Caring for the Child with an Endocrinological or Metabolic Condition Flashcards by Divya Adukuzhiyil

Endocrine System: What is it composed of? What does if involve?

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

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Endocrine System: What does it influence?

Influences all physiologic processes

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Endocrine System: Influences all physiologic processes like?

Growth and development.

Metabolic processes related to fluid and electrolyte balance and energy
production.

Sexual maturation and reproduction.

The body’s response to stress.

Maintenance of internal homeostasis.

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Organs or Tissues of the Endocrine System include:

Pituitary gland and hypothalamus (“control centers”).

Thyroid gland.

Parathyroid glands.

Adrenal glands.

Gonads (ovaries and testes).

Islets of Langerhans located in the pancreas.

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Health history: What questions should be included?

History should include questions related to family history or growth and development difficulties (late development of secondary sex characteristics)

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Health history: What else should be included?

Diet and elimination patterns. Extreme thirst, excessive appetite, frequent voiding.

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Common Medications for Endocrine Disorders

Hypoglycemics (oral, injectable)

Hormone therapy (supplemental)

Hormone suppression therapy

Corticosteroids and mineralocorticosteroids

Desmopressin acetate (DDAVP)

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Laboratory and Diagnostic Testing for Endocrine Disorders

Newborn metabolic screening

Serum chemistry

Random and timed serum hormone testing

Growth hormone stimulation testing

Blood glucose (fasting, random and OGTT), HgA1C

Urine testing (ketone, glucose, 24 hour collections)

Genetic testing

Water deprivation study

Bone age radiographs

Imaging studies—CT, MRI, nuclear medicine, ultrasonography

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Pituitary Disorders: What two hormones are involved?

Anterior hormones

Posterior hormones

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Pituitary Disorders: Anterior hormones can cause?

Growth hormone deficiency

Hyperpituitarism

Precocious puberty

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Pituitary Disorders: Posterior hormones can cause?

Diabetes insipidus

Syndrome of inappropriate antidiuretic hormone secretion

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Complications of Growth Hormone Deficiency and Therapy

Altered carbohydrate, protein, and fat metabolism

Hypoglycemia

Glucose intolerance/diabetes

Slipped capital femoral epiphysis (SCFE)

Pseudotumor cerebri

Leukemia

Recurrence of CNS tumors

Infection at the injection site

Edema and sodium retention

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Common Medical Treatments for Endocrine Disorders include:

Dietary interventions.

Glucose monitoring and insulin delivery via programmable pumps.

Irradiation/administration of radioactive iodine.

Surgery.

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Goals of Nursing Management of Precocious or Delayed Puberty: What are you educating about?

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

Teaching how to correctly use the prescribed medications.

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Goals of Nursing Management of Precocious or Delayed Puberty: What are you helping child with?

Helping the child to deal with self-esteem issues related to the differences in the rate of growth and development of secondary sexual characteristics compared to peers.

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Goals of Nursing Management of Precocious or Delayed Puberty: What are you promoting?

Promoting age-appropriate physical development and pubertal progression.

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Comparison of Diabetes Insipidus versus Syndrome of Inappropriate ADH (SIADH)

DI: level of water? urine? salt? serum osmolality? Urine specific gravity? Urine osmolality? Symptoms?

“High and dry”

Increased urine

Hypernatremia

High serum osmolality

Low urine specific gravity

Low urine osmolality

Dehydration and thirst

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Comparison of Diabetes Insipidus versus Syndrome of Inappropriate ADH (SIADH)

SIADH: level of water? urine? salt? serum osmolality? Urine specific gravity? Urine osmolality? Symptoms?

“Low and wet”

Decreased urine output

Hyponatremia

Low serum osmolality

High urine specific gravity

High urine osmolality

Fluid retention, weight gain, Increased bp

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Thyroid Disorders in Children:

Hyperthyroidism: How common is it in children?

rare in children

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Thyroid Disorders in Children include:

Hyperthyroidism: rare in children

Hypothyroidism: can be congenital or acquired

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Thyroid Disorders in Children:

Hypothyroidism: How can children get it?

can be congenital or acquired

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Thyroid Disorders in Children:

Hyperthyroidism: How is it mostly seen?

mostly seen as Graves Disease.

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Thyroid Disorders in Children:

Hyperthyroidism: How are levels present in this condition?

Excessive T3, T4, T3 resin uptake.

TSH usually low.

