lecture 9 [endocrine + cerebral dysfunctions] Flashcards
what is the dx for T1DM?
(4)
- glycosuria
- polyuria
- history of wt loss
- metabolic acidosis
what are the s/s of T1DM?
(7)
- polyuria
- polyphagia
- polydipsia
- flushed/ dry skin
- confusion
- wt loss
- retinopathy
what is the treatment for T1DM?
replace insulin (child is unable to produce insulin on their own)
what is the MOA of insulin?
- aids in transporting carbs, fats, & protein into the cells
- transports glucose into muscle & fat cells
- stores glucose as glycogen in the liver & muscle
what is the Dawn phenomenon?
a spike of glucose between 5am & 6am due to the release of GH during the night
how can you counteract Dawn phenomenon?
use long-acting insulin
insulin glargine
what is the treatment for hypoglycemia?
15grams of carbs & glucagon
what are the nursing actions after treating hypoglycemia w/ 15g carbs & glucagon?
- recheck glucose 15mins after until levels are 70mg/dL or above
- continue to monitor for 2hrs
what causes insulin levels to be extremely low or absent in T1DM?
islet cell destruction from presence of antibodies
islet cells produce insulin
what is the HgbA1c level for hyperglycemia?
6.5%
what is the fasting BG level for hyperglycemia?
126mg/dL or above
what is the Somogyi effect?
hyperglycemia in the morning in response to child having hypoglycemia during the night
how can you prevent Somogyi effect?
bedtime snack w/ proper insulin administration the night before
what are the characteristics of T1DM?
(4)
- genetic predisposition
- lack of beta cells that produce insulin
- body is unable to obtain adequate glucose
- starvation response
what is the starvation response in T1DM?
fatty acid is broken down (to obtain more energy from the body) and in the process produced ketone bodies
starvation response over a prolonged period of time can lead to which complication?
diabetic ketoacidosis
what are the s/s of DKA?
- Kussmaul respirations
- fruity breath
what are the characteristics of a patient with T2DM?
(6)
- hx of exposure to gestational DM
- insulin resistance
- sedentary lifestyle
- obesity
- HTN
- older age
what are the functions of the endocrine system?
(5)
- energy production
- growth
- fluid balance
- response to stress
- sexual reproduction
what are the hormones secreted by the anterior pituitary gland?
- FSH
- LH
- GH
what are the hormones secreted by the posterior pituitary gland?
- ADH
- oxytocin
what is the role of follicle stimulating hormone?
- stimulates secretion of estrogen & progesterone
- produces seminiferous tubules to produce sperm
what is the role of luteinizing hormone?
- stimulates ovulation
- stimulates secretion of testosterone in males
what is the role of growth hormone?
- promotes growth
- maintain glucose levels
- promotes bone & soft tissue growth
what is the function of ADH (vasopressin)?
stimulates distal loop of kidney to reabsorb water & sodium
what is the function of oxytocin?
- stimulates uterine contractions
- stimulates let-down reflex in breast-feeding women
what are the manifestations of hypopituitarism?
GH deficiency
- delayed bone growth
- weight-height ratio disparity
what is the condition associated with hypopituitarism?
achondroplasia
how is hypopituitarism diagnosed?
- endocrine tests
- skeletal surveys
- absence of GH
how is hypopituitarism treated?
Somatropin
(GH replacement)
what are the conditions associated with hyperpituitarism?
- acromegaly
- gigantism
when do growth hormones surge for gigantism?
BEFORE epiphyseal shafts close
BEFORE puberty
when do growth hormones surge for acromegaly?
AFTER epiphyseal shafts close
AFTER puberty
how is hyperpituitarism diagnosed?
- family Hx
- GH levels
- x-rays/ MRI
- endocrine tests
what are the treatments for hyperpituitarism?
- surgery
- irradiation
tumors/ brain lesions can commonly occur with abnormal levels of GH
true
what is precocious puberty?
early sexual development due to premature activation of the hypothalamic-pituitary-gonadal axis
what is diabetes insipidus?
under secretion of ADH leading to diuresis
what are the urine characteristics of diabetes insipidus?
- increased urine output
- diluted urine
what are the actions to diagnosediabetes insipidus?
restrict fluid intake then observe fluid output (amount & color)
water deprivation test
what is the treatment for diabetes insipidus?
- vasopressin tannate (Desmopressin)
- stict I&O
what is the first sign of diabetes insipidus?
bedwetting
what are the common s/s of diabetes insipidus?
- polyuria
- polydipsia
what is syndrome of inappropriate ADH (SIADH)?
excess secretion of ADH, leading to kidneys reabsorbing fluid & returning it to central circulation
what are the manifestations of SIADH?
- fluid retention
- hyponatremia
- elevated urine osmolality
- hypotonicity
what does elevated urine osmolality indicate?
elevated solutes in a solution, indicating a darker urine
what is the priority nursing action for SIADH?
monitor for fluid overload
which medications help with hyponatremia in SIADH?
- Declomycin
- sodium supplements
what are the labs that nurses need to check for SIADH?
- BUN
- electrolytes
- urine & serum osmolality
what is hypothyroidism?
deficiency of thyroid hormone
what are the manifestations of hypothyroidism?
- growth cessation
- developmental delays
- problems w/ memory, attention, & visuospatial processing
what is the most common endocrine problem among children?
hypothyroidism
how long does treatment for hypothyroidism last?
