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PEDS > Week 10 > Flashcards

Week 10 Flashcards

1
Q

Pediatric endocrine system - differences between gender

A
  • 7-8 weeks of gestation
  • during childhood production of sex hormones is low
  • puberty kicks things into high gear (9yr in girls, 11y in boys)
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2
Q

Adrenarche (3)

A
  • adrenal hormones,
  • acne,
  • pubic hair,
  • adult body hair
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3
Q

Puberty sequence - female (3)

A

1) breast development
2) pubic hair growth
3) menarche

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4
Q

Puberty sequence - males (5)

A

1) testicular enlargment
2) pubic hair growth
3) apperance of spermatozoa in seminal fluid
4) facial hair
5) voice change

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5
Q

Menarche (3)

A
  • onset of menstruation
  • around age 12
  • FSH, LH, estrogen, progesterone for 1-2 years
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6
Q

Sperm production - when

A
  • occures once testicular and penile growth has occurred
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7
Q

Major organs and glands of endocrine system (6)

A
  • hypothalamus
  • pitutiary
  • parathyroid
  • thyroid
  • adrenal cortex
  • pancreas
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8
Q

Endocrine/metabolic - g+d (3)

A
  • affects g/d, metabolism, behaviour
  • early identificaiton and treatment of problems is key to prevent complications
  • treat with hormoen supplements/adjusments, +/- diet
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9
Q

Pitutiary responsibilities - posterior pitutiary (2)

A
  • regulation of antidiuretic hormone (ADH)
  • production of oxytocin
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10
Q

Anterior pitutiary responsibilities (8)

A
  • master gland
  • production and release of Thyroid stimulating hormone (TSH)
  • adrenocorticotropic hormone (ATCH)
  • Lutenizing hormone (LH)
  • Follicle-stimulating hormone (FSH)
  • growth hormone GH)
  • prolactin (PRL)
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11
Q

Major actions of anterior pitutiary (5)

A
  • GH –> bone and muscle
  • prolactin –> mammary glands
  • FSH and LH –> testes/ovaries
  • TSH –> thyroid
  • ACTH –> adrenal cortex
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12
Q

Growth hormone - what (5)

A
  • from anterior pitutiary, controlled by hypothalamus
    stimulates
  • linear growth
  • bone mineral density
  • growth of all body tissues
  • synthesis of proteins in the liver (insulin like growth factors)
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13
Q

Growth hormone deficiency - cause

A
  • infarction of pituitary gland]
  • CNS disease
  • tumors of pituitary gland or hypothalamus (ex craniopharyngiomas and gliomas)9
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14
Q

Growth hormone deficiency - diagnosis suspicion

A
  • born with normal weights and heights but slowly fall off the curve
  • grow less per year
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15
Q

Growth hormone deficiency - physical appearance (7)

A
  • cherubic youthful faces
  • “ripply” abdominal fat
  • decreased muscle mass
  • delayed skeletal maturation’
  • delayed sexual maturation
  • higher pitched voices
  • delayed dentition
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16
Q

Growth hormone deficiency - diagnosis (7)

A
  • young child falls off the growth curve
  • insulin like growth factors serum level
  • assessment of short stature
  • full history
  • MRI of pituitary
  • Radiologic studies
  • medication challenge
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17
Q

Growth hormone deficiency - medications

A
  • replacment therapy with GH
  • daily injections until full growth
  • growth is rapid in first year
  • careful eye to titrate dose to achieve normal growth pattern
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18
Q

Growth hormone deficiency medications - side effects (6)

A
  • headache
  • progression of scoliosis
  • slipped capital forminal efesis?? (head out of socket)
  • hyperthyroidism
  • hypoglycemia
  • intracranial hypertensions
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19
Q

Growth hormone deficiency - nursing focus (3)

A
  • body image issues
  • encourage parents/teachers to treat child in age-appropriate manner
  • patient/parent education (Sub-Q injection)
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20
Q

Too much GH Hyperpituitarism (4)

A
  • excessive growth
  • affected children can grow 7-8 feet in height
  • acromegaly (abnormal growth of feet and hands, protruding brow and lower jaw, nasal bone enlarges, spacing of teeth increases)
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21
Q

Acromegaly (4)

A
  • abnormal growth of feet and hands,
  • protruding brow and lower jaw,
  • nasal bone enlarges,
  • spacing of teeth increases
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22
Q

Hyperpituitarism (4)

A
  • if child’s predictive height is much taller than the parents it needs to be investigated
  • radiological exam for bone age
  • MRI/CT used to detect a tumor
  • increased serum insulin-like growth factor
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23
Q

