Pedi Endocrine

Question 1

Growth hormone, TSH, adrenocorticotropic, prolactin, follicle stimulating, lutenizing

Answer 1

Hormones made by Anterior Pituitary

Question 2

Antidiuretic and oxytocin

Answer 2

Hormones made by posterior pituitary

Question 3

Thyroxine, triidothyronine, calcitonin

Answer 3

Hormones made by Thyroid

Question 4

Parathyroid hormone

Answer 4

Hormones made by parathyroid gland

Question 5

Epinephrine and norepinephrine

Answer 5

Hormones made by adrenal medulla

Question 6

Cortisol and aldosterone

Answer 6

Hormones made by adrenal cortex

Question 7

Insulin and glucagon

Answer 7

Hormones made by pancreas

Question 8

Testosterone

Answer 8

Hormone made by testes

Question 9

Estrogen and progesterone

Answer 9

Hormones made by ovaries

Question 10

Thymosin

Answer 10

Hormone made by the thymus

Question 11

Melatonin

Answer 11

Hormone made by pineal gland

Question 12

Child is normal size at birth; percentiles decrease with age. Smaller than other children of same age and gender (below 3rd percentile). Delayed puberty. Without treatment, unlikely to meet full growth potential; premature aging. Careful growth monitoring (? more than 2 SD’s below mean?). Labs: hormone levels; GH stim test

Answer 12

Hypopituitarism (Growth Hormone Deficiency)

Question 13

Treatment: Recombinant Human Growth Hormone (rhGM) IM at bedtime; Somatropin SQ (may also need suppression of luteinizing hormone)
Teaching: Importance of med, self-administration

Answer 13

Treatment and Teaching for Growth Hormone Deficiency (Hypopituitarism)

Question 14

Inappropriately increased growth. Most common cause: Pituitary adenoma. Careful growth monitoring ( more than 2 SD’s above mean? Excessive foot/finger? Wide facial features?)

Answer 14

Growth Hormone Excess (Hyperpituitarism)

Question 15

Treatment: Remove pituitary adenoma. Watch for recurrence, diabetes insipidus.
Nursing: Pre and post op care; age-appropriate interaction; self image support

Answer 15

Treatment and Nursing Interventions for Hyperpituitarism (Growth Hormone Excess)

Question 16

Boys before age 9. Girls before age 8. More common in females and more commonly idiopathic. In males, related to CNS abnormality. Central vs Peripheral. Treatment: Treat the cause. Gonadotropin releasing hormone (GnRH) agonist.
Nursing: education; support mental heath

Answer 16

Precocious puberty

Question 17

Boys- not occurring by age 14. Girls- not occurring by age 12.
Primary- turner syndrome, klinefelter syndrome; chemo, radiation, autoimmune disease or infection and gonadal injury
Secondary- Decreased secretion of FSH and LH
Treatment: work up for other disorders; short term hormonal therapy
Nursing: Education; support mental health

Answer 17

Delayed Puberty

Question 18

Kidneys cannot concentrate urine. lack of/decreased sensitivity to Vasopressin (ADH). Nephrogenic (rare) vs Central (lesion, tumor, injury).
Polyuria, polydipsia, nocturia, enuresis, dehydration, increased NA+, increased osmolarity, decreased specific gravity.

Answer 18

Diabetes Insipidus

Question 19

Treatment: Control dehydration! Vasopressin (oral, intranasal, IV). Low sodium low protein diet.
Teach: prevent dehydration. S/s of dehydration, monitoring I and O. Medical alert bracelet

Answer 19

Treatment and Nursing for Diabetes Insipidus

Question 20

Excessive secretion of ADH. Continuous ADH, water reabsorbed. Decreased urine output, fluid retention, decreased sodium (dangerous, LOC changes). JVD, increased BP, pulmonary congestion, dark urine; water intoxication
Due to CNS changes: head trauma, tumor, infection.
Can be secondary to CF, asthma.