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Thyroid Disorders in Children:

Hyperthyroidism: How is it treated?

Treated by destruction of thyroid gland.

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Thyroid Disorders in Children: Hypothyroidism: What populations are at risk?

Certain populations at risk (Downs, maternal hypothyroidism).

Thyroid Disorders in Children: Hypothyroidism: What are hormone levels?

Decreased thyroid hormones. Decreased T3, T4, T3 resin uptake. TSH usually elevated.

Thyroid Disorders in Children: Hypothyroidism: What is needed to treat this?

Lifelong thyroid supplementation.

Hypothyroidism Versus Hyperthyroidism Hyperthyroidism symptoms:

Nervousness Diarrhea Heat intolerance Weight loss Smooth, velvety skin

Hypothyroidism Versus Hyperthyroidism Hypothyroidism symptoms:

Tiredness/fatigue Constipation Cold intolerance Weight gain Dry, thick skin, Edema of face, eyes and hands Decreased growth

Promoting Growth for a Child With Congenital Hypothyroidism: What should be measured and recorded?

Measure and record growth at regular intervals.

Promoting Growth for a Child With Congenital Hypothyroidism: How are thyroid levels measured?

Measure thyroid levels every 2 to 4 weeks until the target range is reached on a stabilized dose of medication.

Promoting Growth for a Child With Congenital Hypothyroidism: When should testing be done?

Obtain tests every 3 to 4 months for the first several years of life, changing to every 6 to 12 months during adolescence.

Promoting Growth for a Child With Congenital Hypothyroidism: What should you monitor for signs of?

Monitor for signs of hypo- or hyperfunction, including changes in vital signs, thermoregulation, and activity level.

Promoting Growth for a Child With Congenital Hypothyroidism: What should you provide?

Provide adequate rest periods and meet thermoregulation needs.

Signs of Thyroid Storm

Sudden onset of severe restlessness and irritability Fever Diaphoresis Severe tachycardia

Disorders of parathyroid gland: What does the parathyroid gland secrete?

The parathyroid gland secretes parathyroid hormone (PTH).

Disorders of parathyroid gland: What regulates calcium and phosphate homeosstasis?

PTH + Vitamin D + calcitonin --> regulates calcium/phosphate homeostasis

Disorders of parathyroid gland: What are the two disorders?

HYPOparathyroid: HYPERparathyroid:

Disorders of parathyroid gland: HYPOparathyroid:

Deficiency of PTH;

Disorders of parathyroid gland: HYPOparathyroid: What can lead to a deficiency of PTH? What can deficiency lead to?

aplasia/hypoplasia, or accidental removal or trauma --> decreased Ca, increased Phosphorus

Disorders of parathyroid gland: HYPERparathyroid:

Hypersecretion of PTH ;

Disorders of parathyroid gland: HYPERparathyroid: What can cause a hypersecretion of PTH?

parathyroid adenoma; Secondary hyperparathyroid d/t renal failure

Disorders of adrenal gland include:

Addison Disease: Cushing syndrome: CAH

Disorders of adrenal gland: Addison Disease: What is it?

Deficiency in adrenal steroids, glucocorticoids (cortisol), and mineralocorticoids (aldosterone)

Disorders of adrenal gland: Addison Disease: What can cause it?

Damage or destruction of adrenals by infection, dysfunction of hypothalamus, autoimmune or familial

Disorders of adrenal gland: Addison Disease: What are symptoms of it?

Hyperpigmentation of skin Hypoglycemia, hypotension, hyponatremia, hyperkalemia, dehydration

Disorders of adrenal gland: Addison Disease: What is a severe form of it?

Adrenal crisis

Disorders of adrenal gland: Cushing syndrome: What is it?

Excess levels of one or all of the hormones

Disorders of adrenal gland: Cushing syndrome: What is it caused by?

Caused by small ACTH pituitary adenoma, but most common cause is excessive corticosteroid therapy.

Disorders of adrenal gland: Congenital Adrenal Hyperplasia (CAH): What is it?

CAH is a group of autosomal recessive disorders in which there is insufficient supply of the enzymes required for synthesis of cortisol and aldosterone.

Disorders of adrenal gland: CAH: What is a symptom?

Ambiguous genitalia

Polycystic ovarian syndrome: What is it?

Functional ovarian hyperandrogenism or ovarian androgen excess Testosterone production in ovaries is excessive

Polycystic ovarian syndrome: What does it cause?

