Week 6 - Endocrine Flashcards
Pediatric Endocrine System
Responsible for sexual development, stimulating growth during childhood / adolescence, & production of sex hormones leading to puberty
Hypopituitarism (GHD)
↓ activity of the pituitary gland leading to deficient growth hormone secretion
↓ pituitary gland activity = ↓ growth hormone secretion
Signs & Symptoms of Hypopituitarism
- 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
Hypopituitarism Treatment
Biosynthetic growth hormone injections
Take at night when normal secretion occurs!!!
- very pricey
- Expect to grow 8-9 cm/yr after tx
Hypopituitarism Nursing
- Identify growth problems
- Record height & weight
- Prepare family for diagnostic tests / daily injections
- Teach back injections
Precocious Puberty
KNOW THIS!!!!
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
Tx of precocious puberty
KNOW THIS!!!!
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
Precocious Puberty Nursing
KNOW THIS!!!!
- Promote positive body image - child appropriate terms
- Provide famnily education - emotional support
Hypothyroidism
KNOW THIS!!!!
↓ 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
What is primary hypothyroidism?
KNOW THIS!!!
Thyroid problem
- ↑ TSH
- ↓ T4
What is Central hypothyroidism?
KNOW THIS!!!!
Hypothalamus problem
* normal TSH
* ↓ T4
Nursing for Hypothyroidism
- Plot growth
- Education
- Medication administration
- Follow up
Signs & Symptoms of congenital Hypothyroidism in INFANTS
KNOW THIS!!!!
- Thick tongue
- Hypotonia
- Umbilical hernia
- Hoarse cry
- Constipation
- Large fontanelles
Signs & Symptoms of Hypothyroidism (or acquired thyroid dysfunction) in Children
KNOW THIS!!!!
- ↓ appetite
- dry, cool skin
- hair thinning
- bradycardia
- constipation
- depressed DTRs
- cold temperature sensitivity
- abnormal menses
- goiter
Hypothyroidism Treatment
KNOW THIS!!!!
Levothyroxine, 15mcg/kg/day
- life-long tx
Type 1 DM
KNOW THIS!!!!
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
Type 2 DM
KNOW THIS!!!!
Insulin resistance; prolonged exposure to elevated glucose levels
- controlled with diet & exercise
- Often obese or comorbid conditions such as PCOS, lipid disorders, & HTN
Signs & Symptoms of Type 1 DM
KNOW THIS!!!!
- 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
Type 1 DM Nursing Management
- Check for ketones if blood glucose > 200 mg/dL
- Check blood glucose frequently
- Education on meals / carb counting
- Maintain growth
Rapid Acting Insulin
KNOW THIS!!!!
Onset: 15 minutes
* Novolog & Humalog
- Eat immediately after; for meal dosing
Intermediate Insulin
KNOW THIS!!!!
Onset: 1-3 hours
* NPH or Humulin N
- is cloudy
- not often used in children
Long Acting Insulin
KNOW THIS!!!!1
Insulin acts over 12-24 hours
* *glargine (Lantus) or detemir (Levemir)
- usually injections in morning or night
- can NOT be mixed with other insulin
What is the fastest insulin absorption site?
Abdomen
What is the IC Ratio?
KNOW THIS!!!!
Amount of carbohydrates 1 unit of insulin will cover
Ex. - 1:15
How to calculate IC Ratio
Understand this!
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
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?
45 / 15 = 3
Correction Factor (CF)
KNOW THIS!!!!!
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
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?
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)
Hypoglycemia
- know what is considered hypoglycemia in children & neonates
KNOW THIS!!!!
Children: blood glucose < 70 mg/dL
Neonates: blood glucose < 60 mg/dL
What is considered hypoglycemia in children?
KNOW THIS!!!!
Blood glucose < 70 mg/dL
What is considered hypoglycemia in neonates?
KNOW THIS!!!!
Blood glucose < 60 mg/dL
Signs & Symptoms of Hypoglycemia
KNOW THIS
- Pallor
- sweating
- tremors
- dizziness
- altered mental status (AMS)
- numb lips / mouth
- irritability
Tx of Hypoglycemia
KNOW THIS!!!!
Oral Glucose (juice, sweetener, raisins, glucose tabs)
* recheck in 15 minutes
Unconscious give IM, SQ, nasal glucagon OR glucose paste on the gums
Diabetic Ketoacidosis (DKA)
KNOW THIS!!!!!
** 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
DKA as defined by International Society for Pediatric & Adolescent Diabetes (ISPAD)
KNOW THIS!!!!
- BG > 200 mg/dL
- Keto - ketonuria & ketonemia
- pH < 7.3
Signs & Symptoms of DKA
KNOW THIS!!!!!
- 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
DKA Nursing Management
KNOW THE BOLD
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
Turner Syndrome
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
Signs & Symptoms of Turner Syndrome
- 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
What is the treatment for Tuner Syndrome?
Growth hormone
Klinefelter Syndrome
KNOW THIS!!!!!
A chromosomal disorder in which males have an extra X chromosome, making them XXY instead of XY
Signs & Symptoms of Klinefelter Syndrome
KNOW THIS!!!!!
- 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)
Addison’s Disease (Adrenal Insufficiency)
KNOW THIS!!!!
Hyposecretion (↓ secretion) of aldosterone & cortisol (ACTH)
Signs & Symptoms of Addison’s Disease
KNOW THIS!!!!!
STEROID
* Sodium/sugar low (↓ Na / sugar)
* Tired
* Electrolyte imbalance
* Reproductive changes
* lOw BP
* Increased pigmentation
* Diarrhea/depression
Addisonian Crisis (Adrenal crisis / acute adrenal insufficiency)
kNOW THIS!!!!
5 S’s
- Severe pain
- Syncope
- Shock
- Super low BP (↓↓↓ BP)
- Sever vomiting / diarrhea
Tx: IV cortisol
What is the treatment for Addsonian Crisis?
KNOW THIS!!!!!
IV Cortisol
Cushing’s Disease
KNOW THIS!!!!
Hypersecretion of cortisol (ACTH)
Signs & Symptoms of Cushing’s Disease
KNOW THIS!!!!!
STRESSED
- Skin fragile
- Truncal obesity (abdominal obesity)
- Rounded face (moon face)
- Ecchymosis
- Striae
- Sugar extremely high (↑ glucose)
- Excessie body hair
- buffalo hump
- Depression
Treatment for Cushing’s Disease
Adrenalectomy
