Care of Children with Alterations in Endocrine System

Question 1

growth hormone secreted by the anterior pituitary gland

Answer 1

somatotropin

Question 2

somatotropin is a growth hormone secreted by the?

Answer 2

anterior pituitary gland

Question 3

Children cannot grow to full size if the production of human growth hormone (GH), or somatotropin (growth hormone secreted by the anterior pituitary gland) is deficient.

Answer 3

GROWTH HORMOME DEFICIENCY

Question 4

If GROWTH HORMOME DEFICIENCY is not treated, most children with this disorder will not reach more than ______________ in height

Answer 4

3 or 4 feet

Question 5

Deficient production of GH may result from a _________________________ of embryonic origin that places pressure on the pituitary gland or from increased intracranial pressure as a result of trauma.

Answer 5

nonmalignant cystic tumor

Question 6

GROWTH HORMOME DEFICIENCY SIGNS AND SYMPTOMS

Answer 6

• The child with deficient production of GH is usually normal in size and weight at birth.
• Within the first few years of life however, the child begins to fall below the third percentile of height and weight on growth charts
• The face appears infantile because the mandible is recessed and immature; the nose is usually small.
• Child’s teeth may be crowded in a small jaw.
• Child’s voice is high pitched, and the onset of pubic, facial, and axillary hair and genital growth is delayed

Question 7

GH deficiency is treated by the administration of _____________________________________(rhGH) ____ times a week, “Somatoprin (Nutropin, Humatrope)”

Answer 7

intramuscular (IM) recombinant human growth hormone ; 2-3

Question 8

GH is usually given at ____________, the time of the day at which GH normally peaks.

Answer 8

bedtime

Question 9

In treatement of Growth Hormone Deficiency, closely monitor children’s _______________ and their ____________; treatment should be stopped ___________________________

Answer 9

growth rate; bone age; prior to epiphyseal closure

Question 10

It is a disease in which there is decreased release of antidiuretic hormones(ADH) by the pituitary gland

Answer 10

DIABETES INSIPIDUS

Question 11

may reflect an X-linked dominant trait, or it may be transmitted by an autosomal recessive gene.

Answer 11

DIABETES INSIPIDUS

Question 12

It may result from lesion, tumor, or injury to the posterior pituitary; or it may have an unknown cause.

Answer 12

DIABETES INSIPIDUS

Question 13

DIABETES INSIPIDUS
SIGNS AND SYMPTOMS

Answer 13

• experience thirst (polydipsia) that is relieved only by drinking water, not breast milk or formula, as well as
  polyuria.
• Parents may notice polyuria first as bedwetting in a toilet trained child.
• Weight loss occurs because of the large loss of fluid.
• 3P’s – Polydipsia – excessive thirst
  Polyuria – frequent urination
  Polyphagia – excessive hunger

Question 14

DIABETES INSIPIDUS
THERAPEUTIC MANAGEMENT

Answer 14

• Surgery is the treatment of choice if a tumor is present.
• If the cause is idiopathic, the condition can be controlled by the administration of desmopressin (DDAVP)

Question 15

In treatement of Diabetes Insipidus, _____________ is the treatment of choice if a tumor is present

Answer 15

surgery

Question 16

In Diabetes Insipidus, if the cause is idiopathic, the condition can be controlled by the administration of _________________________

Answer 16

desmopressin (DDAVP)

Question 17

is a synthetic form of ADH that helps the kidneys reabsorb water, reducing urine output and relieving thirst.

Answer 17

desmopressin (DDAVP)

Question 18

occurs as a result of an absent or nonfunctioning thyroid gland in a newborn baby

Answer 18

CONGENITAL HYPOTHYROIDISM

Question 19

An early sign that the child has hypothyroidism is that the child ___________________________

Answer 19

sleeps excessively.

Question 20

CONGENITAL HYPOTHYROIDISM
SIGNS AND SYMPTOMS

Answer 20

• child sleeps excessively.
• tongue becomes enlarged
• child’s neck appears short and thick.
• extremities appear short and fat, with hypotonic muscles
• floppy, rag-dull appearance.
• Overall the skin is dry and perhaps scaly, and the child does not perspire.

Question 21

The treatment for hypothyroidism is oral administration of synthetic thyroid hormone, _____________________. The dose is usually __________________

Answer 21

sodium levothyroxine; 5 to 6 mcg

Question 22

In treatement of Congenital Hypothyroidism, ___________________________ may also be given to prevent the developments of rickets when, with the administration of thyroid hormones.

Answer 22

supplemental vitamin D

Question 23

In Congenital Hypothyroidism, be certain that the parents know the rules for long term medication administration with children, particularly the rule about not putting medicine in large amount of food (thyroxine tablets must be _________________ and added to food or small amount of formula or breast milk).

