Endocrine Dysfunction Flashcards
(153 cards)
1
Q
S/S of T1DM
A
3 Ps (polyphagia, polyuria, polydipsia)
wt loss
bed wetting to nocturia
irritable (not themselves)
short attention
low frustration
dry, flushed skin
blurred vision
poor wound healing w/ infections
fatigue
HA
Hyperglycemia (glucosuria)
Diabetic ketosis ( ketones and glucose in urine, dehydration)
DKA (dehydration, electrolyte imbalance, acidosis, deep, rapid breathing)
2
Q
Monitoring of Blood Glucose Levels using
A
self-monitoring and control of insulin (tolerate)
3
Q
Glycosylated hemoglobin monitoring
A
Reflects the glucose level in the blood from 2-3 months
- assess control and effectiveness
- detects nonadherence
4
Q
Nondiabetic levels for A1C
A
4-6%
5
Q
Diabetic child’s A1C acceptable level
A
6.5-8%
6
Q
It is recommended that urine ketone tests be done every ____ hours during an illness.
A
3
7
Q
When should you check for ketones in the urine?
A
illness
glucose level is over 240 without an illness
8
Q
What are acceptable ways to monitor diabetes?
A
Blood glucose tests (finger)
Hemoglobin A1C
9
Q
Hypoglycemic episodes most commonly occur
A
before meals or when insulin effect is at its peak
10
Q
Hypoglycemic S/S
A
rapid (minutes)
labile, irritable, nervous
difficulty concentrating
shaky
hunger
COLD AND CLAMMY
Tachycardia
tremors
11
Q
Hypoglycemia is when the glucose is below
A
60
12
Q
Hyperglycemia s/s
A
High and dry, sugar high
gradual over days
lethragic
confused
thirtst, weak
N/V
flushed and dry (dehydrated)
low hr
KUSSMAUL BREATHING
13
Q
Hyperglycemia with s/s occurs when the glucose is
A
greater than 250
14
Q
Rule of thumb for hypoglycemia
A
15-15-15 rule
15g of simple arb
wait 15 to check glucose
15g protein and fat
15
Q
Mild hypoglycemia
A
fruit juice
16
Q
Severe hypoglycemia
A
glucagon
- vomiting can occurs so caution aspirations
17
Q
Rebound hyperglycemia
A
Somogyi effect
- elevated glucose at bedtime and drop at 0200 and rebound later
18
Q
Endocrine System controls and regulates
A
metabolism
- energy production
- growth
- fluid and electrolyte balance
- response to stress
- sex development
19
Q
Hormones are
A
Chemical substances which control/regulate activities of other cells/organs
20
Q
Hormones are regulated by
A
endocrine glands into bloodstream
feedback mechanism
21
Q
What is the master gland of the endocrine system?
A
Anterior Pituitary
22
Q
Anterior pituitary gland is controlled by
A
hypothalamus
23
Q
What hormone is regulated by other mechanisms
A
Insulin - glucose regulated
24
Q
Hypopituitarism is caused by 1+ of these hormones
A
Gonadotropin deficiency
-Absence of secondary sex hormones
Growth hormone (GH) deficiency
Thyroid-stimulating hormone (TSH) deficiency
Adrenocorticotropic hormone (ACTH) deficiency
25
Gonadotropin deficiency causes
Absence of secondary sex hormones
26
Hypopituitarism Caused by
**Tumors** (brain or in the pituitary gland)
Incomplete/**underdevelopment** of the pituitary gland or hypothalamus
Congenital (with hypoglycemia and seizures)
Surgery in the brain or near
**Radiation**
Trauma
Autoimmune
Idiopathic
27
The s/s of hypopituitarism of the GH deficiency shows what after the 1st year?
below the 3rd percentile
28
GH
stimulate linear growth across growth
BUT stops growing height after 1st year
29
S/S of GH deficiency
After 1st year - below **3rd **percentile
**Height stunted** more than weight
-**appear overwt**
Skeletal proportions normal for age
Primary teeth - normal age
**Permanent teeth – delayed**
Teeth **overcrowded and mispositioned – smaller underdeveloped jaw**
Delayed sexual development till 30-40
30
Hypopituitarism is mainly the deficiency of what hormone?
growth
31
What teeth are delayed in hypopituitarism?
permanent
- overvrowded and mispositioned becuase of the smaller underdeveloped jaw
32
Sexual development is delayed till when with hypopituitarism?
