[Exam 4] Chapter 48 – Alteration in Metabolism/Endocrine Disorder Flashcards
Growth Hormone Deficiency: What is this known as
Hypopituitarism or dwarfism.
Growth Hormone Deficiency: What does GH stimulate?
Linear growth, bone mineral density, and growth in all body tissues
Growth Hormone Deficiency: When is this first identified?
When they assess growth patterns. Within few years, they are less than the third percentile on grwoth chart
Growth Hormone Deficiency: Possible complications related to this?
Altered carbohydrate, protien, and fat metabolism, hypoglycemia, and glucose intolerance.
Growth Hormone Deficiency - Patho: What occurs on patho level?
Failure of anterior pituitary or hypothalamic stimulation on pituitary to produce sufficient GH.
Growth Hormone Deficiency - Patho: Lack of GH causes what?
Impairs body ability to metabolize protein, fat, and carbohydrates
Growth Hormone Deficiency - Patho: Primary causes of this?
Injury to, destruction of, the anterior pituitary gland or hypothalamus.
Growth Hormone Deficiency - Patho: Psychosocial dwarfism results from
emotional deprivation that causes suppression of production of pitutiary hormones, resulting in decreased GH.
Growth Hormone Deficiency - Patho: How will child act?
Withdrawn, bizzare eating, and drinking habits like drinking from toilets, and primitive sppech
Growth Hormone Deficiency - Patho: Treatment for this?
Remove child from dysfunctional enviroment and provide normal dietary intake.
Growth Hormone Deficiency - Therapeutic Mx: Involves use of what
supplemental GH.
Growth Hormone Deficiency - Therapeutic Mx: Secondary GH deficiency requires what
removal of any tumors thrat may be underlying problems, followed by GH therapy.
Growth Hormone Deficiency - Therapeutic Mx: How is biosynthetic GH given?
Frm recombinant DNA, given by subcutaneous injection. Weekly dosage of 0.2-0.3 mg/kg divided into equal doses.
Growth Hormone Deficiency - Therapeutic Mx: How long will doses last
until near final height is achieved.
Growth Hormone Deficiency - Health Hx: Health Hx may reveal what?
Family pattern of short stature or prenatal history of maternal disorders.
Growth Hormone Deficiency - Health Hx: How will they appear?
Prominent SQ deposit of abdominal fat, large prominent forehead, high-pitched voice, and delayed sexual maturation.
Growth Hormone Deficiency - Health Hx: What labs can be performed?
Bone Age (X-Rays) CT/MRI Pituitary function testing
Growth Hormone Deficiency - Nursing Mx, Promoting Growth: Goal of this is what?
Improved growth rate, by at least 3-5 inches in linear growth in first year of treatment without complications.
Growth Hormone Deficiency - Nursing Mx, Promoting Growth: When does treatment stop
when epiphyseal growth plates fuse
Growth Hormone Deficiency - Nursing Mx, Promoting Growth: How often will height be measured?
Every 3-6 months.
Growth Hormone Deficiency - Nursing Mx, Educating Fam: How is this available?
As apwoder that is mixed with packaged diluents. This includes pen delivery systems.
Growth Hormone Deficiency - Nursing Mx, Educating Fam: instruct family to report what?
headaches, rapid weight gain, increased thirst or urination, or painful hip or knee joints
Growth Hormone Deficiency - Nursing Mx, Educating Fam: How often will they visit the doctor?
Every 3-6 months to monitor for growth
Congenital Hypothyroidism: Why does this happen?
After failure of thyroid gland to migrate during fetal development. REsults in malformation or malfunction of thyroid gland.
Congenital Hypothyroidism: Malfunction of thyroid gland leads to what?
Insufficient production of thyroid hormone. Low concentration of T3 and T4.
Congenital Hypothyroidism: Complications of this?
intelectual disability if left untreated, short stature, growth failure, and delayed physical maturation
Congenital Hypothyroidism - Patho: This is due to what?
Defect in development of thyroid glan in the fetus due to a spontaneous gene mutation, autosomal recessive trait.
Congenital Hypothyroidism - Therapeutic Mx: What is done to fix this?
Thyroid hormone replacemenet with sodium L-Thyroxine. 10-15 ug / kg per day.
Congenital Hypothyroidism - Therapeutic Mx: How long will treatment be needed?
Lifelong to maintain normal metabolism ad promote normal physical and mental growth
Congenital Hypothyroidism - Health Hx: What question should you ask first
If metabolic screening was performed.
Congenital Hypothyroidism - Health Hx: When do they beegin to show signs?
During the first month.
Congenital Hypothyroidism - Health Hx: Inspsection will reveal what in a baby?
