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Pediatrics Exam 2 > Week 6 - Endocrine > Flashcards

Week 6 - Endocrine Flashcards

1
Q

Pediatric Endocrine System

A

Responsible for sexual development, stimulating growth during childhood / adolescence, & production of sex hormones leading to puberty

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2
Q

Hypopituitarism (GHD)

A

↓ activity of the pituitary gland leading to deficient growth hormone secretion

↓ pituitary gland activity = ↓ growth hormone secretion

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3
Q

Signs & Symptoms of Hypopituitarism

A
  • Growth at a rate < 5 cm per year
  • Falls below 3rd percentile on growth chart
  • Seizures
  • hyponatremia
  • neonatal jaundice
  • pale optic discs
  • micropenis / undescended testes

Dx: history, hand x-ray for bone ossification, blood & endo testing

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4
Q

Hypopituitarism Treatment

A

Biosynthetic growth hormone injections

Take at night when normal secretion occurs!!!

  • very pricey
  • Expect to grow 8-9 cm/yr after tx
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5
Q

Hypopituitarism Nursing

A
  • Identify growth problems
  • Record height & weight
  • Prepare family for diagnostic tests / daily injections
  • Teach back injections
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6
Q

Precocious Puberty

KNOW THIS!!!!

A

Sexual development before age 9 in boys & 8 in girls; also advanced bone growth making them taller

  • can result in stunted growth if growth plates close too soon

Causes: disorders of gonads, adrenals, hypothalamus releases GnRH (gonadotropin-releasing hormone)
* 80-90% of girls = no cause

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7
Q

Tx of precocious puberty

KNOW THIS!!!!

A

GnRH agonist like Lupron (breast cancer drug) to slow growth to normal rates

  • Tx is discontinued at age for normal pubertal changes to resume

  • Failure to treat may result in stunted growth as children with precocious puberty have advanced bone age
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8
Q

Precocious Puberty Nursing

KNOW THIS!!!!

A
  • Promote positive body image - child appropriate terms
  • Provide famnily education - emotional support
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9
Q

Hypothyroidism

KNOW THIS!!!!

A

↓ active levels of thyroid hormone

  • newborn screen for T3/T4 (hypothyroidism can be congenital)

Primary: thyroid problem (↑ TSH, ↓ T4)

Central: hypothalamus problem (normal TSH, ↓ T4)

Nursing: plot growth, education, medication administration, follow up

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10
Q

What is primary hypothyroidism?

KNOW THIS!!!

A

Thyroid problem

  • ↑ TSH
  • ↓ T4
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11
Q

What is Central hypothyroidism?

KNOW THIS!!!!

A

Hypothalamus problem
* normal TSH
* ↓ T4

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12
Q

Nursing for Hypothyroidism

A
  • Plot growth
  • Education
  • Medication administration
  • Follow up
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13
Q

Signs & Symptoms of congenital Hypothyroidism in INFANTS

KNOW THIS!!!!

A
  • Thick tongue
  • Hypotonia
  • Umbilical hernia
  • Hoarse cry
  • Constipation
  • Large fontanelles
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14
Q

Signs & Symptoms of Hypothyroidism (or acquired thyroid dysfunction) in Children

KNOW THIS!!!!

A
  • ↓ appetite
  • dry, cool skin
  • hair thinning
  • bradycardia
  • constipation
  • depressed DTRs
  • cold temperature sensitivity
  • abnormal menses
  • goiter
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15
Q

Hypothyroidism Treatment

KNOW THIS!!!!

A

Levothyroxine, 15mcg/kg/day

  • life-long tx
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16
Q

Type 1 DM

KNOW THIS!!!!

A

Insulin dependent; body’s immune system attacks beta cells (which produce insulin) & ↑ glucose levels

Bimodal Peaks: diagnosis around ages 4-6 & 10-14

Tx: insulin, blood glucose monitoring

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17
Q

Type 2 DM

KNOW THIS!!!!