4-8 weeks
what are the s/s of hyperthyroidism?
- irritability
- hyperactivity
- exophthalmos
- goiter
- wt loss
what is Grave’s disease?
a form of hyperthyroidism that is usually an autoimmune response to TSH receptors
hyperthyroidism is more common in girls (at least 5x more likely)
true
what are the s/s of Grave’s disease?
- fever
- enlarged thyroid gland
- exophthalmos
- urticaria
- vasculitis
- agranulocytosis
what are the common s/s of neurological impairment in children?
- bulging fontanels
- altered LOC
- clonus
- jittery
- pupillary changes
definition
persistent vegetative state
lost function of cerebral cortex
definition
obtunded
only responds to pain
definition
stupor
responds to vigorous stimulation or patient is in a deep sleep state
children can become hyperthermic or hypothermic when in a toxic coma
true
blood pressure is the last sign to change in neurologic dysfunctions
true
when do respirations slow in pediatric neurologic dysfunctions?
- deep sedation
- post-ictal state
- cerebral infections present
what do nurses need to examine on the skin for neurologic dysfunctions?
- petechiae (meningococcal infections)
- bites
- ticks
indication: pupilary response
pinpoint
poisoning
indication: pupilary response
widely dilated
reactive to light
post-ictal state
indication: pupilary response
bilateral fixation for 5 minutes
brainstem damage
indication: pupilary response
sudden fixed & dilated
emergency
can lead to death
what does decorticate posturing indicate?
cerebral cortex/ brainstem dysfunction (may be due to tumor)
what does decerebrate posturing indicate?
midbrain to brainstem dysfunction (due to stroke)
what does a nurse observe for in a child’s motor movement?
- response to pain
- spotaneous movement
what are the normal reflexes of infants?
- Moro reflex
- tonic neck
- withdrawal reflexes
- positive Babinsky
what are the absence of reflexes that are associated with severe brain damage?
- corneal reflex
- tonic neck
what are the major causes of cerebral trauma?
(3)
- falls
- MVA
- bicycle injuries
what are the complications of cerebral trauma?
- hemorrhage
- cerebral edema
- infection
- hernia
a patient sustained a cerebral edema that caused them to lose consciousness & vomit three times, what is the priority nursing action?
initiate hyperosmolar therapy STAT
what are the condtions that come with a near-drowning incident?
- hypoxia
- aspiration
- hypothermia
how long does it take for neurons to irreversibly deteriorate due to hypoxia from near-drowning?
4-6 minutes
what are the conditions that the child can acquire from aspiration during near-drowning?
- pulmonary edema
- atelectasis
- airway spasm
- pneumonitis
what is the etiology of bacterial meningitis?
an acute inflammation of the meninges and CSF
which vaccine prevents meningitis?
Hib vaccine
which bacteria causes meningitis?
group B strep
adhesions of pus or fibrin from infection in meningitis can obstruct the flow of CSF
true
what are the s/s of meningitis?
- abrupt onset fever
- vomiting
- photophobia
- HA
- inability of neck flexion
what is the diagnostic procedure for meningitis?
lumbar puncture
what are the CSF characteristics for bacterial meningitis?
- elevated WBC
- cloudy color
- elevated protein
- decreased glucose
- (+) Gram stain
what are the CSF characteristics for viral meningitis?
- clear color
- elevated WBC
- normal protein content
- normal glucose
- (-) Gram stain
what kind of positioning does a child with meningitis adopt?
- Brudzinsky sign
- Kernig’s sign
- Nuchal rigidity
what is encephalitis?
inflammation of the brain
what causes encephalitis?
- MMR
- varicella
- herpes
- West Nile virus
how is rabies transmitted?
through saliva of infected animal
what is the treatment for rabies?
- inactivated rabies vaccine
- globulins containing preformed antibodies
how many doses of the vaccine for rabies need to be given?
5
0, 3, 7, 14, 28
what is Reye syndrome?
a neurological dysfunction that affects the liver & brain causing liver dysfunction & cerebral edema
which medication is the cause for Reye syndrome heavily associated with?
Aspirin
Reye syndrome typically follows a viral illness such as flu or varicella
true
what is the pathophysiology of seizures?
abnormal electrical discharges in the brain
what are the categories of seizures?
- generalized
- partial
what are the types of partial seizures?
- simple w/ motor
- simple w/ sensory
- complex (psychomotor)
what are the phases of tonic-clonic?
- tonic
- clonic
- postictal
what are the types of generalized seizure?
- tonic-clonic
- absence
- myoclonic
- atonic/ akinetic (drop attacks)
what are the treatments for seizure?
(6)
- Ketogenic diet
- antiepileptic drugs
- vagus nerve stimulation
- focal resection
- hemispherectomy
- corpus callostomy
what is status epilepticus?
seizures that may last for 30 minutes that lead to respiratory failure or death
what are the emergent measures for status epilepticus?
(5)
- airway
- oxygen
- suction
- IV ativan
- thermoregulation
what causes hydrocephalus?
impaired CSF absorption
what are the manifestations of hydrocephalus?
(5)
- bulging fontanel
- wide head circumference
- Cri du chat (high-pitched cry)
- sunsetting eyes
- sluggish pupils
what are the treatments for hydrocephalus?
- endoscopic fenestration
- externalized shunt