Lethargic baby with hypotonia, hypoactivity, and a dull expression.
Congenital Hypothyroidism - Health Hx: What physical changes may they have?
Persisten open posterior fontanel, short neck, enlarged tongue, pale skin, and sparse hair.
Congenital Hypothyroidism - Health Hx: Palpation of abdomen may reveal what
evidence of umbilical hernia or a mass due to constipation
Congenital Hypothyroidism - Lab: What should every newborn have done at hospital?
Screen for thyroid hormone level before discharge.
Congenital Hypothyroidism - Nursing Mx, Promoting Appropriate Growth: When are thyroid levels measured?
Every 2 weeks until target range is reached, then once every 1-3 months until child is 1 . Then every 2-3 months.
Congenital Hypothyroidism - Nursing Mx, Promoting Appropriate Growth: Monitor medication for signs of what
hypo or hyperfunction,, including changes in VS, thermoregultion and activity level.
Congenital Hypothyroidism - Nursing Mx, Promoting Appropriate Growth: Signs of thyroid hormone overdose?
Irritability, rapid pulse, dyspnea, sweating and fever.
Congenital Hypothyroidism - Nursing Mx, Promoting Appropriate Growth: Signs of ineffective treatment?
Fatigue, constipation and decreased appetite
Congenital Hypothyroidism - Nursing Mx, Educating Fam: What to tell them about L-Thyroxine?
Oral medication. Must be crushed for ifnants and young children. Can be mkixed with formula.
Congenital Hypothyroidism - Nursing Mx, Educating Fam: L-Thyroxine affected byw hat?
Soy-based formulas, fiber, and iron preparations
Congenital Hypothyroidism - Nursing Mx, Educating Fam: Missed doses can lead to what
developmental dleays and poor growth.
Congenital Hypothyroidism - Nursing Mx, Educating Fam: What needs to be done to evaluate thyroid function?
Frequent blood tests.
Acquired Hypothyroidism: What is this?
Autoimmune. Antibodies develop against the thyroid gland, causing gland to be inflamed, infiltrated, and progressively destroyed.
Acquired Hypothyroidism: Therapeutic management of this?
Oral Sodium L-Thryoxine, 2-5 ug / kg per day to maintain T4 in upper half of normal range and suppress TSH
Acquired Hypothyroidism, Nursing Assess: What complaints may they notice?
Fatigue, weakness, weight gain, coldintolerance, constipation and dry skin.
Acquired Hypothyroidism, Nursing Assess: Reviewing growth pattern may reveal what
slowed or arrested growth rate and increased weight
Acquired Hypothyroidism, Nursing Assess: Physical exam will reveal what
goiter (enlargement of thyroid gland)
Acquired Hypothyroidism, Nursing Assess: How will deep tendon reflexes be
sluggish . Face, eyes, and hands may be edematous
Acquired Hypothyroidism, Nursing Assess: Diagnostic eval involves what
serum thyroid functions tudies (TSH, T3, T4)
Acquired Hypothyroidism, Nursing Mx: Work with family to do what with meds?
Take meds 30-60 minutes before a meal.
Acquired Hypothyroidism, Nursing Mx: Child with chronic or severe hypothyroidism may be at risk for what
restlessness, insomnia, or irritability
Hyperthyroidism: When does this most commonly occur?
Adolescence as a result of Grave sDisease.
Hyperthyroidism: What is Graves disease?
Autoimmune disorder that cuases excessive a mount of thyroid to be released. Goiter develops.
Hyperthyroidism: Current treatment?
Antithyroid medication, radioactive iodine therapy and subtotal thyroidectomy.
Hyperthyroidism: first-line treatment involves?
Propylthiouracil or methimazole, which blocks T3 and T4 production
Hyperthyroidism: Adjunct therapy with B-Adrenergic blockers used when
for children with marked symptoms.
Hyperthyroidism: How does radioactive iodine therapy occur?
For those greater than 10. Given orally. REsults in itssue damage and destroys thyroid gland in 6-18 weeks, but can result in hypothyrodiism.
Hyperthyroidism, Assess: What problems will they first report?
Problem with sleep, school performance, and distractibility. Become frustrated, overheated, and farigued during PE.
Hyperthyroidism, Assess: Child will compain of what
Diarrhea, excessive perspiration and muscle weakness.
Hyperthyroidism, Assess: Physical exam will revewal what
increased rate of growth, weight loss, hyperactivity, fine tremors and goiter.
