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ADN005 Pediatrics > Week 7 Chapter 48 > Flashcards

Week 7 Chapter 48 Flashcards

1
Q

Composed of glands, tissues, or clusters of cells that produce and release hormones in a negative feedback system involving the hypothalamus and nervous system

A

Endocrine System

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2
Q

Influences all physiologic processes
Growth and Development
Metabolic processes related to fluid and electrolyte balance and energy production
Sexual Maturation and reproduction
Body response to stress
Maintenance of internal homeostasis

A

Endocrine System

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3
Q

Most endocrine glands develop in the

A

1st trimester but still incomplete at birth

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4
Q

Complete hormonal control is lacking during early years of life

A

Means infant can not

Balance fluid concentration, electrolytes, amino acids, and glucose

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5
Q

Endocrine and nervous system work together to maintain optimal internal environment for the body

A

Homeostasis

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6
Q

Organs or tissues of the Endocrine System

A

Pituitary Gland
Hypothalamus
Parathyroid glands
Adrenal Glands
Gonads
Islets of Langerhans of the Pancreas

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7
Q

Water Deprivation Study

A

Child is deprived of fluids for several hours and serum sodium and urine osmolarity are monitored

Used to diagnose Diabetes Insipidus

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8
Q

Used to evaluate presence of tumors, cysts, or structural abnormalities

A

Imaging

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9
Q

Lab and Diagnostic Testing

A

Newborn Metabolic Screening
Serum Chemistry
Random and timed serum hormone testing
Growth Hormone Stimulation Testing
Blood Glucose
Hemoglobin A1c
Genetic Testing
water Deprivation Study
Bone Age Radiographs
Imaging Studies

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10
Q

Common Medical treatments for Endocrine Disorders

A

Dietary Interventions
Glucose Monitoring
Insulin Delivery
Irradiation- Increase hormone secretion
Administration of radioactive iodine
Surgery- Removal of cysts

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11
Q

Oral glipizide, glyburide, metformin and injectable insulin

A

Hypoglycemics

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12
Q

Hormone Therapy

A

Growth hormone and levothyroxine

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13
Q

Hormone Suppression Therapy

A

Octreotide
Methimazole

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14
Q

Mineral corticoid

A

Florinef- Adrenal Insuffciency

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15
Q

Corticosteroids

A

Dexamethasone
Hydrocortisone

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16
Q

Desmopressin Acetate

A

DI

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17
Q

Treatment goals for endocrine disorders

A

Decreasing excessive hormone production or replacing diminished hormones

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18
Q

Pituitary Disorders

A

Growth Hormone Deficiency
Precocious Puberty
Delayed Puberty
DI
SIADH

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19
Q

Complications of GH Deficiency and Therapy

A

Altered carb, fat, and protein metabolism
Hypoglycemia
Glucose Intolerance/ Diabetes
SCFE
Pseudotumor Cerebri
Leukemia
Recurrence of CNS Tumors
Infection at the Injection Site
Edema and Sodium Retention

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20
Q

Develops sexual characteristics before usual age of puberty

A

Precocious Puberty

Age 8 or less- girls
Age 9 or less- boys

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21
Q

Breasts not developed in girls by age of 12

No testicular enlargement or scrotal changes of boys by age 14

A

Delayed Puberty

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22
Q

Educating the child and family about the physical changes the child is experiencing

Teach how to use meds correctly

Help child with self esteem issues

Promote age appropriate physical development and pubertal progression

A

Goals of Nursing Management of Precocious or Delayed Puberty

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23
Q

DI

A

High and Dry
Increased Urination
Hypernatremia
Serum Osmolarity>300
Urine Specific Gravity <1.005
Decreased Urine Osmolarity
Dehydration, Thirst

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24
Q

SIADH

A

Low and Wet
Decreased urination
Hyponatremia
Serum Osmolarity <280
Urine Specific Gravity >1.030
Increased Urine Osmolarity
Fluid Retention and weight gain; Increased BP

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25
Q

Rare syndrome occurs when ADH is secreted bin presence of low serum osmolarity because the feedback mechanism that regulates ADH does not function properly

A

SIADH

Decreasing DDAVP, fluid restriction, IV fluids to correct hyponatremia and increase serum osmolarity

DI- Give Vasopressin-DDVAP

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26
Q

Rare in children
Mostly seen in Graves Disease
Excessive T3, T4, T3 resin uptake
TSH usually low
Treated by destruction of thyroid gland

A

Hyperthyroidism

27
Q

Can be congenital or acquired
Certain populations at risk - Down Syndrome, Maternal Hypothyroidism
Decreased Thyroid hormones
Decreased T3, T4, T3 resin uptake
TSH usually elevated
Lifelong Thyroid Supplementation

A

Hypothyroidism

28
Q

Autoimmune disorder causes excessive amounts of thyroid hormone to be released in response to TSI

A

Graves’ Disease

29
Q

Uncommon in children but peak incidence occurs during adolescence

Occurs 5x more often in girls than boys and goiter usually develops

A

Graves Disease

30
Q

Hypothalamus secretes TRH
TRH stimulates TSH from anterior pituitary gland
TSH stimulates T3 and T4 production in the Thyroid

T and T4 exert by feedback on pituitary and hypothalamus

A

HPTA

31
Q

Nervousness/ Anxiety
Diarrhea
Heat intolerance
Weight Loss
Smooth velvety skin

A

Hyperthyroidism

32
Q

Tiredness/ fatigue
Constipation
Cold intolerance
Weight Gain
Dry thick skin, edema on face, eyes, and hands
Decreased Growth

A

Hypothyroidism

33
Q

Sudden release of high levels of thyroid hormones
- Progresses to heart failure and shock

