Pedi Endocrine Flashcards
Endocrine System
Human Growth Hormone
somatotropin
naturally occuring substance secreted by pituitary gland
important for normal growth, development, cellular metabolism
deficiency prevents somatic growth throughout body
Diabetes Mellitus
partial or complete metabolic deficiency of insulin
contributes to development of cardiovascular disease, hypertension, renal failure, blindness, stroke
Type 1 Diabetes
Risk factors
Genetics
toxins and viruses destroy beta cells
Type 2 Diabetes
Risk factors
genetics
obesity, physical inactivity, high triglycerides (greater than 250), hypertension
Hypoglycemia
Manifestations
less than 60mg/dL
Autonomic nervous system responses rapid onset: hunger, lightheadedness, shakiness headache anxiety/irritability pale, cool skin diaphoresis normal/shallow respirations tachycardia/palpitations
impaired cerebral function gradual onset: strange/unusual feelings decreasing level of consciousness difficulty in thinking and inability to concentrate change in emotional behavior slurred speech headache/blurred vision seizures/coma
Hypoglycemia
Treatments
fast acting, simple carbs (15 g)
4 oz juice or regular soda; 8oz of milk; 3 glucose tabs; 1 tube glucose gel; 1 pack of fruit snacks
observe for 10 mins, recheck, goal is greater than 70. exceeds 70 = follow up with solid food snack or next meal.
if no improvement = repeat until above 70
Hyperglycemia
Manifestations
greater than 250mg/dL
thirst polyuria (early) oliguria (late) N&V, abdominal pain warm, dry, flushed skin with poor turgor dry mucous membranes confusion weakness lethargy weak pulse diminished reflexes rapid, deep repirations with acetone/fruity odor due to ketones (Kussmaul respirations)
Hyperglycemia
Treatment
give water
insulin
test urine for ketones
call MD if symptoms progress
Diabetes
Laboratory Tests confirming DM DX
8 hour fasting blood glucose of 126 mg/dL or more
Random blood glucose of 200 mg/dL or more with classic signs
Oral glucose tolerance test of 200 mg/dL or more in 2 hr sample
Client Education
Fasting Blood Glucose
ensure fasting for 8 hr prior to blood draw
antidiabetic meds should be postponed until after level is drawn
Client Eduation
Oral glucose tolerance test
consume balanced diet for 3 days prior to test
fast for 8 hr prior to test
fasting level drawn at start
consume specific amount of glucose
levels drawn every 30 min for 2 hr
the child must be assessed for hypoglycemia throughout procedure
Glycosylated hemoglobin (HbA1c)
expected range: 4%-6%
target for child w/ DM: 6.5%-8%
target goal: less than 7%
Self-monitored blood glucse (SMBG)
before meals and at bedtime
journal record: time, date, serum glucose level, insulin dose, food intake, events that may alter (activity, illness)
Diabetes
Nursing Care
nair care foot care prevention of infection nutritional guidelines - 15g of carbs=1 carb exchange techniques for SMBG exercise plan
Diabetes
Sick Plan
Monitor blood glucose every 3 hr
continue to take insulin or oral anti-diabetic agents
encourage sugar-free, non-caffeinated liquids to prevent dehydration
meet carb needs by eating soft foods if possible, consume liquids that are equal to usual carb content
test urine for ketones q3h
rest
Diabetes
Sick Plan
Call MD
blood glucose greater than 240mg/dL fever is greater than 38.9/102, fever does not respond to acetaminophen or lasts longer than 12 hr positive ketones in urine disorientation or confusion rapid breathing vomiting occurs more than once diarrhea occurs more than 5 times or for longer than 24 hrs liquids cannot be tolerated illness lasts longer than 2 days
Diabetes
Insulin pumps
regular insulin, programmed amt on consistent basis
alarm will sound: pump failure, occluded tubing, no insulin,
alarm will not sound if needle becomes dislodged
Diabetes
Insulin injections
2+ times per day; mixing insulin: rapid-acting and intermediate acting
rotate injection site (prevent lipohypertrophy) within one anatomic site to prevent changes in absorption rate
Rapid Acting Insulin
Name: Insulin lispro (Humalog)
Onset: less than 15 min
Peak: 0.5-1 hr
Duration: 3-4 hr
Short Acting Insulin
Name: Regular insulin (Humulin R)
Onset: 0.5-1 hr
Peak: 2-4 hr
Duration: 5-7 hr
Intermediate Acting Insulin
Name: NPH insulin (Humulin N)
Onset: 1-2 hr
Peak: 4-12 hr
Duration: 18-24 hr