Causes hirsuitism, balding, acne, increased muscle mass, decreased breast size

Polycystic ovarian syndrome: Complications include:

Complications include insulin resistance, infertility, CVD

Classification of Diabetes What are the types of Diabetes?

Type 1: Type 2: Diabetes secondary to certain conditions Gestational diabetes (diabetes during pregnancy).

Classification of Diabetes What is Type 1 diabetes caused by:

Type 1: caused by a deficiency of insulin secretion due to pancreatic β-cell damage.

Classification of Diabetes What is Type 2 diabetes caused by:

Type 2: consequence of insulin resistance that occurs at the level of skeletal muscle, liver, and adipose tissue with different degrees of β-cell impairment.

Classification of Diabetes Diabetes can occur secondary to certain conditions like what?

Diabetes secondary to certain conditions such as cystic fibrosis, glucocorticoid use (as in Cushing syndrome), and certain genetic syndromes such as Down syndrome, Klinefelter syndrome, and Turner syndrome .

Classification of Diabetes What is gestational diabetes?

Gestational diabetes (diabetes during pregnancy).

Examples of Nursing Diagnoses for Endocrine Disorders

Delayed growth and development. Disturbed body image. Deficient knowledge (specify). Interrupted family processes. Imbalanced nutrition: less than or more than body requirements. Deficient or excess fluid volume. Noncompliance.

Insulin Type, Action, and Duration: What are the types of insulin?

Rapid Acting Short Acting Intermediate acting Long acting

Insulin Type, Action, and Duration: Rapid Acting insulin includes:

Lispro Aspart Glulisinc

Insulin Type, Action, and Duration: Rapid Acting insulin (LAG) onset is:

Within 15 minutes

Insulin Type, Action, and Duration: Rapid Acting insulin (LAG) peak is?

30-90 minutes

Insulin Type, Action, and Duration: Rapid Acting insulin (LAG) duration is?

3-5 hours

Insulin Type, Action, and Duration: Short acting insulin includes?

Regular insulin

Insulin Type, Action, and Duration: Short acting insulin onset is?

30-60 minutes

Insulin Type, Action, and Duration: Short acting insulin peak is?

2-4 hours

Insulin Type, Action, and Duration: Short acting insulin duration is?

5-8 hours

Insulin Type, Action, and Duration: Intermediate acting includes:

NPH

Insulin Type, Action, and Duration: Intermediate acting onset is?

1--3 hours

Insulin Type, Action, and Duration: Intermediate acting peak is?

4-10 hours

Insulin Type, Action, and Duration: Intermediate acting duration is?

10-16 hours

Insulin Type, Action, and Duration: Long acting insulin includes:

Glargine Determir

Insulin Type, Action, and Duration: Long acting insulin onset is?

1-2 hours

Insulin Type, Action, and Duration: Long acting insulin peak is?

No clear peak, offer continuously steady coverage

Insulin Type, Action, and Duration: Long acting insulin duration is?

6-24 hours

Complications of Diabetes Mellitus

Retinopathy Nephropathy Dyslipidemia Hypertension Celiac disease Hypothyroidism

Signs and Symptoms of Diabetic Ketoacidosis

Anorexia, nausea and vomiting. Lethargy, stupor, altered level of consciousness, confusion. Decreased skin turgor. Abdominal pain. Kussmaul respirations and air hunger. Fruity (sweet-smelling) or acetone breath odor. Presence of ketones in urine and blood. Tachycardia, and if left untreated, coma and death.

Goals of Therapeutic Management of Diabetes Mellitus

Achieving normal growth and development.

Goals of Therapeutic Management of Diabetes Mellitus: What do you want to promote?

Promoting optimal serum glucose control, including fluid and electrolyte levels and near-normal hemoglobin A1C or glycosylated hemoglobin levels. Promoting positive adjustment to the disease, with ability to self-manage in the home.

Goals of Therapeutic Management of Diabetes Mellitus: What do you want to prevent?

Preventing complications.

Teaching Points for Diabetes Management

Self-measurement of blood glucose. Urine ketone testing. Medication use. Signs and symptoms and treatment of hypoglycemia and hyperglycemia. Monitoring for and managing complications. Sick-day instructions. Laboratory testing and follow-up care. Diet and exercise as part of DM management.

Caring for the Child with an Endocrinological or Metabolic Condition Flashcards

Exam 3 (83 cards)