Week 7 Chapter 48 Flashcards
Composed of glands, tissues, or clusters of cells that produce and release hormones in a negative feedback system involving the hypothalamus and nervous system
Endocrine System
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
Endocrine System
Most endocrine glands develop in the
1st trimester but still incomplete at birth
Complete hormonal control is lacking during early years of life
Means infant can not
Balance fluid concentration, electrolytes, amino acids, and glucose
Endocrine and nervous system work together to maintain optimal internal environment for the body
Homeostasis
Organs or tissues of the Endocrine System
Pituitary Gland
Hypothalamus
Parathyroid glands
Adrenal Glands
Gonads
Islets of Langerhans of the Pancreas
Water Deprivation Study
Child is deprived of fluids for several hours and serum sodium and urine osmolarity are monitored
Used to diagnose Diabetes Insipidus
Used to evaluate presence of tumors, cysts, or structural abnormalities
Imaging
Lab and Diagnostic Testing
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
Common Medical treatments for Endocrine Disorders
Dietary Interventions
Glucose Monitoring
Insulin Delivery
Irradiation- Increase hormone secretion
Administration of radioactive iodine
Surgery- Removal of cysts
Oral glipizide, glyburide, metformin and injectable insulin
Hypoglycemics
Hormone Therapy
Growth hormone and levothyroxine
Hormone Suppression Therapy
Octreotide
Methimazole
Mineral corticoid
Florinef- Adrenal Insuffciency
Corticosteroids
Dexamethasone
Hydrocortisone
Desmopressin Acetate
DI
Treatment goals for endocrine disorders
Decreasing excessive hormone production or replacing diminished hormones
Pituitary Disorders
Growth Hormone Deficiency
Precocious Puberty
Delayed Puberty
DI
SIADH
Complications of GH Deficiency and Therapy
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
Develops sexual characteristics before usual age of puberty
Precocious Puberty
Age 8 or less- girls
Age 9 or less- boys
Breasts not developed in girls by age of 12
No testicular enlargement or scrotal changes of boys by age 14
Delayed Puberty
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
Goals of Nursing Management of Precocious or Delayed Puberty
DI
High and Dry
Increased Urination
Hypernatremia
Serum Osmolarity>300
Urine Specific Gravity <1.005
Decreased Urine Osmolarity
Dehydration, Thirst
SIADH
Low and Wet
Decreased urination
Hyponatremia
Serum Osmolarity <280
Urine Specific Gravity >1.030
Increased Urine Osmolarity
Fluid Retention and weight gain; Increased BP
Rare syndrome occurs when ADH is secreted bin presence of low serum osmolarity because the feedback mechanism that regulates ADH does not function properly
SIADH
Decreasing DDAVP, fluid restriction, IV fluids to correct hyponatremia and increase serum osmolarity
DI- Give Vasopressin-DDVAP
Rare in children
Mostly seen in Graves Disease
Excessive T3, T4, T3 resin uptake
TSH usually low
Treated by destruction of thyroid gland
Hyperthyroidism
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
Hypothyroidism
Autoimmune disorder causes excessive amounts of thyroid hormone to be released in response to TSI
Graves’ Disease
Uncommon in children but peak incidence occurs during adolescence
Occurs 5x more often in girls than boys and goiter usually develops
Graves Disease
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
HPTA
Nervousness/ Anxiety
Diarrhea
Heat intolerance
Weight Loss
Smooth velvety skin
Hyperthyroidism
Tiredness/ fatigue
Constipation
Cold intolerance
Weight Gain
Dry thick skin, edema on face, eyes, and hands
Decreased Growth
Hypothyroidism
Sudden release of high levels of thyroid hormones
- Progresses to heart failure and shock
Thyroid Storm
Immediately report:
Acute onset of severe restlessness and irritability
Fever
Diaphoresis
Severe Tachycardia
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
Promoting Growth for a child with Congenital Hypothyroidism
Other Endocrine Disorders include:
Adrenal Gland Disorders
- Congenital Adrenal Hyperplasia
- Cushing Syndrome
- Addison Disease
- Polycystic Ovary Syndrome
Walnut sized glands that sit atop of kidneys
Powerhouse of endocrine system
Adrenals
- Stress response
- Sleep Patterns
- Immune Health
- Mood and Mental Clarity
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
Cushing’s Syndrome
-Bronze color of skin
- Tachycardia
- GI disturbances
- Weakness
- Fatigue
- Depression
- Hypoglycemia
- Weight Loss
- Anorexia
- Postural Hypotension
Addison’s Disease
Adrenal Crisis
- Profound and fatigue
- Dehydration
- Vascular Collapse
- Low Na
- High K
Caused by a deficiency of insulin secretion due to pancreatic beta cell damage
Type 1
Consequence of insulin resistance that occurs at the level of skeletal muscle, liver, and adipose tissue with different degrees of beta cell impairment
Type 2
Diabetes secondary to certain condition such as
Cystic Fibrosis
Glucocorticoid Use
Down Syndrome
Turner Syndrome
Klinefelter Syndrome
Gestational Diabetes occurs during
Pregnancy
Insulin replacement therapy is cornerstone management of
Type 1 DM and administered daily by subq injections into adipose tissue over large muscle masses using a traditional insulin syringe or subcutaneous injector
During Pregnancy
Goes away after pregnancy
May have BIG baby
Risk for Type 2
Gestational Diabetes
Insufficient Insulin Production
Ketoacidosis
Adults after 40 most often
Familial
May need insulin shots
Type 2
No insulin produced
Most often before age of 15
Was called juvenile diabetes
Auto Immune Disorder
Familial and Lifelong
Type 1
Type and Type 2 Diabetes 3 Ps
Polyuria
Polyphagia
Polydipsia
- Fatigue and UTIs
Assessment of Type 1
Decreased weight
Increased Thirst
Bed Wetting
Rapid onset
Assessment of Type 2
Increased weight
Eye problems
Slow onset
Dx of diabetes
FBG greater than 126 mg/dl
Causal random > 200mg/ dl
OGTT
hbA1c greater than 6.5%
Treatment of DM
Insulin
Oral hypoglycemics
Diet
Less insulin with increased exercise
low glucose fluctuation
Complications of DM
DKA- Type 1
HHNC - Type 2
Fluid and electrolyte Imbalances
Insulin Complications
Hypoglycemia
Lipodystrophy
Somogyi Effect
Allergic Reaction
Long Term Complications of Diabetes
Angiopathy
PVD
Retinopathy
Nephropathy
Neuropathy
Infections
Medical Emergency requires early recognition and prompt intervention
Increased risk of stress such as illness and infection
DKA
S/S of DKA
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
Aspart
Lispro
Glulisine
Rapid Acting
Regular Insulin
Short acting
NPH is
Intermediate acting
Complications of DM
Failure to grow
Delayed sexual maturation
Poor wound healing
Recurrent infections
Retinopathy
Neuropathy
Vascular Complications
Nephropathy
Cerebrovascular Disease
Cardiovascular Disease
PVD
Glargine
Detemir
Degludec
Long Acting
Goals of Therapeutic management of DM
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
Nursing Diagnoses for Endocrine Disorders
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
Teaching points for Diabetes Management
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
