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PEDS > lecture 9 [endocrine + cerebral dysfunctions] > Flashcards

lecture 9 [endocrine + cerebral dysfunctions] Flashcards

1
Q

what is the dx for T1DM?

(4)

A
  • glycosuria
  • polyuria
  • history of wt loss
  • metabolic acidosis
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2
Q

what are the s/s of T1DM?

(7)

A
  • polyuria
  • polyphagia
  • polydipsia
  • flushed/ dry skin
  • confusion
  • wt loss
  • retinopathy
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3
Q

what is the treatment for T1DM?

A

replace insulin (child is unable to produce insulin on their own)

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4
Q

what is the MOA of insulin?

A
  • aids in transporting carbs, fats, & protein into the cells
  • transports glucose into muscle & fat cells
  • stores glucose as glycogen in the liver & muscle
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5
Q

what is the Dawn phenomenon?

A

a spike of glucose between 5am & 6am due to the release of GH during the night

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6
Q

how can you counteract Dawn phenomenon?

A

use long-acting insulin

insulin glargine

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7
Q

what is the treatment for hypoglycemia?

A

15grams of carbs & glucagon

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8
Q

what are the nursing actions after treating hypoglycemia w/ 15g carbs & glucagon?

A
  • recheck glucose 15mins after until levels are 70mg/dL or above
  • continue to monitor for 2hrs
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9
Q

what causes insulin levels to be extremely low or absent in T1DM?

A

islet cell destruction from presence of antibodies

islet cells produce insulin

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10
Q

what is the HgbA1c level for hyperglycemia?

A

6.5%

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11
Q

what is the fasting BG level for hyperglycemia?

A

126mg/dL or above

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12
Q

what is the Somogyi effect?

A

hyperglycemia in the morning in response to child having hypoglycemia during the night

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13
Q

how can you prevent Somogyi effect?

A

bedtime snack w/ proper insulin administration the night before

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14
Q

what are the characteristics of T1DM?

(4)

A
  • genetic predisposition
  • lack of beta cells that produce insulin
  • body is unable to obtain adequate glucose
  • starvation response
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15
Q

what is the starvation response in T1DM?

A

fatty acid is broken down (to obtain more energy from the body) and in the process produced ketone bodies

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16
Q

starvation response over a prolonged period of time can lead to which complication?

A

diabetic ketoacidosis

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17
Q

what are the s/s of DKA?

A
  • Kussmaul respirations
  • fruity breath
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18
Q

what are the characteristics of a patient with T2DM?

(6)

A
  • hx of exposure to gestational DM
  • insulin resistance
  • sedentary lifestyle
  • obesity
  • HTN
  • older age
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19
Q

what are the functions of the endocrine system?

(5)

A
  • energy production
  • growth
  • fluid balance
  • response to stress
  • sexual reproduction
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20
Q

what are the hormones secreted by the anterior pituitary gland?

A
  • FSH
  • LH
  • GH
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21
Q

what are the hormones secreted by the posterior pituitary gland?

A
  • ADH
  • oxytocin
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22
Q

what is the role of follicle stimulating hormone?

A
  • stimulates secretion of estrogen & progesterone
  • produces seminiferous tubules to produce sperm
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23
Q

what is the role of luteinizing hormone?

A
  • stimulates ovulation
  • stimulates secretion of testosterone in males
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24
Q

what is the role of growth hormone?

A
  • promotes growth
  • maintain glucose levels
  • promotes bone & soft tissue growth
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25
Q

what is the function of ADH (vasopressin)?

A

stimulates distal loop of kidney to reabsorb water & sodium

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26
Q

what is the function of oxytocin?

A
  • stimulates uterine contractions
  • stimulates let-down reflex in breast-feeding women
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27
Q

what are the manifestations of hypopituitarism?

GH deficiency

A
  • delayed bone growth
  • weight-height ratio disparity
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28
Q

what is the condition associated with hypopituitarism?

A

achondroplasia

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29
Q

how is hypopituitarism diagnosed?

A
  • endocrine tests
  • skeletal surveys
  • absence of GH
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30
Q

how is hypopituitarism treated?

A

Somatropin
(GH replacement)

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31
Q

what are the conditions associated with hyperpituitarism?

A
  • acromegaly
  • gigantism
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32
Q

when do growth hormones surge for gigantism?

A

BEFORE epiphyseal shafts close

BEFORE puberty

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33
Q

when do growth hormones surge for acromegaly?

