Exam 3 Endocrine Disorders Flashcards
Hypothyroidism =
Diagnosed via =
= low or no production of T4, involves the thyroid and anterior pituitary gland
= newborn screening (1/40,000)
S/S of Hypothyroidism
- Large Fontanels
- Protruding tongue
- Umbilical Hernia
- Lethargy, Fatigue
- Constipation
- Prolonged jaundice (in newborn period)
- dry skin, brittle hair/nails
Diagnosis/Prevention/Teaching for Hypothyroidism
- ____ diagnosis to prevent?
- N___ S____
- Screen ____/____ in childhood/teens
- Early, prevent cognitive deficits
- Newborn Screen
- T4 (low), TSH (high)
Tx for Hypothyroidism
- Daily ______*
- Serum ___ and ___ testing at each well visit
SYNTHROID*
- T4 (low), TSH (high)
Precocious Puberty =
Girls =
Boys =
= Early physical sexual development
= < 9 y
= < 9.5 y
Causes of Precocious Puberty (5)
Why is it important to check for precocious puberty?
1) Obesity
2) Heredity
3) Stress
4) Environmental exposure
5) Adrenal, CNS, Gonad tumors
Tumors are major factor
S/S of Precocious Puberty for Girls/Boys?
- Advanced ____ staging
Girls = breast development, pubic hair, axillary hair, growth spurt, early menarche Boys = voice changes, testicular enlargement, penile growth
Tx for Precocious Puberty = *
Teach parents how to?
Treat child how?*
Monthly IM injection of LUPRON*
- how to administer
- treat age appropriately**
Precocious Puberty, monitor what hormones (4)
FSH, LH, Testosterone, Estrogen
Type I Diabetes Mellitus =
Destruction of pancreatic beta cells ->
Almost always ___ mediated, __ known cause
= Autoimmune illness which is caused by insulin deficiency followed by destruction of insulin producing pancreatic beta cells
- > absolute insulin deficiency
- immune, no known cause (idiopathic)
Type II Diabetes Mellitus =
- Ability to -> _____ but inability to -> ____ causing ->
- Can result in beta cell _____ -> eventually leads to complete ____ _____
=combination of insulin resistance due to failure of insulin to act on tissues and relative insulin deficiency
- Ability to produce insulin but inability to use it correctly -> causing excessive production of insulin
- exhaustion -> insulin deficiency
Risk Factors for Type II DM
- Obesity BMI > ___%
- Family History of? Mother with?
- Physical ____
- Races (4)
- Greater in boys or girls?
- > 85%
- hx of Type II, Mother with gestational diabetes
- physical inactivity
- AA, American Indians, Hispanic, Asian Americans
- Girls
S/S of Type II DM
- ____ uria
- Recurrent _____
- Increase in ___, ____
- _____ ______** (early or late sign?)
- Ketonuria
- Recurrent infections
- Increase thirst, urination
- Acanthosis Nigricans (early sign) - velvety thickening and darkening of skin found on back of neck, axillae, medical aspect of thighs or any folds (80%)
Diagnosis of Type II DM
- Fasting Glucose >/- ____
- Random Glucose >/- _____, ____ symptoms
- Oral glucose tolerance test (OGTT) >/- _____
> /- 126
/- 200, with
/- 200
Tx of Type II DM * =
- D___ and E____
= Metformin* -> increases insulin sensitivity, suppresses appetite, improves lipid profile, and reduces hepatic glucose output
- Diet, Exercise
S/S of Diabetes
- Polyuria, Polydipsia, Polyphagia (excessive hunger)
- Enuresis (frequent urination)
- Weight loss
Diagnosis of Diabetes
1) Fasting Plasma Glucose >/- _____
2) Random Plasma Glucose >/- _____
3) Hemoglobin A1C >/- _____%
4) Antibodies = presence of circulating _____ specific antibodies
5) Insulin level = __-__
1) 126
2) 200
3) 6.5%
4) islet
5) low to zero
Tx for Diabetes = *
1) For which DM?
2) Goal is maintain near normal glucose (____-___)
3) 4 types of insulin
Insulin*
1) For type 1 DM is treated w insulin dt absolute insulin deficiency; insulin replacement is the key to managing type I
2) 90-130
3) Rapid, Short, Intermediate, Long acting
Tx for Diabetes Giving Injections
1) _____ sites
2) Delivered IM or SQ?
3) May use a syringe, injector, or pen
4) Skin doesn’t need to be pinched if?
