PEDIATRIC ENDOCRINE FUNCTION AND DYSFUNCTION Flashcards
FUNCTIONS
- regulates body metabolism through release of hormones
- maintain optimal hormone levels
- maintain homeostasis
A AND P DIFFERENCES
- endocrine system responsible for sexual differentiation during fetal development
- hormones regulate growth and development
- stimulates reproductive system and regulates puberty
NEGATIVE FEEDBACK
- hypothalamus -pituitary axis produce releasing and inhibiting hormones
- hypothalamus synthesizes release of hormones when needed
- secretion inhibited when target cells have received adequate hormone
- secretion resumes when levels of hormone are low
assessment of endocrine system
- growth
- BP
- facial characteristics
- neck
- muscles
- genitalia
- body odor
- skin
- family history
PUBERTY
-hypothalamus stimulates pituitary to release hormones LH and FSH
Girls
- LH and FSH = ova maturation and ovulation
- mean onset girls before boys and blacks before whites
Boys
- LH = testosterone production
- FSH= sperm production
- mean onset 11.5yrs
PUBERTY IN GIRLS
- Therlarche - presence of breast buds in girls (1st sign of puberty in girls )
- adrenarche- growth of pubic hair
- menarche- initial presence of menses
AMENORRHEA
primary- absence of menarche by age 16 years
-due to hormonal imbalance , structural defect
Secondary- skip 3 menstrual periods in a row
-due to pregnancy , extreme exercise without eating
AMENNOHREA
-history: weight gain or loss, sports training Birth control pills, drugs
exam: vaginal to determine patency
labs: pregnancy test, estrogen, LH , FSH, prolactin
Bone age x ray
TREATMENT
- depends on cause
- birth control pills with estrogen and progesterone
- balanced meals, high calorie for athletes
PUBERTY IN BOYS
- enlargement of testses
- scrotal changes
- pubertal delay considered if no changes by 13-14yrs
GYNECOMASTIA
- breast enlargement in boys during puberty
- common and benign : self limiting
- ratio of estrogen to testosterone is greater than usual
-adolescents concerned with body image
TANNER STAGES
- used to classify stage of puberty
- stages 1-5
stage 1: no secondary sex characteistics
stage 2: first signs of puberty
stage 3 and 4: progressive puberty
stage 5: puberty complete
NORMAL GROWTH PATTERNS IN PUBERTY
- final 20-25% of height attained during puberty
- Girls: growth spurt age 10-14 years yrs
- Boys growth spurt 11-16 yrs
- growth ceases age 16-20 yrs
- seem to grow from feet up. first shoes, slacks, then shirts get too small
CONSTITUTIONAL GROWTH DELAY
- delayed linear growth
- sexual and skeletal maturation behind peers
- may have family history of late bloomers
- delayed bone age
- experience puberty and growth spurt later
- achieve normal height without treatment
- different from familial short stature - short due to genetic potential
PRECOCIOUS PUBERTY (PP)
secondary sexual characteristics
- 7 years(white)
- 6 (black)
- 9 (boys)
- central or true PP occurs when hypothalamus is activated to secrete GNGH
- may start out tall for their age, have advanced bone age
- growth stops early as hormones stimulate closure of epiphyseal plate
PRECOCIOUS PUBERTY
- labs: LH,FSH , testosterone or estradiol
- bone age xray
- provocative testing confirms diagnosis
- CNS tumors: surgery , chemo, or radiation
- GnRH analogue given to stop puberty
- Lupron IM monthly or synarel intranasal BID
- treatment stops at normal age of puberty
some children may only have careful growth monitoring
NURSING MANAGEMENT
- teaching , emotional support, medications
- kids want to hear they are normal
- dress in age- appropriate clothes
- may have mood swings
PHENYLKETONURIA
- autosomal recessive disorder of amino acid metabolism
- enzyme missing to convert phenylalanine to tyrosine
- results in build up of PKU in blood
- leads to mental retardation , seizures, death
PKU SCREENING AND TREATMENT
- screening in all 50 states
- after 24 hrs of birth
- positive test needs to be repeated
- 2 positive tests? referral
- treated by diet;
- special formulas
- low protein and low aspartame foods
- elemental medical foods
- low phenylalanine diet for life
NURSING MANAGMENT
- mainly supportive
- education of parents
- PKU sources of food
- strict adherence to diet to avoid decline in IQ
- negotiations with insurance companies to pay for medical food
- genetic counseling
TYPE 2 DIABETES MELLITUS
- impaired insulin action (insulin resistance)
- visceral fat produces TNF - insulin receptors are desensitized
- impaired insulin secretion
- hyperinsulinemia, eventually decreased insulin release
- leads to hyperglycemia , impaired glucose tolerance , diabetes
T2DM
risk factors
- obesity
- low physical activity
- low socioecomonic status
- race
- family H/O of diabetes
NURSING MANAGEMENT
- assess child with BMI at 85 percentile or above for signs or insulin resistance
- acanthosis nigricans, HTN, dyslipidemia
- family H/O diabetes in overweight child
- Hgb A1C levels
NURSING MANAGMENT
EDUCATION
- disease and lifestyle, BG testing
- weight loss or maintainenece if going through growth spurt
- annual screening for potential complications
- BP, lipids, eye exam , neuro exam of extremities , liver and renal function
TYPE 1 DIABETES
- pancreatic islet cells fail to produce insulin
- autoimmune, genetic genetic predisposition
CLINICAL MANIFESTATIONS
-polyuria, polydipsia, polyphagia, weight loss, fatigue, lethargy, candida vaginitis DKA
CLINICAL THERAPY
-monitor BG, insulin, CHO balancing, exercise
NURSING MANAGEMENT
-physiological assessment
- Vitals, LOC
- hydration status
- labd: blood gas, glucose, electrolytes
- cardiac intake
NURSING MANAGMENT
PSYCHOSOCIAL ASSESSMENT
- coping mechanisms
- family resources
- ability to manage disease
- educational needs
DEVELOPMENTAL ASSESSMENT
- FINE MOTOR SKILLS
- COGNITIVE LEVEL
DEVELOPMENTAL CONSIDERATIONS
Toddlers
-picky eaters , need to consume enough calories
PRECHOOLERS
- allow choices with food , which finger to test BG
School- age
- learn to obtain BG and administer insulin
- can be taught food management
Adolescents
- compliance can become an issue
- may skip insulin doses
- may eat like their peers (candy )
- alcohol
NURSING MANGEMENT T1DM TEACHING
SICK DAY GUIDLINES
- be seen for fever or infection
- monitor BG frequently
- test urine for ketones
- don’t skip insulin
- may need more insulin
- maintain hydration
- drinks with CHOs if eating less
NURSING TEACHING
- good foot care
- rotate injection sites
- medical alert ID
- school health plan
- carry rapid sugar product
- hypoglycemia treatment
- vaccinations
- balance food and insulin dosage with activity
- summer camp- active need more food
HYPOGLYCEMIA
- signs: pallor, HA, sweating, tremors, dizziness, altered LOC, irritability
- Test BG: if less than or equal to 70
- give 1/2 cup of juice or soda , small box raisins, or 3-4 glucose tabs
- wait 15min and retake BS ( repeat juice if 70 or less and repeat BS)
- unconscious administer IM glucagon or glucose paste on gums