Hyperthyroidism, Assess: Labs reveal what
Elevated T4 and T3 while TSH suppressed
Hyperthyroidism, Assess: Sudden high levels of thyroid causes thyroid storm, which progresses to what
heart fialure and shock. Signs include irritability, fever, diaphoresis, and severe tachycardia
Hyperthyroidism, Nursing Mx: Monitor for adverse effefcts include
rash , mild leukopenia, loss of taste, sore throat, GI disturbances and arthralgia.
Hyperthyroidism, Nursing Mx: Help child cope with symptoms like what
intolerance, emotional liability or eye problems.
Diabetes: What is type 1?
Cause by deficiency of insulin secretion due to pancreatic beta-cell damage
Diabetes: What is type 2?
Consequence of insulin resistance that occurs at level of skeletal muscle.
Diabetes - Patho: When does Type 1 occur?
Autoimmune disorder. Occurs in genetically susceptible individuals who may have been exposed to chemical factors. T cells destroy the beta cells of pancreas.
Diabetes - Patho: What condition does Type 1 DM cause?
Hyperglycemia, because body cannot consume glucose.
Diabetes - Patho: What happens as kidney try to lower blood glucose?
Glycosuria and polyuria result, and protein and fat are broken down for energy. Leads to ketones and acidosis.
Diabetes - Patho: What is Type 2 DM?
Pancreas produces insulin but body is resistant to insulin. Eventually insulin production decreases.
Diabetes - Patho: What can occur if its not treated
DKA, or fat catabolism develops (deficiency or ineffectiveness of insulin results, resulting in anorexia, N/V, lethargy, stupor, altered LOC.
Diabetes - Patho: Prolonged exposure to high blood glucose levels causes what
damage to blood vessels and nerves.
Diabetes - Patho: Long term complciations of this?
Failure to grow, delayed sexual maturation, poor wound healing, and recurrent infections.
Diabetes - Therapeutic Mx: This involves what?
Blood glucose monitoring, daily injections, and well-balanced diet
Diabetes - Monitoring Glycemic Control, Blood GLucose Monitoring: Why is self-monitoring of blood glucose (SMBG) necessary?
To improve glycemia control, provide self-management and to prevent complications
Diabetes - Monitoring Glycemic Control, Blood GLucose Monitoring: When should this be obtained?
Before meals and bedtime snacks
Diabetes - Monitoring Glycemic Control, Blood GLucose Monitoring: When would you perform monitoring more often?
During prolonged exercise, if ill, or if eaten more food.
Diabetes - Monitoring Glycemic Control, Blood GLucose Monitoring: What is the normal range?
Usually under 200
Diabetes - Monitoring Hemoglobin A1C Levels: What A1C levels are expected for Those <6 years, those from 6-12, nd those from 13,19 years
<6 years:
Diabetes - Insulin Replacement Therapy: How is this adminsitered?
By SQ injection into adipose tissue over large muscle masses
Diabetes - Insulin Replacement Therapy: Advanages of insulin pumps?
Fewer injections/trauma
Can deliver minute doses for precision
Diabetes - Insulin Replacement Therapy: What is necessary to do to achieve use of insulin pump’?
Count carbs, monitor glucose levels, and work closely with physician
Diabetes - Insulin Replacement Therapy: Types of insulin?
Rapid acting, short acting, intermediate acting, and long acting
Diabetes - Insulin Replacement Therapy: How should they be stored and how long to keep them for?
Keep at room temperature, and should be discarded after 1 month. Unopened should be stored in refrigerator
Diabetes - Oral Diabetic Medications: When are these used?
When glucose control cannot be achieved by diet and exercise.
Diabetes - Oral Diabetic Medications: How do these medications work?
Stimulate insulin secretion by increasing response ot beta cells to glucose.
Diabetes - Oral Diabetic Medications: How do biguanides work?
Reduce glucose production from the liver. This includes Metformin.
Diabetes - Oral Diabetic Medications: What are insulin sensitizers?
Used to decrease insulin resistance and improve the bodies ability ot use insulin in the liver and skeletal tissue.
Diabetes - Oral Diabetic Medications: What are Alpha-Glucosidase Inhibitors?
Used to slow digestion of strach in the small intestines so that glucose from starch enters bloodstream more slowly.
Diabetes - Oral Diabetic Medications: Common side effects of these medications?
Headache, dizziness, flatulence, and GI distress, edema, and liver enzyme elevation.
Diabetes - Oral Diabetic Medications: What happens if these do not wok?
Insulin injections will be required to manage this
Diabetes - Duet and Exercise: Medical nutrition therapy may be initiated why
to prevent type d diabetes in children showing signs of prediabetes.
Diabetes - Duet and Exercise: What is an important component of this?
Monitoring carbohydrate intake
Diabetes - Duet and Exercise: What nutritional recommendations should they follow?