A

Thyroid Storm

Immediately report:
Acute onset of severe restlessness and irritability
Fever
Diaphoresis
Severe Tachycardia

34
Q

Measure and record growth at regular intervals
Measure thyroid levels at recommended intervals
-Every 2-4 weeks until the target range is reached on a stabilized dose of medication, then 1-3 months and decreasing in frequency as the child gets older
- Monitor for signs of hypo- or hyperfunction, including changes in vital signs, thermoregulation, and activity level
- Provide adequate rest periods and meet thermoregulation needs

A

Promoting Growth for a child with Congenital Hypothyroidism

35
Q

Other Endocrine Disorders include:

A

Adrenal Gland Disorders
- Congenital Adrenal Hyperplasia
- Cushing Syndrome
- Addison Disease

  • Polycystic Ovary Syndrome
36
Q

Walnut sized glands that sit atop of kidneys
Powerhouse of endocrine system

A

Adrenals
- Stress response
- Sleep Patterns
- Immune Health
- Mood and Mental Clarity

37
Q

Includes the following:
-Personality changes
- Moon Face
- Gynecomastia
- Osteoporosis
- Fat Deposits on face, back, and shoulders
- CNS Irritability
- Na and Fluid retention
- Thin Extremities
- GI Distress
- Purple Striae
- Bruises
- Hyperglycemia

A

Cushing’s Syndrome

38
Q

-Bronze color of skin
- Tachycardia
- GI disturbances
- Weakness
- Fatigue
- Depression
- Hypoglycemia
- Weight Loss
- Anorexia
- Postural Hypotension

A

Addison’s Disease

Adrenal Crisis
- Profound and fatigue
- Dehydration
- Vascular Collapse
- Low Na
- High K

39
Q

Caused by a deficiency of insulin secretion due to pancreatic beta cell damage

A

Type 1

40
Q

Consequence of insulin resistance that occurs at the level of skeletal muscle, liver, and adipose tissue with different degrees of beta cell impairment

A

Type 2

41
Q

Diabetes secondary to certain condition such as

A

Cystic Fibrosis
Glucocorticoid Use
Down Syndrome
Turner Syndrome
Klinefelter Syndrome

42
Q

Gestational Diabetes occurs during

A

Pregnancy

43
Q

Insulin replacement therapy is cornerstone management of

A

Type 1 DM and administered daily by subq injections into adipose tissue over large muscle masses using a traditional insulin syringe or subcutaneous injector

44
Q

During Pregnancy
Goes away after pregnancy
May have BIG baby
Risk for Type 2

A

Gestational Diabetes

45
Q

Insufficient Insulin Production
Ketoacidosis
Adults after 40 most often
Familial
May need insulin shots

A

Type 2

45
Q

No insulin produced
Most often before age of 15
Was called juvenile diabetes
Auto Immune Disorder
Familial and Lifelong

A

Type 1

46
Q

Type and Type 2 Diabetes 3 Ps

A

Polyuria
Polyphagia
Polydipsia

  • Fatigue and UTIs
46
Q

Assessment of Type 1

A

Decreased weight
Increased Thirst
Bed Wetting
Rapid onset

47
Q

Assessment of Type 2

A

Increased weight
Eye problems
Slow onset

48
Q

Dx of diabetes

A

FBG greater than 126 mg/dl
Causal random > 200mg/ dl
OGTT
hbA1c greater than 6.5%

48
Q

Treatment of DM

A

Insulin
Oral hypoglycemics
Diet
Less insulin with increased exercise
low glucose fluctuation

49
Q

Complications of DM

A

DKA- Type 1
HHNC - Type 2
Fluid and electrolyte Imbalances

50
Q

Insulin Complications

A

Hypoglycemia
Lipodystrophy
Somogyi Effect
Allergic Reaction

50
Q

Long Term Complications of Diabetes

A

Angiopathy
PVD
Retinopathy
Nephropathy
Neuropathy
Infections

51
Q

Medical Emergency requires early recognition and prompt intervention
Increased risk of stress such as illness and infection

A

DKA

52
Q

S/S of DKA

A

Anorexia, nausea, vomiting
Lethargy, stupor, altered level of LOC, confusion
Decreased skin turgor
Abdominal pain
Kussmaul respirations and air hunger
Fruity breath or acetone breath odor
Presence of ketones in urine or blood
Tachycardia and not treated may lead to coma and death

53
Q

Aspart
Lispro
Glulisine

A

Rapid Acting

54
Q

Regular Insulin

A

Short acting

55
Q

NPH is

A

Intermediate acting

56
Q

Complications of DM

A

Failure to grow
Delayed sexual maturation
Poor wound healing
Recurrent infections
Retinopathy
Neuropathy
Vascular Complications
Nephropathy
Cerebrovascular Disease
Cardiovascular Disease
PVD

56
Q

Glargine
Detemir
Degludec

A

Long Acting

56
Q

Goals of Therapeutic management of DM

A

Achieve normal growth and development
Promoting optimal serum glucose control, including fluid and electrolyte levels and near normal hemoglobin A1c or glycosylated hemoglobin levels
Preventing complications
Promoting positive adjustment to the disease with the ability to self manage in the home

57
Q

Nursing Diagnoses for Endocrine Disorders

A

Imbalanced nutrition
Deficient or excess fluid volume
Risk for delayed development
Disturbed Body image
Knowledge deficit
Ineffective health maintenance
Interrupted family processes
Risk for caregiver role strain

57
Q

Teaching points for Diabetes Management

A

Self measurement of glucose
Urine Ketone testing
Medication Use
S/S of hypo or hyperglycemia
Monitoring and managing complications
Sick Day
Lab testing and follow ups
Diet and exercise as part of DM management

ADN005 Pediatrics (21 decks)

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