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CPN Exam > CPN Exam Endocrine/Metabolic > Flashcards

CPN Exam Endocrine/Metabolic Flashcards

1
Q

Hypothyroidism

A

Thyroid gland secretes too little thyroid hormone
Congenital/Acquired

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2
Q

Hypothyroid Assessment

A

Impaired growth and development
Constipation
Sleepiness
Hypotonia
Hypothermia
Weight gain

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3
Q

Hypothyroid Management

A

Thyroid Hormone (TH) replacement– Prompt treatment is required for the infant to reduce neurologic impairment
Monitor progress of growth and development which should resolve with adequate treatment
Routine monitoring of serum TH levels

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4
Q

Hyperthyroidism (Grave Disease)

A

Thyroid gland over secretes thyroid hormone

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5
Q

Hyperthyroidism Assessment

A

Irritability and emotional lability
Short attention span
Weight loss despite voracious appetite Accelerated linear growth and bone age Hyperactivity of GI Tract
Hyperactivity
Tremors
Insomnia
Tachycardia
Tachycardia, bounding pulse

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6
Q

Hyperthyroidism Treatment

A

Drug therapy
Propylthiouracil (PTU)
Methimazole (MTZ, Tapazole)
Subtotal thyroidectomy
Ablation with radioiodine

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7
Q

Thyrotoxicosis Thyroid Storm

A

Sudden symptoms such as rapid heart rate, blood pressure and increased body temperature (manifested as fever)– Requires immediate medical attention (give an anti-thyroid drug)

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8
Q

Cushing Syndrome

A

A cluster of clinical abnormalities resulting from excessive levels of adrenocortical hormones.

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9
Q

Cushing Syndrome Etiologies

A

(1.) Adrenocortical tumor (infants and young children)
(2.) Excessive or prolonged steroid therapy (older children)

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10
Q

Cushing Syndrome Assessment

A

Central Obesity
Moon face
Susceptibility to infection/wound healing
Hypertension
Osteoporosis
Hirsutism
Mood disorder

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11
Q

Cushing Syndrome Management

A

Gradual discontinuation of exogenous steroids
Surgical removal of tumor
Steroid replacement therapy

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12
Q

Diabetes Insipidus (DI)

A

Hi and dry” = hi sodium (Na) and dehydration
Posterior pituitary hypofunction resulting in a hyposecretion of antidiuretic hormone (ADH) also called vasopressin

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13
Q

DI Assessment

A

Large volumes of urine and diuresis (i.e. polyuria)
Intense polydipsia (thirst)

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14
Q

DI Management

A

Hydrate
– Oral administration of water
– IV fluids
Drug therapy (oral or nasal)– DDAVP (exogenous vasopressin)

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15
Q

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

A

syndrome of hyponatremia and hypoosmolality that results from the excessive production or release of antidiuretic hormone (ADH) also called vasopressin which causes diminished water elimination.

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16
Q

SIADH

A

Opposite of DI is “low and too much H20” = low sodium (Na) and over volumized– Low Na is a risk for cerebral edema

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17
Q

SIADH Assessment

A

Decreased urine, fluid retention, weight gain, hyponatremia, muscle weakness, lethargy, confusion, seizures
Serum Laboratory Tests:
-Osmolality is low = means there is ↑ fluid volume and ↓ solute volume
-Blood Urea Nitrogen (BUN) is low = due to total body water dilution

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18
Q

SIADH Management

A

Correct hyponatremia with neurologic monitoring
Drug therapy: vasopressin receptor antagonists; diuretics
Fluid restrictions and fluid monitoring
Neuro checks and seizure precautions

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19
Q

Type I Diabetes

A

Most common endocrine disease in children
Autoimmune disorder causing destruction of the pancreatic beta cells
No insulin is produced so cells cannot utilize glucose