Limit sweets, ensure consist food intake, monitor carbs intake, eat whole grats and limit fat
Diabetes - Mx of Complications: How to prevent Retinopathy?
Type 1: Eye exam once child is 10.
Type 2: Eye exam ASAP
Diabetes - Mx of Complications: How to treat nephropathy?
Type 1: Annual screening for microalbuminura once child 10
Type 2: Annual screening ASAP
Diabetes - Mx of Complications: What are the two phases a nurse must do during assessment?
First is identify child who may have this. Then identify problems that might develop
Diabetes - Health Hx: What changes may a parent report to do hyperglycemia?
(Weakness, fatigue, and mood changes). May also report excessive thirst (polydipsia) with frequent urination (polyuria)
Diabetes - Health Hx: What symptoms will a child with DM1 and DM2 report?
1: Acute symptoms and hyperglycemia
2: Can go undiagnosed until complications appear
Diabetes - Labs: What is used to diagnose this?
flasting plasma, 2 hour fasting, or A1C.
Diabetes - Labs: Fasting glucose should be at what range
<126 mg/Dl
Diabetes - Labs: 2 hour plasma glucose should be what?
< 200 mg/dL
Diabetes - Labs: H1C should be what?
< 6.5%
Diabetes - Labs: Risk factors for this?
Family Hx, with Type 2DM’
Ethnic background
Age older than 10
Diabetes - Regulating Glucose Control: Regimen for insulin injection?
3 injections of intermediate-acting with addition of rapid acting before breakfast and dinner.
Diabetes - Regulating Glucose Control: Adjustment of insulin dosing based on what
carbohydrate intake
Diabetes - Regulating Glucose Control: Appropriate sites?
SQ injection. Abdomen, thighs, butt, back of arms, or scapula
Diabetes - Regulating Glucose Control: How should insulin be drawn up if short and long-acting drawn together?
Draw short-acting first, and then long .
Diabetes - Regulating Glucose Control: How is glucose controlled in those with Type 2 DM
oral diabetic medications, deit, and exercise or combination of all three
Diabetes - Monitoring for and Managing Complications: When in hospital, monitor for what complications?
Acidosis, coma, hyperkalemia or hypokalemia or edea. Assess every 2hours
Diabetes - Monitoring for and Managing Complications: What are some signs of hypoglycemia?
Behavioral changes, confusion, slurred speech, diaphoresis, tremors, palpitations, and tachycardia
Diabetes - Monitoring for and Managing Complications: What are some signs of hyperglycemia?
Blurred vision, dry flushed skin, and fruity odor
Diabetes - Monitoring for and Managing Complications: What to administer if child has severe hypoglycemia reaction?
Glucagon. Dextrose can also be given
Diabetes - Monitoring for and Managing Complications: What can be given if child feels symptoms of low blood sugar?
10-15 g or simple carbs like orange juice. Then follow with complex carbohydrate like peanut butter
Diabetes - Monitoring for and Managing Complications: What is done if child in PICU from DKA?
Fluid therapy given to treat dehydration , correct electrolyte imbalance and improve perfusion.
A young mother brings her new baby, diagnosed with congenital hypothyroidism, to the clinic so she can learn how to administer levothyroxine. The nurse should include which of the following instructions?
Crush the medication and place it in a full bottle of formula to disguise the taste. Administer the medication every other day. Use an oral dispenser syringe or nipple to give the crushed medication mixed with a small amount of formula. Tell the mother that the medication will not be needed after the age of 7.
Use an oral dispenser syringe or nipple to give the crushed medication mixed with a small amount of formula.
During a well-child examination which of the following comments made by the parent would indicate the possibility of a growth hormone deficiency?
“I have to buy my child new clothes every 2 to 3 months” “I have to buy my child much larger shirts than pants but then the sleeves are too long.” “My child wears out his clothes before he outgrows them.” “I can hand down my child’s clothes to his younger brother.”
“My child wears out his clothes before he outgrows them.”
The nurse is caring for a 14-year-old boy with type 1 DM. He takes NPH insulin every morning at 7:30 AM. Which assessment data will the nurse use to evaluate the therapeutic effectiveness of the medication?
Presence of signs and symptoms of hypoglycemia or hyperglycemia during the morning physical assessment Blood glucose level at 1630 Appetite and food intake at lunch Blood glucose level before breakfas
Blood glucose level at 1630
When monitoring the blood glucose level of a 12-year-old child with type 2 DM, your reading is 50 mg/dL. Which is the most appropriate action?
Encourage the child to get out of bed and increase activity. Take the child’s vital signs. Ask the child about frequent urine output. Give the child 4 oz of orange juice.
Give the child 4 oz of orange juice.