5) Always count to ___ after injection, before removing needle
6) Age appropriate for administration?
1) Rotate
2) SQ
4) small needle
5) 5 seconds
6) No set age
Insulin Pump =
Closely imitates =
Pump must be programmed to deliver a bolus dose before each _____
= electromechanical device designed to deliver fixed amounts of regular or lispro insulin continuously (basal rate)
= release of hormone by islet cells
meal
Diabetes Monitoring: Blood
Take Serum Glucose when? (4)
Urine Ketone Testing when? (2)
= before meals, at night, when not feeling well, before physical activity
= during illness, when glucose >/- 240
Why do ketones form?
When your body doesn’t have enough glucose or insulin to use glucose, your body starts breaking down fat for energy ketones are a byproduct of this breakdown
Diabetes Monitoring: Nutrition
1) Timing of consumption must be regulated to correspond to time and action of ____ prescribed
2) Total # of calories should be ____ day to day
3) Provide what w exercise?
4) Avoid what types of food (2) to prevent hyperglycemia
1) insulin
2) consistent
3) extra food
4) High sugar, Carbs
instead eat fruits, vegetables, grains, beans, dairy, sugar
Diabetes Monitoring: Exercise
1) Maintain ____ fitness
2) Control ___ and help body use insulin more ______
3) Children w diabetes should participate full in
1) cardiovascular
2) weight, efficiently
3) physical education classes, sports
Hypoglycemia =
Causes (4)
Can lead to -> (2)
= low blood sugar < 70 mg/dL
Too little food, Too much insulin, increase in exercise, skipping or delaying meals
Seizures, death
S/S of Hypoglycemia
Shaking, sweating, dizziness, anxious, hunger, rapid HR, impaired vision, weakness/fatigue, headache, irritability
Tx for Hypoglycemia
1) F____
2) Close ____ Monitoring
3) Give IM ______*
4) Feed once ____
1) Fluids
2) Blood
3) GLUCAGON*
4) awake
15 g of carbs is equal to
1) ____ glucose tabs
2) __ lifesavers
3) ___ butterscotch candies
4) __ small box of raisins
5) ___ oz regular soft drink or juice box
6) ___ oz milk
7) ___ tbsp honey
8) ____ tbsp of sugar
1) 3
2) 6
3) 3
4) 1
5) 4
6) 8
7) 1
8) 2
Hyperglycemia =
Causes of Hyperglycemia (6)
= high blood sugar
Too much food, too little insulin
Illness, infection, stress (more corticoids)
Emotional upset
S/S of Hypergylcemia
Very thirsty, more urination
Dry skin, Hungry, Sleepy
Blurry vision
Infection/injury heals slower
Tx for Hyperglycemia = (2)*
= Short acting insulin* , Fluids to prevent dehydration and flush out ketones
Diabetic Ketoacidosis =
- Ketones are produced when body breaks ___ for energy
- Ketone bodies are strong ___ = ____ serum ph < _____
- Causes ____ _____
= LIFE THREATENING complication resulting from excessive ketone production and lack of insulin
- fat
- acids, lowers, 7.35
- metabolic acidosis
S/S of Diabetic Ketoacidosis
1) Poly____, Poly_____, E_____
2) Dehydration -> T_____, or ____, _____ pain, N/V
3) ____ breath, _____ breathing
4) Mental Status changes
1) Polyuria, Polydipsia, Enuresis
2) Tachycardia, Orthostatsis, abdominal
3) Fruity, Kussmaul (agonized)
4) Combative, drunk, coma
Tx for Diabetic Ketoacidosis (4)
Fluids
Insulin
Close blood monitoring at least every hour
CAT scan bc acidotic may lead to brain bleeds
Long Term Complications of Diabetes (4)
Diseases (2)
1) Retinopathy -> potential vision loss
2) Nephropathy -> renal failure
3) Peripheral neuropathy -> foot ulcers, amputation
4) Autonomic neuropathy -> GI, GU, cardio, sexual dysfunction
Atherosclerotic cardiovascular peripheral, Arterial and cerebrovascular disease/ HTN
Early complications are even greater in what type?
- ____ damage is proportional to degree of hyperglycemia and duration of exposure
Type II
-Organ
Impact on Family and Child
- Fear, Anxiety
- Continual drainage of emotional, financial resources
- Feelings of guilt
- parents lose ability to protect child from harm and suffering
- Restricted independence
- Stressful daily planning
- adolescents have difficulty adjusting, compliance issues