Long Acting Insulin
Name: Insulin glargine (Lantus)
Onset: 3-4 hr
Peak: none
Duration: 10.4-24 hr
Insulin
Client Education
observe child and parent drawing up insulin
do not mix glargine (Lantus) with other insulins due to incompatibility
rotate injection sites to prevent lipohypertrophy
inject at a 90degree angle (45degree if thin)
do not aspirate blood
draw up shorter-acting insulin into syringe first and then longer-acting insulin
Diabetic Ketoacidosis
life threatening condition defined by hyperglycemia, greater than 300mg/dL
caused by missed dose of insulin or poor insulin administration technique
causes a breakdown of body fat for energy and an accumulation of ketones in blood and urine
onset is rapid and mortality is high
Diabetic Ketoacidosis
Causes
insufficient insulin (usually failure to take appropriate dose) acute stress (trauma or surgery) poor management of acute illness
Diabetic Ketoacidosis
Nursing Actions
Admit to ICU
provide rapid isotonic IV fluid (0.9% sodium chloride) to maintain perfusion to vital organs, large quantities may be required, monitor for fluid volume excess
follow with IV hypotonic fluid (0.45% sodium chloride) to continue replacing losses to total body fluid
When serum glucose levels approach 250 mg/dL add glucose to IV fluids to minimize risk of cerebral edema associated with drastic changes in serum osmolality
admin Regular insulin 0.1 unit/kg as an IV bolus then follow with continuous infusion of regular insulin at 0.1 unit/kg/hr
DKA
Monitor Glucose
monitor glucose levels hourly
DKA
Monitor Potassium
monitor serum potassium
initially will be elevated, insulin will shift potassium into cells and child needs to be monitored for hypokalemia = provide potassium replacement therapy in all replacement IV fluids, make sure urinary output is adequate before administering K
normal range = 3.7-5.2
DM
Long-Term Complications
nephropathy retinopathy neuropathy cardiovascular disease altered thyroid function limited mobility of small joints
Growth Hormone Deficiency
Human Growth Hormone (GH) somatotropin, secreted by pituitary gland
GH is important for normal growth, development and cellular metabolism
Growth Hormone Deficiency
Hormones that Assist GH
Adrenocorticotropic (ACTH)
Thyroid stimulating hormone (TSH)
Gonadotropins, Follicle stimulating hormones (FSH)
Luteinizing Hormone (LH)
Growth Hormone Deficiency
Risk Factors
structural factors (tumors, trauma, structural defects, surgery)
heredity disorders
other pituitary hormone deficiencies (deficiencies of TSH or ACTH)
idiopathic
Growth Hormone Deficiency
Manifestations
short in stature delayed epiphyseal closure increased insulin sensitivity delayed dentition underdeveloped jaw delayed sexual development
Growth Hormone Deficiency
Diagnostics - GH Stimulation
testing done if low level of IGF-1 and IGFBP-3 and short stature
draw baseline blood between 0600 and 0800
admin meds that trigger release of GH (arginine or GH-releasing hormone)
obtain blood sample every 30 min for 3hr period following med admin
NPO 10-12 hrs before test
limit activity 10-12 hr before test
Growth Hormone Deficiency
Diagnostics - Radiological Assessments
assess skeletal maturity by comparing epiphyseal centers on x-ray to age-appropriate published standards
perform general skeletal survey in children under 3, or survey hands and wrists in older children
assist in positioning
Growth Hormone Deficiency
Diagnostics - CT scan, MRI, skull x-rays
identify tumors or structural defects
monitor during procedure
sedate
provide emotional support
Growth Hormone Deficiency
Diagnostics - evaluation of growth curve
accurately obtain and plot height and weight
assess height velocity or over time
determine height-to-weight relationship
project target height in context of genetic potential
Growth Hormone Deficiency
Nursing Care
height and weight measured and marked on growth chart
bone age usually matches height
children less than 3 years measure every 6 mos and greater than 3 measure every year
monitor effectiveness of GH replacement
admin other hormone replacements (thyroid hormone)
provide psychosocial support and reassure lack of cognitive delays or deficits
Growth Hormone Deficiency
Somatropin
replacement for human growth hormone
admin via subcutaneous injections
use cautiously in children receiving insulin