A

Insulin resistance; prolonged exposure to elevated glucose levels

  • controlled with diet & exercise
  • Often obese or comorbid conditions such as PCOS, lipid disorders, & HTN
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18
Q

Signs & Symptoms of Type 1 DM

KNOW THIS!!!!

A
  • Polyuria
  • Polydipsia
  • Polyphagia
  • Glucosuria (glucose in urine)
  • glucogenesis (breaking down protein/fat for energy)
  • rapid weight loss
  • dry skin
  • irritability
  • drowsiness/fatigue
  • abdominal discomfort
  • ketoacidosis
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19
Q

Type 1 DM Nursing Management

A
  • Check for ketones if blood glucose > 200 mg/dL
  • Check blood glucose frequently
  • Education on meals / carb counting
  • Maintain growth
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20
Q

Rapid Acting Insulin

KNOW THIS!!!!

A

Onset: 15 minutes
* Novolog & Humalog

  • Eat immediately after; for meal dosing
21
Q

Intermediate Insulin

KNOW THIS!!!!

A

Onset: 1-3 hours
* NPH or Humulin N

  • is cloudy
  • not often used in children
22
Q

Long Acting Insulin

KNOW THIS!!!!1

A

Insulin acts over 12-24 hours
* *glargine (Lantus) or detemir (Levemir)

  • usually injections in morning or night
  • can NOT be mixed with other insulin
23
Q

What is the fastest insulin absorption site?

A

Abdomen

24
Q

What is the IC Ratio?

KNOW THIS!!!!

A

Amount of carbohydrates 1 unit of insulin will cover

Ex. - 1:15

25
Q

How to calculate IC Ratio

Understand this!

A

1.) Calculate the total gram of carbs in the meal

2.) Divide total number of carbs in the meal by total grams by the ratio

26
Q

IC Ratio Example:

A patient orders 45 grams of carbs for lunch. The IC is 15. How many units of insulin should the patient receive for this meal?

A

45 / 15 = 3

27
Q

Correction Factor (CF)

KNOW THIS!!!!!

A

Determines insulin coverage ased on target glucose

Example
* target glucose = 150
* current glucose = 300

1.) high BG - goal BG - 300 - 150 = 150
2.) divide by CF (CF = 50) 150 / 50 = 3 units of insulin

28
Q

CF Example

Mary has Type 1 DM. Her order read: I:C 1:20 and her target blood sugar is 150 with a CF of 50. You are her nurse & she is ready to order lunch. She orders a pizza slice and milk. Dietary reports that her total carbs for the meal are 85. You obtain her blood glucose and it is 300. How much insulin do you anticipate the PNP to order?

A

1.) Insulin needed for the meal = Carbs / IC
* 85 carbs / 20 = 4.25 u

2.) Insulin needed for higher blood sugar = (Current BG - Target BG) / CF -
* (300 - 150) / 50
* 150 / 50 = 3 u

3.) Add the insulin needed for the meal to the insulin needed for higher blood sugar
* 4.25 u + 3 u = 7.25 (round down to 7 units)

29
Q

Hypoglycemia

  • know what is considered hypoglycemia in children & neonates

KNOW THIS!!!!

A

Children: blood glucose < 70 mg/dL

Neonates: blood glucose < 60 mg/dL

30
Q

What is considered hypoglycemia in children?

KNOW THIS!!!!

A

Blood glucose < 70 mg/dL

31
Q

What is considered hypoglycemia in neonates?

KNOW THIS!!!!

A

Blood glucose < 60 mg/dL

32
Q

Signs & Symptoms of Hypoglycemia

KNOW THIS

A
  • Pallor
  • sweating
  • tremors
  • dizziness
  • altered mental status (AMS)
  • numb lips / mouth
  • irritability
33
Q

Tx of Hypoglycemia

KNOW THIS!!!!

A

Oral Glucose (juice, sweetener, raisins, glucose tabs)
* recheck in 15 minutes

Unconscious give IM, SQ, nasal glucagon OR glucose paste on the gums

34
Q

Diabetic Ketoacidosis (DKA)

KNOW THIS!!!!!