A

AFTER epiphyseal shafts close

AFTER puberty

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34
Q

how is hyperpituitarism diagnosed?

A
  • family Hx
  • GH levels
  • x-rays/ MRI
  • endocrine tests
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35
Q

what are the treatments for hyperpituitarism?

A
  • surgery
  • irradiation
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36
Q

tumors/ brain lesions can commonly occur with abnormal levels of GH

A

true

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37
Q

what is precocious puberty?

A

early sexual development due to premature activation of the hypothalamic-pituitary-gonadal axis

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38
Q

what is diabetes insipidus?

A

under secretion of ADH leading to diuresis

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39
Q

what are the urine characteristics of diabetes insipidus?

A
  • increased urine output
  • diluted urine
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40
Q

what are the actions to diagnosediabetes insipidus?

A

restrict fluid intake then observe fluid output (amount & color)

water deprivation test

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41
Q

what is the treatment for diabetes insipidus?

A
  • vasopressin tannate (Desmopressin)
  • stict I&O
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42
Q

what is the first sign of diabetes insipidus?

A

bedwetting

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43
Q

what are the common s/s of diabetes insipidus?

A
  • polyuria
  • polydipsia
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44
Q

what is syndrome of inappropriate ADH (SIADH)?

A

excess secretion of ADH, leading to kidneys reabsorbing fluid & returning it to central circulation

45
Q

what are the manifestations of SIADH?

A
  • fluid retention
  • hyponatremia
  • elevated urine osmolality
  • hypotonicity
46
Q

what does elevated urine osmolality indicate?

A

elevated solutes in a solution, indicating a darker urine

47
Q

what is the priority nursing action for SIADH?

A

monitor for fluid overload

48
Q

which medications help with hyponatremia in SIADH?

A
  • Declomycin
  • sodium supplements
49
Q

what are the labs that nurses need to check for SIADH?

A
  • BUN
  • electrolytes
  • urine & serum osmolality
50
Q

what is hypothyroidism?

A

deficiency of thyroid hormone

51
Q

what are the manifestations of hypothyroidism?

A
  • growth cessation
  • developmental delays
  • problems w/ memory, attention, & visuospatial processing
52
Q

what is the most common endocrine problem among children?

A

hypothyroidism

53
Q

how long does treatment for hypothyroidism last?

A

4-8 weeks

54
Q

what are the s/s of hyperthyroidism?

A
  • irritability
  • hyperactivity
  • exophthalmos
  • goiter
  • wt loss
55
Q

what is Grave’s disease?

A

a form of hyperthyroidism that is usually an autoimmune response to TSH receptors

56
Q

hyperthyroidism is more common in girls (at least 5x more likely)

A

true

57
Q

what are the s/s of Grave’s disease?

A
  • fever
  • enlarged thyroid gland
  • exophthalmos
  • urticaria
  • vasculitis
  • agranulocytosis
58
Q

what are the common s/s of neurological impairment in children?

A
  • bulging fontanels
  • altered LOC
  • clonus
  • jittery
  • pupillary changes
59
Q

definition

persistent vegetative state

A

lost function of cerebral cortex

60
Q

definition

obtunded

A

only responds to pain

61
Q

definition

stupor

A

responds to vigorous stimulation or patient is in a deep sleep state

62
Q

children can become hyperthermic or hypothermic when in a toxic coma

A

true

63
Q

blood pressure is the last sign to change in neurologic dysfunctions

A

true

64
Q

when do respirations slow in pediatric neurologic dysfunctions?

A
  • deep sedation
  • post-ictal state
  • cerebral infections present
65
Q

what do nurses need to examine on the skin for neurologic dysfunctions?

A
  • petechiae (meningococcal infections)
  • bites
  • ticks
66
Q

indication: pupilary response

pinpoint

A

poisoning

67
Q

indication: pupilary response

widely dilated

reactive to light

A

post-ictal state

68
Q

indication: pupilary response

bilateral fixation for 5 minutes

A

brainstem damage

69
Q

indication: pupilary response

sudden fixed & dilated

A

emergency

can lead to death

70
Q

what does decorticate posturing indicate?

A

cerebral cortex/ brainstem dysfunction (may be due to tumor)

71
Q

what does decerebrate posturing indicate?

A

midbrain to brainstem dysfunction (due to stroke)

72
Q

what does a nurse observe for in a child’s motor movement?

