dehydration
  • Increased lethargy
  • Kussmaul respirations
  • Coma
38
Q

Evaluation of DM: Labs

A
  • Fasting blood glucose >126
  • Random serum glucose >200
  • Oral glucose tolerance test >200
  • Hemoglobin A1C of 6.5% or > (< 7% is good)
39
Q

Diabetes Mellitus Management: Insulin Honeymoon Phase

A
  • Occurs after initiation of insulin therapy
  • Characterized by hypoglycemia and a decreased need for insulin
  • May last from a few weeks to a year
40
Q

Insulin Requirements are based on

A
  • Age
  • Body weight
  • Pubertal status
41
Q

Honeymoon Phase: Nursing responsibility

A

Prepare the child and family for the possibility of honeymoon phase, both to:

  • Avoid misconception that the diabetes is going away
  • And to provide instruction on recognition and treatment of hypoglycemia
42
Q

Signs and Symptoms of Hypoglycemia

A
  • Sweating
  • Trembling
  • Dizziness
  • Mood changes
  • Hunger
  • Headaches
  • Blurred vision
  • Extreme tiredness and paleness
43
Q

Signs and symptoms of hyperglycemia

A
  • Dry mouth
  • Frequent urge to urinate
  • Extreme thirst
  • Drowsiness
  • Stomach pain
  • Frequent bed wetting
44
Q

Diabetes Mellitus Management: Nutrition

A

Build a diet plan:

  • Consistent intake that is easy to understand and tailored to food preferences
  • Change as needed to meet child’s dietary needs
45
Q

Diabetes Mellitus Management: Physical Activity

A
  • Encourage to participate in age appropriate activities
  • Teach how to prevent hypoglycemia
  • Maintain proper hydration
  • Avoid exercise when insulin is peaking
  • Add carbohydrates as appropriate for exercise
  • Monitor blood glucose before exercise
46
Q

Diabetes Mellitus Management: Developmental Issues

A
  • Know the developmental characteristics of each age group
  • Allow for child to manage task as appropriate for age.
  • Let the child help with diet
47
Q

Insulin Management

A
  • Store insulin in cool, dry place. Don’t freeze or expose to excessive heat.
  • Do not shake; roll vial back and forth
  • Check expiration date before using
  • Once opened, date the vial
  • When mixing: Inject right amount of air into both vials, withdraw clear (short) FIRST then cloudy (intermediate)
48
Q

DM Management: Blood Glucose Monitoring

A
  • Record blood glucose results in diary

- A 3-4 day alteration in glucose levels requires an adjustment of insulin doses

49
Q

What are complications of DM?

A
  • Hypoglycemia
  • Hyperglycemia
  • DKA
50
Q

DM Management: Sick Days

A
  • Illness, infection and stress = increased need for insulin.
  • Do not withhold insulin during these times
  • May lead to hyperglycemia and ketoacidosis
51
Q

DM: Sick Day Managment

A
  1. ALWAYS give insulin even if they don’t want to eat.
  2. Test blood glucose q4H or more if hypo or hyperglycemic
  3. Test urine ketones w/ each voiding
  4. Encourage intake of caloric free liquids (aids in clearing ketones from blood)
  5. Follow child’s usual meal plan: replace the usual grams of carbs with simple carbs used
  6. Encourage rest: exercise = ketones
  7. Notify if symptoms of DKA
52
Q

Types of Insulin

A

Not sure if going to be tested on

53
Q

DKA

A

Consequence of a severe insulin deficit leading to hyperglycemia, ketone bodies in the blood and metabolic acidosis

54
Q

Most common causes of DKA in children

A
  • Insulin resistance
  • Stress
  • Infection
55
Q

Most common causes of DKA in adolescents

A

-Missed insulin injections

56
Q

What are clinical manifestations of DKA?

A
  • N/V
  • Dehydration symptoms
  • Kussmaul respirations
  • Fruity breath
  • Abdominal or chest pain
  • Decreased LOC
57
Q

Management of DKA

A
  • Admission to PICU
  • Restore circulating volume
  • Monitor:
    1. Glucose (administer IV insulin)
    2. I&O
    3. V/S
    4. Neuro checks
    5. IV fluid replacements (0.9% or 0.45% NS to correct dehydration)
    6. F&E status (K+ levels change when child receives insulin; if it decreases -> K+ replacement but make sure they are voiding adequately to prevent hyperkalemia)
58
Q

DKA: Labs

A
  • Blood glucose >300 mg/dL

- Urine and serum ketones: (+)

NURS 406 (18 decks)

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