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endo Flashcards

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1
Q

PKU management

A

breast feed or Phe free formula forever (for protein), no meat or dairy, limited fruits and veggies, limit grains
meet nutritional needs for optimum growth, maintain Phe 2-6

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2
Q

PKU cm: untreated - kids

A

decreased height and weight, musty odor (urine and sweat), hypopigmentation (fair skin, blue eyes, bland hair, eczema), v, irritable, seizure, hyperactive, retardation

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3
Q

PKU cm: untreated - adults

A

short attention, poor short term memory, vision, decreased motor coordination, mood disorders, decreased grey matter
on diet for life!

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4
Q

PKU nc

A

test, teach (normal vaccine), refer for genetic counseling, support, flex feeding schedule, no extra developmental assessment, encourage early treatment

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5
Q

galactosemia cm

A

v, weight loss, jaundice, lethargy, hypotonia, cataracts
long term: learning disability, decreased IQ, short attention, behavior problems

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6
Q

galactosemia tm

A

lactose free, dont breast feed unless mom is dairy free, soy formula, Ca supplement, med caution - sensitive to penicillin and other meds that contain galactose

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7
Q

hypothyroid s/s

A

everything slows down
fatigue, exercise intolerance, slower reaction time, weight gain, constipation, sparse, coarse, dry hair and skin, slow pulse, cold intolerance, muscle cramps, sides of eyebrows thin or fall out, dull facial expression, hoarse voice, slow speech, droopy eyelids, puffy and swollen face, enlarged thyroid (goiter), increased menstrual flow and cramping in younger, hypotherm, large protruding tongue, short thick neck, delayed dentition, hypotonia, poor feed, mental defects if delayed diagnosis

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8
Q

hypothyroid nc

A

recognize early, compliance and periodic monitoring, med amin - teach to avoid heat, dont mix with soy, check interactions, not liquid

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9
Q

goiter nc

A

airway, noticeable with rapid growth (puberty), large are obvious and small must palpate (swallow)

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10
Q

goiter tm

A

oral hormone replacement, prompt treatment (brain growth), may admin in increasing amounts over 4-8 weeks to reach euthryroidism, compliance!! with meds for life

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11
Q

hyperthyroidism s/s

A

everything speeds up
enlarged thyroid (goiter), increased heart rate and BP, slight tremor, lighter and less frequent menstrual, irritated and bulging eyes with redness or visible blood vessles on white part, pain when moving eyes, inability to fully open eyelid, increased activity, restless, poor sleep, fatigue, increased appetite, increased BM, heat intolerance, decreased school performance, difficulty concentrating, lump in throat

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12
Q

hyperthyroidism tm

A

diagnose with T3 and T4 levels with decreased TSH
drugs (PTU) can cause agranulocytosis: toxic reaction that decreased wbc, if they have sore throat or fever they need to stop and isolate and call hcp to start abx and steroids (they are immunocompromised)

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13
Q

hyperthyroidism nc

A

identify, limit activity and demands, counsel fam and teachers (low stress), high cal and nutritious diet, meds (SE)

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14
Q

thyrotoxicosis

A

crisis or storm, can be life threatening
from sudden release of hormone, precipitated by infection, Sx, discont of antithyroid therapy

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15
Q

thyrotoxicosis tm

A

antithyroid drugs and propanolol

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16
Q

hypopituitarism - gh cm

A

absences or regression of secondary sex characteristics, normal h and w at birth and progressively deviate, distinguish from - constitutional delay, familial short stature, or genetic disorder (turners syndrome)
<3rd %, w normal-heavy, skeletal proportions normal, retarded bone age, appear younger, delayed perm teeth erupt, emotional issues because so small

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17
Q

hypopituitarism - gh tm

A

diagnose with history, assessment, x ray, low serum gh (stim test - q 30 min after insulin)
daily SQ GH injection until adult height (growth plate close around 14 or 18), may continue because of effect on bone and muscle, replace other hormones prn
very expensive and painful

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18
Q

hypopituitarism - gh nc

A

fam support - realistic expectation, response varies
body image
daily injection at bed, 5-7 times/wk
usually school aged
expensive
identify (plot on growth chart), assist with test, emotional support, teach, promote realistic expectation

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19
Q

precoscious puberty

A

before 9 or 8

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20
Q

precoscious puberty tm

A

treat cause, lupron (monthly IM) until they are supposed to start puberty, psych support

