Peds Exam 3a - Endo (minor) Flashcards
PKU clinical manifestations
-restricted growth
-musty odor and sweat
-fair skin, blue eyes, blonde
-Vomiting, irritabile
-seizure
-cognitive impairment
pku mgt
-breast feed or phen free formula
-phen free diet for life (no meat, no dairy, limited fruits & veg, limited grains)
galactosemia
cannot convert galactose to glucose (autosomal recessive)
not lactose intolerant
galactosemia clinical manifestations
-vomiting
-wt loss
-jaundice
-lethargy
-hypotonia
-cataracts
long term consequence of galatosemia
-learning disabilities
-lower IQ
-short attention span
-behavior problems
galactosemia mgt
-lactose free diet
-calcium supplements
-medication cautions (BC has lactose in it)
cannot be breastfed
hypothyroidism symptoms
everything slows down & high TSH
-constipated
-wt gain
-hypothermia & tonia
-poor feeding & delayed dentition
-prolonged jaundice
-short, thick neck
-long protruding tongue
-goiter; can be an airway problem
hyperthyroidism symptoms (graves)
everything speeds up & low TSH
-sweaty
-hair loss
-wt loss
-eyes bulge
therapeutic mgt of hypothyroidism
oral thyroid hormone replacement (start low and slowly move up)
nursing considerations for hypothyroidism
-early recognition
-encourage compliance and periodic monitoring (med doses change as they age)
-teach medication admin (avoid heat exposure & do not mix w/ soy based formula)
therapeutic mgt of hyperthyroidism
-dx w/ t3 & t4 w/ suppressed TSH
-anti thyroid drugs (PTU & MTZ, tapazole)
-subtotal thyroidectomy
-ablation w/ radioiodine
what do you do if you have a child with hyperthyroidism and they are put on PTU then develop a sore throat or an infection
very series take them to the doctors immediately & keep them away from people because PTU makes them immunocompromised
nursing considerations for hyperthyroidism
-identify early
-limit activity & demands placed on child
-counsel family & teachers
-high kcal, nutritious diet
-medications (PTU)
thyrotoxicosis
may occur from sudden release of hormone a life threatening thyroid crisis
everything is in overdrive
thyrotoxicosis treatment
-antithyroid drugs
-propranolol
growth hormone deficiency
-born normal wt then just do not grow
-takes a lot to dx, need parents height & predictions
-grow proportional, just small
appears younger than their age but cognitive function develops normally, causing psych/social issues
growth hormone deficiency treatment
administer growth hormones at night subQ 5-7x/wk , usually do school age children
growth hormone deficiency education
-when giving shot squeeze fat & can use ice before to reduce pinch
-make sure parents know timing of doses
-not making extremely tall kids, just normal for their predicted
-treat as their age, not their appearance
how do you treat true/complete precocious puberty
lupron injection 1x/mon IM at a clinic until normal pubertal changes occur
G&D question for age and how to engage/prep the child in their care and give some control
congenital adrenal hyperplasia
too much sex hormone production & not enough cortisol production causing increase urine Na, ambiguous genitalia (sometimes cannot tell gender), wt gain problems & dehydration
in congenital adrenal hyperplasia, infants specifically have a problem because
they have a decreased stress response causing hypotension, compromised immune systems, hypoNa dehy, and increase inflammatory response
in congenital adrenal hyperplasia, later in life when you have a decreased stress response, what do you do
cortisol replacement for the rest of their life
congenital adrenal hyperplasia therapeutic mgt
-confirm diagnosis & assign a sex according to genotype
-cortisone to suppress abnormally high secretion of ACTH
-reconstructive surgery as required