A

** INSUFFICIENT INSULIN for body demands** in a diabetic patient that results in the production of ketones (metabolic acidosis)

  • BG > 200
  • Ketonuria
  • Ketonemia
  • pH < 7.30
35
Q

DKA as defined by International Society for Pediatric & Adolescent Diabetes (ISPAD)

KNOW THIS!!!!

A
  • BG > 200 mg/dL
  • Keto - ketonuria & ketonemia
  • pH < 7.3
36
Q

Signs & Symptoms of DKA

KNOW THIS!!!!!

A
  • signs of dehydration
  • flushed ears / cheeks
  • tachyardia
  • kussmaul breathing
  • fruity breath (acetone breath)
  • altered mental status (AMS)
  • hypotension

If not treated: dehydration, electrolyte imbalances, coma, & death

37
Q

DKA Nursing Management

KNOW THE BOLD

A

Judicious fluid replacement
* 0.9% NS 20 mL/kg bolus
* add dextrose to IVF when BG = 200 - 500
* adjust glucose to prevent rapid drop in blood glucose ( > 100 g/dL/hr)

Monitoring & Nursing Management
* Hourly BG checks
* ABGs
* Serum electrolytes
* Serum ketones
* Osmolarity / urine ketones convert to SQ insulin when pH & HCO3 are normal

38
Q

Turner Syndrome

A

A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of oen X chromosome is deleted

  • Tx: growth hormone
39
Q

Signs & Symptoms of Turner Syndrome

A
  • Edema of the hands & feet
  • Webbed neck
  • Low hairline
  • High-arched palate
  • Small jaw
  • Low-set ears
  • Droopy eyelids
  • Short 4th toe
  • Short fingers
  • Short stature
  • Broad chest & widely separated nipples
40
Q

What is the treatment for Tuner Syndrome?

A

Growth hormone

41
Q

Klinefelter Syndrome

KNOW THIS!!!!!

A

A chromosomal disorder in which males have an extra X chromosome, making them XXY instead of XY

42
Q

Signs & Symptoms of Klinefelter Syndrome

KNOW THIS!!!!!

A
  • puberty is delayed or an abnormal progression is evident
  • testes are small & firm
  • less facial & body hair may develop
  • Gynecomastia is a characteristic finding (↑ breast gland tissue in boys)
43
Q

Addison’s Disease (Adrenal Insufficiency)

KNOW THIS!!!!

A

Hyposecretion (↓ secretion) of aldosterone & cortisol (ACTH)

44
Q

Signs & Symptoms of Addison’s Disease

KNOW THIS!!!!!

A

STEROID
* Sodium/sugar low (↓ Na / sugar)
* Tired
* Electrolyte imbalance
* Reproductive changes
* lOw BP
* Increased pigmentation
* Diarrhea/depression

45
Q

Addisonian Crisis (Adrenal crisis / acute adrenal insufficiency)

kNOW THIS!!!!

A

5 S’s

  • Severe pain
  • Syncope
  • Shock
  • Super low BP (↓↓↓ BP)
  • Sever vomiting / diarrhea

Tx: IV cortisol

46
Q

What is the treatment for Addsonian Crisis?

KNOW THIS!!!!!

A

IV Cortisol

47
Q

Cushing’s Disease

KNOW THIS!!!!

A

Hypersecretion of cortisol (ACTH)

48
Q

Signs & Symptoms of Cushing’s Disease

KNOW THIS!!!!!

A

STRESSED

  • Skin fragile
  • Truncal obesity (abdominal obesity)
  • Rounded face (moon face)
  • Ecchymosis
  • Striae
  • Sugar extremely high (↑ glucose)
  • Excessie body hair
  • buffalo hump
  • Depression
49
Q

Treatment for Cushing’s Disease

A

Adrenalectomy

Pediatrics Exam 2 (8 decks)

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