Answer 20

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Question 21

Treatment: Monitor/restrict fluids (prevent further dilution of blood). Frequent assessment of labs (sodium).
Nursing: teach fluid restriction; high H20 foods. Medical alert bracelet

Answer 21

Treatment and Nursing Interventions for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Question 22

Deficient production of thyroid hormone since birth. Common, 1 in 3000. Autosomal recessive trait. Low levels of triiodothyronine (T3) and thyroxine (T4). If untreated can result in inrreversible intellectual disability, short stature and growth failure.

Answer 22

Congenital hypothyroidism

Question 23

S/s: Persistent open posterior fontanelle, protuberant tongue, hypotonia, hypoactivity, poor sucking, dull expression, cool skin, bradycardia, protruding abdomen (constipation); elevated TSH
Treatment: Sodium levothyroxine; frequent monitoring of growth and levels
Nursing: Teach families s/s of too much/little TH

Answer 23

S/s, Treatment, and Nursing interventions for Congenital hypothyroidism

Question 24

Deficient production of thyroid hormone later in life due to autoimmune disorder, throid dysfunction, drug toxicity.
Hashimoto’s thyroiditis

Answer 24

Acquired Hypothyroidism

Question 25

S/s: Depends on how long - fatigue, weight gain, weakness, cold intolerance, skin/hair changes, slowed height, menstrual cycle, goiter. Treatment: Sodium levothyroxine, monitor levels every 3-6 mo Nursing: Teach - not with food! (60 mins before or after)

Answer 25

S/s, Treatment, and Nursing Interventions for Acquired Hypothyroidism

Question 26

TOO MUCH thyroid hormone (thyroidtoxicosis). Graves disease (during adolescent period). Can 1st look behavioral: lower school performance, hyperactivity, easily distracted; then weight loss, hot flashes, tachycardia, tremors, exophthalamos, diplopia

Answer 26

Hyperthyroidism

Question 27

Thyroid storm (sudden release) = EMERGENCY. Irritability, fever, tremors, anxiety, diaphoresis, tachycardia.

Answer 27

Hyperthyroidism

Question 28

Treatment: Thyroidectomy, radiactive iodine therapy, anti-thyroid meds; Beta-blockers for extreme symptom management; Sodium levothyroxine if removed. Nursing: Depends of treatment. Med education; level monitoring. Post-op.

Answer 28

Treatment and Nursing Interventions of Hyperthyroidism

Question 29

Deficiency in glucocorticoids (cortisone) and sometimes mineralocoticoids (aldosterone) leading to Body has difficulty managing stress (infection/surgery) Numerous, primary or central; autoimmune disorder, Tb fungal infections, HIV

Answer 29

Adrenal insufficiency (Addison's Disease)

Question 30

S/s are vague: fatigue, skin changes, N/V/D. Stressors (dehydration, illness, trauma) can cause adrenal crisis (lethargy, hypoglycemia, weight changes) Treatment: Replace all deficient hormones; oral hydrocortisone, fludrocotrisone if 1 degree. Crisis: IV fluid, glucose, hydrocortisone (doses increased before and after stressful events) Nursing: Extensive teaching! Meds, different a.m/p.m, side effects, compliance (esp in times of stress); IV doses if vomiting

Answer 30

S/s, Treatment, and Nursing Interventions for Adrenal insufficiency (addisons disease)

Question 31

Autosomal recessive; insufficient enzymes for synthesis of cortisol and aldosterone. 1 in 16,000; majority is related to 21-hydroxylase (21-OH) deficiency (detected in newborn screen) Blocked production of adrenal mineralocorticoids and glucocorticoids, so continuous ACTH, overproduction of androgen

Answer 31

Congenital Adrenal Hyperplasia

Question 32

Affects external genitalia; most common cause of ambiguous genitalia. May cause precocious puberty. Aldosterone insufficieny leads to hyponatremia, hyperkalemia, hypotension. Cortisol insufficiency leads to hypoglycemia. Treatment: Normalize hormones in question. Cortisol to decrease ACTH, hydrocortisone to fludrocortisone to regulate ACTH secretion. Lifelong therapy, increase doses in times of stress

Answer 32

S/s and Treatment of Congenital Adrenal Hyperplasia

Question 33

Overproduction of cortisol (glucocorticoid). Or prolonged exposure to corticosteroid treatment (CAH), chronic respiratory ilness, cancer treatment, or eczema. The disease of this is from a pituitary adenoma.