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20
Q

Hyperglycemia

A

Polyuria
Polydypsia
Polyphasia
“Warm and Dry - Sugar High”
Acetone breath

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21
Q

Pre-Diabetes

A

Fasting Glucose: 100-125
Normal <99

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22
Q

Hypoglycemia

A

Glucose <70
Sweaty, Shaky, Tachycardia, behavior changes
“Cold and clammy, need some candy”

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23
Q

HgbA1c

A

<7% for Type I

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24
Q

Type I Diabetes Management

A

Monitor blood glucose frequently
– Before meals and snacks
– Before and mid-way point when starting new physical activities
Carbohydrate, fat, and protein counting
Administration of insulin
Promote regular exercise and a healthy weight

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25
Q

Diabetes and Exercise

A

↓ blood glucose and ↓ insulin needs
– Either ↓ insulin dose or add 1-2 “uncovered snack(s)”

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26
Q

Diabetes and Sick Day/Illness

A

↑ blood glucose and ↑ insulin needs
– “Sick day rules” with more frequent blood glucose monitoring and insulin “touch ups

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27
Q

Hyperglycemia Management

A

Give rapid-acting insulin
Give fluids without sugar to flush out ketones (This includes IV fluid.)

28
Q

Hypoglycemia Management

A

Give fast-acting carbohydrate (1/2-cup orange juice or soda)
-Avoid complex carbohydrates such as a candy bar
– Give glucagon for unconscious child
Place on side to prevent aspiration with vomiting (i.e. side effect of glucagon)

29
Q

Insulin

A

Lispro/Humalog (Rapid Acting)
– Onset: 10-15 minutes
– Peaks: 30-90 minutes

NPH (Intermediate Acting)
– Onset: 2-4 hours
– Peaks: 8 hours

Lantus (Long Acting)
– Basal needs; no peaks; not related to meals

30
Q

Type II Diabetes

A

Insulin resistance (varying degrees) with some insulin deficiency

31
Q

Type II Diabetes Symptoms

A

Overweight/obesity Sleep apnea
– Hypertension Hyperlipidemia
– Acanthosis Nigricans (90% of kids with type 2 DM)
-Cutaneous thickening and hyperpigmentation

32
Q

Bones in Pediatric Patients

A

Bone lengthening happens in epiphyseal plates
Damage to plates can impact growth
Healing is faster in kids - 1 week for every year of age up to 10

33
Q

Most common fracture in peds

A

Clavicular
Greenstick

34
Q

Clavicular Fracture

A

Occur during vaginal birth due to width of shoulders

35
Q

Greenstick

A

Occur in long bones due to flexibility of growing bones

36
Q

Spiral

A

associated with a twisting force; more closely associated with child abuse than other fractures but also seen in sports injuries like skiing

37
Q

Compound

A

Bone breaks skin

38
Q

Comminuted

A

Bone breaks into pieces

39
Q

Casts

A

Plaster casts: less common; less expensive
Fiberglass casts: more common, lighter, better air flow, better X-ray visualization; more expensive

40
Q

Fracture Assessment

A

Assess Circulation:
-Color
-Pulses
-Sensation
-Movement
-Temperature
-Edema
-Wiggle toes/fingers without tingling/numbness

41
Q

Cast Management

A

Elevate extremity 24-72 hours after placement (reduces swelling and tightness)
Antihistamines for itching
Nothing inside the cast
Regularly assess circulation
Check for pressure as child grows
Cover cast when bathing/in water

42
Q

Compartment Syndrome

A

Complication of a fracture causing swelling or bleeding occurs within a compartment leading to increased pressure and disruption of blood flow to muscles and nerves
– Can lead to tissue death and permanent disability

43
Q

Neurovascular Assessment

A

Pallor - lack of profusion
Pain - most important finding, more intense than expected
Pulse - weak or absent
Paralysis - inability to wiggle toes or fingers
Paresthesia - tingling/Numbness