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21
Q

precoscious puberty - true/complete/central

A

lurpon
normal P, just happens early

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22
Q

precoscious puberty - premature therlarche

A

breast, dont treat, resolves on own

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23
Q

precoscious puberty - prematurue pubarche

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A

hair, not a problem

24
Q

precoscious puberty - premature menarche

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A

period without other development

25
CAH cm
cortisol down, sex hormones up (androgens) decreased stress response, hypogly, increased inflam response, hypotension, compromised immune, hyponatremic dehydration s/s males: precoscious puberty females: ambiguous genitalia - enlarged clit, fused labia, internal intact diagnose with untralsound, chromosome
26
CAH tm
confirm diagnosis, cortisone to decreased ACTH (rest of life), reconstructive sx
27
CAH nc
parental anxiety, teach parents s/s of dehydration and Na loss crises - injectable hydrocortisone, genetic counseling
28
DM 1 cm
3Ps, weight decrease, enuresis (urinalysis), irritable, fatigue, abdominal pain children, insulin dependent, autoimmune Beta cells, rarely overweight or fam history
29
DM 2 cm
overweight, fatigue, freq infection, acanthosis nigricans (skin folds) adults, not insulin dependent, body cant produce and use insulin, overweight, fam hx
30
DM 2 tm
weight loss, exercise, oral meds, insulin
31
DM 1 tm - mnt
fingerstick, eat whatever, count CHO based on what they ate avoid high sugar habits fat increases bg later, dont restrict carbs extra snack before activity, increase insulin with more food
32
DM 1 tm - insulin
rapid (15, 1, 3-4) long acting (4-6, 8-24, all day) intensive: basal/bolus - give based on fingerstick and how much they eat; pens, meters, sq ports changed q 7-10 days, extra batteries and back up kit, strips, alcohol, bandaids; fingerstick before meal and bedtime, count c post meal, sliding scale, combine, admin (rapid) blood glucose monitor (4x - meal and bedtime) and feel or display s/s and before phys activity
33
DM 1 tm - urine ketones
> 240, not enough insulin, when ill, on pump + >240
34
DM 1 dev - toddler
differentiate misbehavior from hypogly, report funny feeling, expect food jags, give choices (injection site, food choices)
35
DM 1 dev - preschooler
reassure not punishment, encourage participation, teach to report lows, teach what to eat when low
36
DM 1 dev - schoolager
educate school personel, age appropriate independence (supervise!), extracuricular, injection
37
DM 1 dev - adolescence
self care, meal plan and adjust, injection, risk takers (sleep late, skip breakfast, OH decreases BG so need to eat), parental involvement and support, menstruation and eating disorder
38
DM 1 tm - sick day
test urine ketones still give insulin and check more frequently
39
hypogly s/s
<60 low bg, hunger, HA, confusion, shaky, dizzy, sweat check BS
40
hypogly tm
check, 15 g rule (1/2c juice or soft drink, 1c milk, glucose tab, cake icing, honey > 1 yr, NO CHOCOLATE), follow with meal/snack (protein) severe - no swallow: glucagon emergency (expires), IM/SQ, on side bc v, feed when awake
41
hypergly s/s
>180 high BG, glucose in urine, polyuria, increased thirst
42
hypergly tm
check ketones, call hcp, increase fluids w/o caffeine (FIRST), no activity
43
ketosis and acidosis s/s
ketosis: 0.3 - 7.0 mmol/L acidosis when >7.0, pH <7.3 s/s: rapid breathing and deep, confusion, lethargy, abd pain
44
ketosis and acidosis tm
A/V BG, electrolytes, AG (low = low bicarb; high = met acidosis)
45
dka cm
deep and rapid breathing (kussmal, resp distress w/o lung patho), v dry mouth (dehyd with excessive UOP), , fruity breath, n/v (w/o d), lethargy, drowsy cerebral edema, hypergly, hypovolemia insulin deficiency with countereg to enhance gluconeogenesis, glycogenolysis, lipolysis hyper/hypoK: K loss from shift to extra to exchange with excess H+ in extra, out in urine dehyd: increased serum osmolarity, h2o shift extra, dilutional hypoNa - out in urine
46
dka tm
correct dehyd, acidosis and reverse ketosis, restore normal BG, avoid complications
47
DKA tm - fluid
NS at 10-20 mL/kg/hr, replace fluid deficit evenly ove 48 hr confirm DKA with labs
48
DKA tm - insulin
separate IV, prime with insulin, not given in first hour bc r/o cerebral edema, d/c any bodily insulin pump 0.1 U/kg/hr, continue until acidosis clears this will turn off ketone production, decrease blood sugar, check glucose q1hr low dose to decrease hypogly or hypok, dont drop more than 50-100 mg/dL/hr (cerebral edema) dont d/c based only on BG - pH >7.3 and HCO3 > 15 and serum ketones clear before admin: neuro, VS, BG continuous IV infusion, regular, high alert, dont give as bolus once BG 250 - 300, maintain insulin and give dextrose (acidosis takes longer to fix)
49
DKA tm - K
hour 2 if urinated start with insulin, consult pharm monitor! usually significant K deficit continue throughout IV therapy max rate is institution specific
50
DKA tm - dextrose
maintain BG 150 - 250, prevent hypogly add to IV when BG 250 - 300, change to 5% with .45 NaCl at rate to complete rehydration in 48 hr, check BG q1hr, electrolytes q2-4hr SQ insulin after DKA resolves
51
DKA tm - bicarbonate
contraindicated in peds bc cerebreal edema (consult) severe acidemia, life threatening hyperK
52
DKA nc - monitor q1
VS, neuro, I+O, poc BG, K cardiac - continuous
53
DKA nc - monitor q2
urine ketones, serum beta OH, serum glucose, electrolytes, BUN, Ca, Mg, P, hct, ABG
54
DKA tm - extra
may need O2, airway, suction, cath (no urine) need peripheral IV for sampling and insulin drip altered mental or LOC: airway, NG suction, bladder cath
55
DKA tm - high risk
icu: <7.1 or 7.2 + young, altered LOC, <5 yr, increased risk of cerebral edema prep for intubation caution with meds that alter LOC
56
DKA tm - transition off IV insulin
pH > 7.3 and HCO3 > 15 -18, AG < 12, eat SQ, d/c IV, IV dextrose, feed known DM pt: prior dosing new DM pt: .7-1 U/kg/day

peds 331 (28 decks)

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