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Pediatrics > PEDIATRIC ENDOCRINE FUNCTION AND DYSFUNCTION > Flashcards

PEDIATRIC ENDOCRINE FUNCTION AND DYSFUNCTION Flashcards

1
Q

FUNCTIONS

A
  • regulates body metabolism through release of hormones
  • maintain optimal hormone levels
  • maintain homeostasis
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2
Q

A AND P DIFFERENCES

A
  • endocrine system responsible for sexual differentiation during fetal development
  • hormones regulate growth and development
  • stimulates reproductive system and regulates puberty
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3
Q

NEGATIVE FEEDBACK

A
  • 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
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4
Q

assessment of endocrine system

A
  • growth
  • BP
  • facial characteristics
  • neck
  • muscles
  • genitalia
  • body odor
  • skin
  • family history
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5
Q

PUBERTY

A

-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
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6
Q

PUBERTY IN GIRLS

A
  • Therlarche - presence of breast buds in girls (1st sign of puberty in girls )
  • adrenarche- growth of pubic hair
  • menarche- initial presence of menses
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7
Q

AMENORRHEA

A

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

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8
Q

AMENNOHREA

A

-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

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9
Q

TREATMENT

A
  • depends on cause
  • birth control pills with estrogen and progesterone
  • balanced meals, high calorie for athletes
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10
Q

PUBERTY IN BOYS

A
  • enlargement of testses
  • scrotal changes
  • pubertal delay considered if no changes by 13-14yrs
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11
Q

GYNECOMASTIA

A
  • 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

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12
Q

TANNER STAGES

A
  • 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

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13
Q

NORMAL GROWTH PATTERNS IN PUBERTY

A
  • 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
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14
Q

CONSTITUTIONAL GROWTH DELAY

A
  • 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
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15
Q

PRECOCIOUS PUBERTY (PP)

A

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
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16
Q

PRECOCIOUS PUBERTY

A
  • 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

17
Q

NURSING MANAGEMENT

A
  • teaching , emotional support, medications
  • kids want to hear they are normal
  • dress in age- appropriate clothes
  • may have mood swings
18
Q

PHENYLKETONURIA

A
  • 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
19
Q

PKU SCREENING AND TREATMENT

A
  • 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
20
Q

NURSING MANAGMENT

A
  • 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
21
Q

TYPE 2 DIABETES MELLITUS

A
  • 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
22
Q

T2DM

A

risk factors

  • obesity
  • low physical activity
  • low socioecomonic status
  • race
  • family H/O of diabetes
23
Q

NURSING MANAGEMENT

A
  • 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
24
Q

NURSING MANAGMENT

A

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
25
Q

TYPE 1 DIABETES

A
  • 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

26
Q

NURSING MANAGEMENT

A

-physiological assessment

  • Vitals, LOC
  • hydration status
  • labd: blood gas, glucose, electrolytes
  • cardiac intake
27
Q

NURSING MANAGMENT

A

PSYCHOSOCIAL ASSESSMENT

  • coping mechanisms
  • family resources
  • ability to manage disease
  • educational needs

DEVELOPMENTAL ASSESSMENT

  • FINE MOTOR SKILLS
  • COGNITIVE LEVEL
28
Q

DEVELOPMENTAL CONSIDERATIONS

A

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
29
Q

NURSING MANGEMENT T1DM TEACHING

A

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
30
Q

NURSING TEACHING

A
  • 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
31
Q

HYPOGLYCEMIA

A
  • 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

Pediatrics (7 decks)

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