Hyperpituitarism - treatment (4)

A
  • depends on what is causing the excessive growth
  • surgical removal of tumour or pituitary
  • radiation therapy
  • high dose of sex steroids to close the growth plates
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24
Q

Diabetes insipidus

A
  • disorders of the pituitary gland
  • inability of kidneys to concentrate urine
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25
Q

Diabetes insipidus - forms (2)

A
  • central/neurogenic
  • nephrogenic
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26
Q

Diabetes insipidus - central/neurogenic

A

inadequet production of vasopressin (ADH)

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27
Q

Diabetes insipidus - nephrogenic

A
  • vasopressin (ADH) not having an effect on the kidney
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28
Q

Diabetes insipidus - fluid balance (3)

A
  • fluid balance = hypothalamus, kidney, pituitary
  • plasma osmolarity is key for ADH secretion
  • when ADH is inadequete, the tubules do not reabsorb water, leading to polyuria
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29
Q

Diabetes insipidus - central - cause (4_

A
  • brain tumours
  • brain trauma
  • CNS infection
  • neurosurgery
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30
Q

Diabetes insipidus - nephrotic - cause (3)_

A
  • not common
  • more severe
  • genetic/drug toxicity
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31
Q

Diabetes insipidus - s+s (11)

A
  • polyuria*
  • polydipsia*
  • hypernatremia
  • dilute urine
  • dehydration
  • nocturia
  • delayed growth
  • seizures (electrolyte imbalances)
  • hypotension
  • tachycardia
  • poor perfusion
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32
Q

Diabetes insipidus - diagnostic tests (7)

A
  • serum electrolyte concentrations
  • urinalysis
  • serum osmality increased
  • urine osmality decreased
  • urine specific gravity decreased
  • serum sodium elevated
  • MRI for visualizing pituitary gland
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33
Q

Diabetes insipidus - central - treatment

A
  • intranasal or oral desmopressin acetate (DDAVP)
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34
Q

Diabetes insipidus - nephrogenic

A
  • thiazide diuretics
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35
Q

Diabetes insipidus - treatment overal (3)

A
  • reduce U/O
  • decrease thirst
  • Decrease bed sheet changes
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36
Q

Syndrome of inappropriate ADH (SIADH) (4)

A
  • exessive amount of serum ADH
  • failure of normal feecback from hypothalamus, pituitary, kidney
  • leads to water reabsorption despite low serum osmolality
  • water intoxication
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37
Q

Syndrome of inappropriate ADH - cause (7)

A
  • CNS infections,
  • brain tumours
  • brain trauma
  • pneumonia
  • asthma
  • CF
  • positive pressure ventilation
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38
Q

Syndrome of inappropriate ADH symptoms (7)

A
  • hypertension
  • distended jugular
  • fluid in lungs
  • weight gain no edema
  • electrolyte imbalance
  • concentrated urine
  • hyponaturemia (cerebral edema, lethargy, confusion, etc.)
39
Q

Syndrome of inappropriate ADH - diagnostic tests (5)

A
  • high urine osmolality
  • elevated specific gravity
  • low serum osmolarity
  • low serum sodium
  • decreased blood urea nitrogen
40
Q

Syndrome of inappropriate ADH - clinical therapy (6)

A
  • fluid management
  • strickt I/O
  • meds (diuretics, demeclocycline)
  • treatment of underlying condition
  • neurovitals
  • education
41
Q

Thyroid

A
  • gorwth and development = regulates cellular metabolism of nutrient and energ
  • muscle skeletal nervous system development-
  • TSH controls production of T3 and T4
  • T4 is synthesized to T3
  • calcitonin works with kidney and bone to control Ca++
42
Q

Hyperthyroidism (5)

A
  • thyroid hormone levels increased
  • metabolic rate increased
  • cardiovascular, gastrointestinal and neuromuscular function
  • adolescents 11-15
  • almost always Graves Disease (5x more likely in females)
43
Q

Grave’s disease - 4

A
  • autoimmune disease
  • affects thyroid
  • exess production of thyroid hormone
  • not curable, symptoms manageable
44
Q

Hypothyroidism

A
  • low thyroid hormone
  • growth is delayed
  • intellectual disability is delayed
45
Q

Types of hypothyroidism (2_

A
  • congenital
  • aquired
46
Q

Congenital hypothyroidism (2)

A
  • early detection and treatment
  • comes with irreversible intellectual disability
47
Q

Aquired hypothyrodism

A
  • idopathic
  • autoimmune (hashimoto’s thyroditis)
48
Q

Congentital hypothyroidism - s/s (8)

