Pedi Endocrine Flashcards
Growth hormone, TSH, adrenocorticotropic, prolactin, follicle stimulating, lutenizing
Hormones made by Anterior Pituitary
Antidiuretic and oxytocin
Hormones made by posterior pituitary
Thyroxine, triidothyronine, calcitonin
Hormones made by Thyroid
Parathyroid hormone
Hormones made by parathyroid gland
Epinephrine and norepinephrine
Hormones made by adrenal medulla
Cortisol and aldosterone
Hormones made by adrenal cortex
Insulin and glucagon
Hormones made by pancreas
Testosterone
Hormone made by testes
Estrogen and progesterone
Hormones made by ovaries
Thymosin
Hormone made by the thymus
Melatonin
Hormone made by pineal gland
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
Hypopituitarism (Growth Hormone Deficiency)
Treatment: Recombinant Human Growth Hormone (rhGM) IM at bedtime; Somatropin SQ (may also need suppression of luteinizing hormone)
Teaching: Importance of med, self-administration
Treatment and Teaching for Growth Hormone Deficiency (Hypopituitarism)
Inappropriately increased growth. Most common cause: Pituitary adenoma. Careful growth monitoring ( more than 2 SD’s above mean? Excessive foot/finger? Wide facial features?)
Growth Hormone Excess (Hyperpituitarism)
Treatment: Remove pituitary adenoma. Watch for recurrence, diabetes insipidus.
Nursing: Pre and post op care; age-appropriate interaction; self image support
Treatment and Nursing Interventions for Hyperpituitarism (Growth Hormone Excess)
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
Precocious puberty
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
Delayed Puberty
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.
Diabetes Insipidus
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
Treatment and Nursing for Diabetes Insipidus
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.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Treatment: Monitor/restrict fluids (prevent further dilution of blood). Frequent assessment of labs (sodium).
Nursing: teach fluid restriction; high H20 foods. Medical alert bracelet
Treatment and Nursing Interventions for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
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.
Congenital hypothyroidism
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
S/s, Treatment, and Nursing interventions for Congenital hypothyroidism
Deficient production of thyroid hormone later in life due to autoimmune disorder, throid dysfunction, drug toxicity.
Hashimoto’s thyroiditis
Acquired Hypothyroidism
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)
S/s, Treatment, and Nursing Interventions for Acquired Hypothyroidism
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
Hyperthyroidism
Thyroid storm (sudden release) = EMERGENCY. Irritability, fever, tremors, anxiety, diaphoresis, tachycardia.
Hyperthyroidism
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.
Treatment and Nursing Interventions of Hyperthyroidism
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
Adrenal insufficiency (Addison’s Disease)
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
S/s, Treatment, and Nursing Interventions for Adrenal insufficiency (addisons disease)
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
Congenital Adrenal Hyperplasia
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
S/s and Treatment of Congenital Adrenal Hyperplasia
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.
Cushing Syndrome
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
S/s, Treatment, and Nursing Interventions for Cushing Syndrome
More than 250 mg/dL; kidneys can not absorb excess glucose: increased urine output, increased thirst
Hyperglycemia
Less than 60 mg/dL; not enough glucose to fuel brain: HA, sweaty, shaky, behavior change, decreased LOC
Hypoglycemia
Autoimmune; pancreatic beta cells damage impairing insulin secretion. T-lymphocytes attack beta cells. 0.2% of peds population
Type 1 Diabetes
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?
S/s and Treatment of Type 1 Diabetes
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
Type 2 Diabetes
Treatment: Diet changes, increase in activity (initial), metformin if not controlled
Nursing: Teach! Glucose monitoring, lifestyle changes, consider socioeconomic status
Treament and Nursing Interventions for Type 2 Diabetes
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.
Hypoparathyroidism
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
S/s and Treatment of Hypoparathyroidism
Excess secretion of parathyroid hormone. Rare in childhood; most commonly caused by parathyroid adenoma or renal failure.
Hyperparathyroidism
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
S/s, Treatment, and Nursing Interventions for Hyperparathyroidism