A
  • response to pain
  • spotaneous movement
73
Q

what are the normal reflexes of infants?

A
  • Moro reflex
  • tonic neck
  • withdrawal reflexes
  • positive Babinsky
74
Q

what are the absence of reflexes that are associated with severe brain damage?

A
  • corneal reflex
  • tonic neck
75
Q

what are the major causes of cerebral trauma?

(3)

A
  • falls
  • MVA
  • bicycle injuries
76
Q

what are the complications of cerebral trauma?

A
  • hemorrhage
  • cerebral edema
  • infection
  • hernia
77
Q

a patient sustained a cerebral edema that caused them to lose consciousness & vomit three times, what is the priority nursing action?

A

initiate hyperosmolar therapy STAT

78
Q

what are the condtions that come with a near-drowning incident?

A
  • hypoxia
  • aspiration
  • hypothermia
79
Q

how long does it take for neurons to irreversibly deteriorate due to hypoxia from near-drowning?

A

4-6 minutes

80
Q

what are the conditions that the child can acquire from aspiration during near-drowning?

A
  • pulmonary edema
  • atelectasis
  • airway spasm
  • pneumonitis
81
Q

what is the etiology of bacterial meningitis?

A

an acute inflammation of the meninges and CSF

82
Q

which vaccine prevents meningitis?

A

Hib vaccine

83
Q

which bacteria causes meningitis?

A

group B strep

84
Q

adhesions of pus or fibrin from infection in meningitis can obstruct the flow of CSF

A

true

85
Q

what are the s/s of meningitis?

A
  • abrupt onset fever
  • vomiting
  • photophobia
  • HA
  • inability of neck flexion
86
Q

what is the diagnostic procedure for meningitis?

A

lumbar puncture

87
Q

what are the CSF characteristics for bacterial meningitis?

A
  • elevated WBC
  • cloudy color
  • elevated protein
  • decreased glucose
  • (+) Gram stain
88
Q

what are the CSF characteristics for viral meningitis?

A
  • clear color
  • elevated WBC
  • normal protein content
  • normal glucose
  • (-) Gram stain
89
Q

what kind of positioning does a child with meningitis adopt?

A
  • Brudzinsky sign
  • Kernig’s sign
  • Nuchal rigidity
90
Q

what is encephalitis?

A

inflammation of the brain

91
Q

what causes encephalitis?

A
  • MMR
  • varicella
  • herpes
  • West Nile virus
92
Q

how is rabies transmitted?

A

through saliva of infected animal

93
Q

what is the treatment for rabies?

A
  • inactivated rabies vaccine
  • globulins containing preformed antibodies
94
Q

how many doses of the vaccine for rabies need to be given?

A

5

0, 3, 7, 14, 28

95
Q

what is Reye syndrome?

A

a neurological dysfunction that affects the liver & brain causing liver dysfunction & cerebral edema

96
Q

which medication is the cause for Reye syndrome heavily associated with?

A

Aspirin

97
Q

Reye syndrome typically follows a viral illness such as flu or varicella

A

true

98
Q

what is the pathophysiology of seizures?

A

abnormal electrical discharges in the brain

99
Q

what are the categories of seizures?

A
  • generalized
  • partial
100
Q

what are the types of partial seizures?

A
  • simple w/ motor
  • simple w/ sensory
  • complex (psychomotor)
101
Q

what are the phases of tonic-clonic?

A
  • tonic
  • clonic
  • postictal
102
Q

what are the types of generalized seizure?

A
  • tonic-clonic
  • absence
  • myoclonic
  • atonic/ akinetic (drop attacks)
103
Q

what are the treatments for seizure?

(6)

A
  • Ketogenic diet
  • antiepileptic drugs
  • vagus nerve stimulation
  • focal resection
  • hemispherectomy
  • corpus callostomy
104
Q

what is status epilepticus?

A

seizures that may last for 30 minutes that lead to respiratory failure or death

105
Q

what are the emergent measures for status epilepticus?

(5)

A
  • airway
  • oxygen
  • suction
  • IV ativan
  • thermoregulation
106
Q

what causes hydrocephalus?

A

impaired CSF absorption

107
Q

what are the manifestations of hydrocephalus?

(5)

A
  • bulging fontanel
  • wide head circumference
  • Cri du chat (high-pitched cry)
  • sunsetting eyes
  • sluggish pupils
108
Q

what are the treatments for hydrocephalus?

A
  • endoscopic fenestration
  • externalized shunt

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