A
  • first weeks little to no symptoms
    first months =
  • thickened tongue, thick lips, dull appearance
  • hypotonia
  • cool extremities, mottling
  • umbilical hernias
  • difficulty feeding
  • lethargy
  • constipation
49
Q

Aquired hypothyroidism - s/s (12)

A
  • decreased appetite
  • dry cool skin
  • thinning or loss of hair
  • bradycardia
  • constipation
  • abnormal menses
  • goiter (enlarged thyroid
  • change in growth pattern
  • weight gain
  • delayed bone/dental age
  • muscle hypertrophy
  • early or delayed puberty
50
Q

what can complicate aquired hypothyroidism

A

having diabetes

51
Q

Diagnosis of hypothyroidism

A
  • decreased serum T4
  • normal serum T3
  • elevated TSH
  • increased antithyroid antibodies
  • goiter presence
52
Q

Hypothyroidism - clinical therapy

A
  • replace thyroid levels with Levothyroxine (start low/go slow to obtain normal function, trial off around 3yrs with congenital
  • do not use SOY formula (inhibits absorption of T4)
53
Q

Adrenal disorders - which hormones/which effects (3)

A
  • epinephrine and norepinephrine
  • affects the nervous and cardiovascular system
  • metabolic rate, temperature, smooth muscle
54
Q

Adrenal cortex produces which hormones (2)

A
  • steroid hormones
  • glucocorticoids
  • mineralocorticoids
55
Q

Glucocorticoids (what, example)

A
  • affect protein and carb metabolism and protect against stress
  • cortisol
56
Q

Cortisol function (3)

A
  • affects metabolism of proteins, glucose, fats
  • stress responses
  • inhibition of inflammation
57
Q

Mineralocorticoids (what, example)

A
  • regulation of fluid and electrolytes
  • aldosterone
58
Q

Aldosterone

A
  • maintains extracellular fluid volume and BP by conserving sodium, chloride, water and excretion of potassium by the kidneys
59
Q

Cushing syndrome (2)

A
  • glucocorticoid exess (cortisol)
  • loss of normal hypothalamic/pituitary/adrenal feedback
60
Q

Cushing syndrome- common cause (2)

A
  • prolonged administration of glucocorticoid hormones
  • prednisone
61
Q

Causes of cushing disease - infancy

A
  • adrenocortical tumour
62
Q

Causes of cushing disease - children over 7

A
  • pituitary tumour (adenoma) secreting excess ACTH –> bilateral adrenal hyperplasia
63
Q

cushing disease -s/s - all ages (5)

A
  • obesity
  • slow linear growth (moon face, prominent cheeks)
  • acne
  • deepening of voice
  • hypertension
64
Q

cushing disease -s/s - older children (7)

A
  • delayed puberty
  • irregular menses
  • heacaches
  • weakness
  • pathological fractures
  • emotional problems
  • hyperglycemia
65
Q

Cushing disease - treatment

A
  • removal of tumour
  • radiation (if removal doesnt reduce cortisol)
  • replaceent of cortisol (lifelong if both adrenal glands are removed)
  • cortisol replacement post-op must be well explained to parents (hydrocortisone)
66
Q

Adrenal insufficiency (Addison Disease) (3)

A
  • deficiency of both glucocorticoids (cortisone) and mineralocorticoides (aldosterone)
  • lack of stress hormones (body struggles with stress)
  • majority is autoimmune
67
Q

Adrenal insufficiency (Addison Disease) - Diagnostics (6)

A
  • decreased serum cortisol
  • urinary 17-hydroxycorticoid levels
  • ACTH stim test detects adrenal gland reserve
  • decreased serum sodium
  • elevated serum potassium
  • low fasting blood glucose
68
Q

Adrenal insufficiency (Addison Disease) - early s/s (6)

A
  • weakness
  • lethargy
  • emotional lability
  • anorexia
  • salt craving
  • poor weight gain/loss
69
Q

Adrenal insufficiency (Addison Disease) - late (5)

A
  • hyperpigmentation at pressure points (body creases, scars)
  • abdominal pain
  • N/V
  • diarrhea
  • symptomatic hypoglycemia
70
Q

Adrenal crisis (12)

A
  • altered LOC
  • severe hypotension
  • weakness
  • fever
  • abdominal pain
  • hypoglycemia
  • hyponatremia
  • hyperkalemia
  • seizures
  • circulatory collapse
  • shock
  • coma
71
Q