Answer 23

crushed

Question 24

ACQUIRED HYPOTHYROIDISM (HASHIMOTO’S THYROIDITIS) a.k.a

Answer 24

HASHIMOTO’S DISEASE

Question 25

is the MOST common form of acquired hypothyroidism.

Answer 25

ACQUIRED HYPOTHYROIDISM (HASHIMOTO’S THYROIDITIS)

Question 26

Hashimoto’s Thyroiditis occurs more often in _____________ than boys at the age of _________________

Answer 26

girls; 10 to 11 years

Question 27

In Hashimoto's Disease, the decrease in the thyroid secretions is caused by the development of an ______________________ that interferes with thyroid production.

Answer 27

autoimmune phenomenon

Question 28

HYPOTHYROIDISM HASHIMOTO’S THYROIDITIS SIGNS AND SYMPTOMS

Answer 28

- In infants, congenital goiter can lead to airway obstruction in children - In children, prominent symptoms are obesity, lethargy, and delayed sexual development. - The thyroid not only enlarges but may become nodular in response to the over secretion of thyroid-stimulating hormone. - If the nodes are benign, there is generally a rapid uptake of radioactive iodine (hot nodes) - If there is no uptake (cold nodes), carcinoma is a much more likely diagnose (rare).

Question 29

Treatment for acquired hypothyroidism is the administration of synthetic thyroid hormone (_____________________________), the same as for congenital hypothyroidism.

Answer 29

sodium levothyroxine

Question 30

It is the over-secretion of thyroid hormones by the thyroid gland.

Answer 30

HYPERTHYROIDISM (GRAVE’S DISEASE)

Question 31

In children, Hyperthyroidism is caused by an autoimmune reaction that results in overproduction of ___________________________, which stimulates the thyroid gland to overproduce thyroxine.

Answer 31

immunoglobulin G (IgG)

Question 32

HYPERTHYROIDISM (GRAVE’S DISEASE) SIGNS AND SYMPTOMS

Answer 32

Nervousness Loss of muscle strength Fatigue Increased basal metabolic rate – hypertension, tachycardia Perspire freely They are always hungry, and although they eat constantly. Exophthalmos

Question 33

HYPERTHYROIDISM (GRAVE’S DISEASE) ASSESSMENT

Answer 33

Radiography Ultrasound

Question 34

Laboratory tests: HYPERTHYROIDISM (GRAVE’S DISEASE)

Answer 34

elevated T4 (thyroxine) and T3 (triiodothyronine) levels increased radioactive iodine uptake Low TSH (Thyroid-Stimulating Hormone)

Question 35

to decrease antibody response

Answer 35

Beta-adrenergic blocking agent (Propanolol)

Question 36

Antithyroid drug:

Answer 36

Propylthiouracil (PTU) or Methimazole (Tapazole)

Question 37

suppress the formation of thyroxine

Answer 37

Propylthiouracil (PTU) or Methimazole (Tapazole)

Question 38

In Hyperthyroidism, monitor the child for drug side effects such as

Answer 38

leukopenia (decrease WBC) and thrombocytopenia (low platelet count).

Question 39

Is a disorder that involves an absolute or relative deficiency of insulin

Answer 39

TYPE 1 DIABETES MELLITUS

Question 40

JUVENILE DIABETES OR INSULINDEPENDENT DIABTES

Answer 40

TYPE 1 DIABETES MELLITUS

Question 41

NON-INSULIN-DEPENDENT

Answer 41

TYPE 2 DIABETES MELLITUS

Question 42

It is characterized by diminished insulin secretion and not caused by autoimmune factors

Answer 42

TYPE 2 DIABETES MELLITUS

Question 43

It is a disorder of carbohydrate metabolism that is characterized by abnormal amounts of galactose in the blood (galactosemia) and in the urine (galactosuria).

Answer 43

GALACTOSEMIA

Question 44

In Galactosemia, the child is deficient in the liver enzyme

Answer 44

galactose 1-phosphate uridyltransferase.

Question 45

GALACTOSEMIA SIGNS AND SYMPTOMS Symptoms appear as soon as the child begins ________________________________

Answer 45

formula feeding or breastfeeding; Lethargy Hypotonia (low muscle tone) Diarrhea Vomiting Cirrhosis – due to liver enlargement Jaundice Bilateral cataract

Question 46

analyzes the cord blood if a child is risk for the disorder.

Answer 46

Beutler test

Question 47

GALACTOSEMIA THERAPEUTIC MANAGEMENT

Answer 47

- Avoid: Milk and all dairy products, processed and pre-packaged foods often contain lactose, tomato sauces, certain medications – tablets, capsules, sweetened liquid drops that contain lactose as a filler, some fruits and vegetables also contain galactose - DIET: Free of galactose or formula with milk substitutes such as casein hydrolysates (Nutramigen). - Calcium supplements, Vitamin D and K

Question 48

Diagnosis

Answer 48

- measuring the level of the affected ezyme in the red blood cells. - Beutler test