Answer 33

Cushing Syndrome

Question 34

Increased cortisol encourages increased glucose. S/s: obesity, moon face, prominent red cheeks, pendulous abdomen, abdominal striae, buffalo hump, hypertension, excessive hair growth (hirsutism), thin extremities (wasting), poor healing; risk for depression/anxiety Treatment: Meds; surgical removal of pituitary adenoma; combo of med and radiation; removal of adrenal glands if continued high cotrisol excresion (lifelong cortisol supplementation) Nursing: Pre and Post Op; Meds (lowest possible steroid doses if needed); nutrition, psych

Answer 34

S/s, Treatment, and Nursing Interventions for Cushing Syndrome

Question 35

More than 250 mg/dL; kidneys can not absorb excess glucose: increased urine output, increased thirst

Answer 35

Hyperglycemia

Question 36

Less than 60 mg/dL; not enough glucose to fuel brain: HA, sweaty, shaky, behavior change, decreased LOC

Answer 36

Hypoglycemia

Question 37

Autoimmune; pancreatic beta cells damage impairing insulin secretion. T-lymphocytes attack beta cells. 0.2% of peds population

Answer 37

Type 1 Diabetes

Question 38

S/s: Polyuria, polydipsia, fatigue, blurred vision, mood changes, weight loss. DKA- EMERGENCY- glucose over 330 mg/dL; acidosis leading to vomiting, tachycardia, fruity breath, confusion, coma. Hemoglobin A1c (HbA1c), glucose levels (random, fasting, 2 hour). Treatment: Multifaceted! Nursing: Glucose monitoring, insulin therapy, nutrition, psychosocial; school; stress/exercise/illness; skin; yearly eye exams. Frequency of monitoring: hourly? continous?

Answer 38

S/s and Treatment of Type 1 Diabetes

Question 39

Insulin is produced but unable to be utlized by the body (insulin resistant). Now occuring more in school-aged and teenaged children due to childhood obesity

Answer 39

Type 2 Diabetes

Question 40

Treatment: Diet changes, increase in activity (initial), metformin if not controlled Nursing: Teach! Glucose monitoring, lifestyle changes, consider socioeconomic status

Answer 40

Treament and Nursing Interventions for Type 2 Diabetes

Question 41

Deficient syndrome of parathyroid hormone (regulates calcium). Rare. Commonly caused by accidential removal of parathyroid gland during surgery. other causes: DiGeorge syndrome, autoimmune illnesses, meds.

Answer 41

Hypoparathyroidism

Question 42

S/s: Hypocalcemia and hyperphosphatemia. Irritability, poor feeding, seizures, Chvosteks sign. Treatment: Manage hypocalcemia: IV calcium gluconate, then oral or IM calcium Nursing: Monitor calcium levels closely (avoid arrythmias and seizures); maintain good IV (infiltration of Calcium is bad). Teach importance of daily calcium adherence

Answer 42

S/s and Treatment of Hypoparathyroidism

Question 43

Excess secretion of parathyroid hormone. Rare in childhood; most commonly caused by parathyroid adenoma or renal failure.

Answer 43

Hyperparathyroidism

Question 44

Hypercalcemia, hypophosphatemia leading to bone pain, fractures, kidney stones. Treatment: Excise tumor on affected gland; (renal failure: Vitamin D supplementation, phosphorus binders) Nursing: Pre op and post op care: Calcium supps, monitoring levels

Answer 44

S/s, Treatment, and Nursing Interventions for Hyperparathyroidism