Adrenal crisis -

A
  • low dose hydrocortisone]
  • fludrocortisone acetate (if child missing aldosterone)
72
Q

Pancreas

A
  • regulates blood glucose metabolism
  • Islets of langerhans (alpha beta delta cells)
  • alpha cells = glucagon (speed up glycogennolysis)
  • beta cells = insulin (glucose metabolism)
73
Q

Alpha cells - pancreas

A
  • secrete glucagon
  • speeds up glycolysis
74
Q

Beta cells pancreas

A
  • secrete insulin
  • pushes glucose protein and fatty acid transport into cells
  • speeds shift of K+ ahd Phos through cell wall with glucose
  • decrease BG and increase metabolism
75
Q

Delta cells pancreas

A
  • produce somatostatin
  • inhibits both insulin and glucagon secretion
76
Q

Type 1 diabetes

A
  • Immune mediated destruction of pancreatic beta cells = absolute absence of insulin
77
Q

Type 2 diabetes

A
  • complex metabolic disorder leading to gradual onset of insulin resistance -
  • dereased sensitivity to insulin
78
Q

Diabetic - first presentation (3)

A
  • wetting bed
  • polydipsia
  • lost weight
79
Q

Cycle of DKA (5)

A

1) without insulin, glucose cannot be processed by body
2) liver produces more glucose to feed body, but it accumulates in bloodstream
3) body needs to find an alternative source of energy and starts breaking down fat. Breakdown of fat produces ketones, which is the built up in bloodstream
4) ketones and glucose are transferred to urine –> kidneys use water to clear blood
5) body attempts to remove ketones and glucose, a lot of water is lost = dehydration and ketoacidosis

80
Q

Type 2 diabetes - risk factors (6)

A
  • obesity
  • low levels of physical activity
  • intake of high energy foods
  • low socioeconomic status
  • race
  • family history of diabetes
81
Q

Pediatric goals - type 2 diabetes (7)

A
  • normalize blood glucose and HbA1C levels
  • decrease weight
  • increase exercise
  • normalize lipid profile
  • normalize BP
  • prevent complications
  • nutrition education and weight loss are KEY = emotional support
82
Q

Treatment of type 2 diabetes - insulin? (3)

A
  • used to gain initial glycemic control
  • should be able to control BG with exercise and diet alone
  • if not enough, you start Metformin (oral med while being weaned off insulin)
83
Q

Hypoglycaemia - S/S (8)

A
  • pallor
  • sweating
  • tremors
  • dizziness
  • numb lips or mouth
  • confusion
  • irritability
  • altered LOC
84
Q

Hypoglycemia - children under 6

A

BG under 6.0 mmol/L with symptoms is enough for treatment

85
Q

Hypoglycemia - children 6 and older

A
  • BG under 4.0mmol/L with symptoms is enough for treatment
86
Q

Causes of DKA

A
  • undiagnosed type 1 diabetes
  • insulin omission or manipulation
  • inadequet insulin dosing and monitoring
  • insulin pump misuse or disconnection
87
Q

DKA Symptoms (12)

A
  • lethargy
  • dehydration
  • N/V
  • abdominal pain
  • fruity smelling breath
  • tachypnea, deep breathing, kussmaul respirations
  • headache
  • ketosis
  • extreme fatigue
  • sudden loss of weight
  • confusion
  • diabetic coma
88
Q

Diagnosis of DKA (4)

A
  • ABG –> detect metabolic acidosis
  • BG - detect hyperglycemia
  • urine dipstick analysis (ketonuria)
  • ketone blood test (ketonemia)
89
Q

Treatment of DKA

A
  • fluid replacement therapy
  • Electrolyte replacement
  • insulin
  • assess for complications (i.e. cerebral edema)
90
Q

Diagnosis of Grave’s disease (5)

A
  • increases with age, more in women
  • blood work
  • radioactive iodine uptake test
  • thyroid scan
  • doppler blood flow measurement
91
Q

Grave’s disease - nursing focus (6)

A
  • maintain normal temperature
  • maintain normal CO
  • give meds (iodine, antithyroid meds, fluids)
  • ensure adequet nutrition and hydration’
  • encourage rest, minimize stimulation
  • client teaching (meds, iodine therapy, need for rest, thyrodectomy, etc.)
92
Q

Grave’s disease - meds

A
  • Methimazole (inhibits thyroid hormone secretion)
  • propanolol atenolol metoprolol (beta blocker)
  • radioiodine
93
Q

Grave’s disease - surgery

A
  • thyroidectomy - remove thyroid for a cure
  • can have complications

PEDS (9 decks)

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