44
Q

Traction

A

Designed to decrease muscle spasms and realign and position bone ends

45
Q

Skin Traction

A

uses adhesive, moleskin, elastic bandage to pull indirectly on the skeleton

46
Q

Skeletal Traction

A

Uses pins and tongs to pull on skeleton directly

47
Q

Traction Assessment

A

Assess skin at site of pin insertion
Neurovascular assessment of extremity (pulses, warmth, brisk cap refill)
Assure that weights hang freely
Use pressure reducing surfaces
Prevent constipation (fluids, fiber, stool softeners)
Manage pain
Provide developmental stimulation

48
Q

Spica Cast

A

Extends from mid-chest to legs
Legs are abducted with a bar between them (never lift using bar)

49
Q

Spica Cast Care

A

Place disposable diaper under edges to prevent cast from getting soiled
Elevate head of bed so urine and stool drain downward
Reposition frequently to reduce pressure; check for pressure as the child grows

50
Q

Development Dysplasia of Hip

A

Abnormal development of the hip socket– Head of the femur comes out of the hip socket
Present at birth
Can affect one or both hips

51
Q

Etiology of DDH

A

Breech Delivery
Fetal position in utero
genetic predisposition

52
Q

DDH Assessment

A

Ortolani/Barlow Sign or Click
Shortened limb on the affected side (telescoping) Asymmetrical skin folds in gluteus and thighs from telescoping and dislocation

53
Q

DDH Treatment

A

Treated with Pavlik harness continuously for 6-12 weeks
– Effective in 95% of cases
Surgical reduction with hip-spica casting (for those not responsive to Pavlik harness

54
Q

Osteogenesis Imperfecta

A

Genetic disorder characterized by bones that break easily due to a collagen defect– Classified from less to more severe (e.g. from a few to hundreds of fractures in a lifetime)

55
Q

OI Assessment

A

Bones fracture easily, sclera is a blue tint, brittle teeth, thin skin, small stature, spinal curvature

56
Q

OI Intervention

A

No cure exists, maximize bone mass and muscle strength through exercise (e.g. swimming and walking, if able

57
Q

Osteomyelitis

A

An infection in a bone spreading from the bloodstream, adjacent tissue, or bone injury

58
Q

Osteomyelitis organism

A

most commonly staphylococcus bacteria commonly found on skin and in nose of even healthy individuals

59
Q

Osteomyelitis Assessment

A

More common in long bones in kids* Fever, pain, swelling, warmth, redness in affected region

60
Q

Osteomyelitis Management

A

4 to 6-week course of antibiotics
May require surgical removal of infected or necrotic tissue

61
Q

Scoliosis

A

A lateral curvature of the spine that may occur in the thoracic, lumbar, or thoracolumbar spinal segment

62
Q

Scoliosis Complications

A

Impaired growth and development
– Impaired mobility
– Debilitating pain
– Respiratory compromise

63
Q

Non-Structural Scoliosis

A

Unequal leg lengths
Abnormal posture

C-shaped curvature of spine
– Curve disappears when child bends at the waist to touch the toes (Adams-Bend test)

64
Q

Scoliosis Management

A

Shoe lifts (if unequal leg lengths the cause)
– Postural exercises (if poor posture is the cause)

65
Q

Structural Scoliosis

A

An S-shaped curvature of the spine
– Asymmetry of hips, ribs, shoulders, scapula
– Curve does NOT disappear when the child bends at the waist to touch the toes (Adams-Bend test)

66
Q

Structural Scoliosis Diagnosis

A

Diagnostic tests
– X-rays of the spine (definitive diagnosis)

67
Q

Structural Scoliosis Management

A

For mild to moderate curvatures < 40 degreeso Prolonged bracing
Tight t-shirt underneath
Keep skin beneath the brace clean and dry
Wear the brace as ordered (16-23 hours per day)
Provide psychological support
Traction
Electrical stimulation

CPN Exam (10 decks)

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