30-40
33
What needs to be ruled out before dx hypopituitarism?
Failure to Thrive
34
Dx of Hypopituitarism
Family Hx – parents appearance, growth hx, siblings
- Prenatal = maternal disorder r/o
- Chronic illness – congenital heart defects
- **Physical exam – accurate ht and wt to watch trends**
X-rays/MRI – <3 y/o
If 3+ then just the arms for maturity of the bones (delayed)
- Brain lesions
Endocrine studies
- Low GH stimulation test
Genetic testing
35
To truly diagnose GH deficiency then need
-poor linear growth
- delayed bone age
- abnormal GH stimulation test
36
Growth Hormone stimulation test
Baselines with fluids
Over hours they will give medications to stimulate the GH and draw labs afterwards
- to show responses
37
Hypopituitarism Tx
correct **underlying** (tumors)
**Growth Hormone replacement** – 80% success
- Biosynthetic growth hormone - SQ daily *at bedtime (natural)*
- Very expensive (insurance partial if doc deficiency sometimes)
38
Child and Family Support in Hypopituitarism
- parents have anger or guilt towards not growing bc disease
Human Growth Foundation
Research, education, support groups, bully prevention
39
Why are X-rays used for Hypopituitarism?
less than 3 = entire body
3+ = hands and wrists
mature and body age and if delayed then GH deficiency
40
What is the growth rate of GH replacement therapy for hypopituitarism?
initially, significant growth then tapers off with slow continues
Continue till bone maturation (boys 16 and girls 14)
41
Hyperpituitarism
overproduction of anterior pit. gland
42
Hyperpituitarism caused by
Hyperplasia of pituitary cells - over g**rowth or tumor formation**
Primary hypothalamic defect
43
Hyperpituitarism complications
Gigantism – excess growth
Hyperthyroidism -
Hypercortisolism – Cushing’s
Precocious puberty
44
S/S of Hyperpituitarism **Before** GROWTH PLATE CLOSURE
Proportional overgrowth of long bones (8ft tall)
Rapid & increased muscle development
Weight increase **in proportion** to height
Proportional head enlargement
**Delayed fontanel closure**
45
S/S of Hyperpituitarism **After** GROWTH PLATE CLOSURE
**Acromegaly**
Enlarged facial features
Separation and malocclusion of teeth
Enlarged hands/feet
Increased facial hair
Thickened, deeply creased skin
Deep/husky voice
**Increased slow tendency toward hyperglycemia & DM**
46
Hyperpituitarism and Acromegaly grow how?
not taller grow transverse
- slow and gradually
overtime look different
47
If Acromegaly is untreated
high mortality due to cardiovascular, metabolic and respiratory complications
48
Hyperpituitarism Dx
History of excessive growth
Increased levels of GH
**Normal bone age
Enlargement of bones**
Endocrine studies – **excess of thyroid, cortisol, and sexual**
49
Hyperpituitarism Tx
Removal of tumor/lesion if present
External radiation/radioactive implants
Pharmacologic agents
**Transphynode surgery**
suppression of GH drugs
emotional support
50
What famous person has acromegaly?
Lincoln
51
Precocious puberty
early onset of sexual development
- more in girls
52
Hyperpituitarism puberty onset when a boy
before 9
53
Hyperpituitarism puberty onset when a caucasian girl
before 7
54
Hyperpituitarism puberty onset when an AA girls
before 6
55
What are the different precocious puberty types
Central (80%)
Peripheral
Incomplete
56
Central Precocious puberty
the hypothalamus releases puberty hormones **too early and matures faster**
- idiopathic
57
Peripheral Precocious puberty
release of androgens by glands cause **secondary sex**characteristics, **testes and ovaries produce – no maturation of gonads**
58
Incomplete Precocious puberty
**one random secondary sex characteristics**
59
Precocious Puberty Tx
Treat specific causes if known (usually regress later on)
MRI
Synthetic hormones
**Lupron Depot injections (1-3 months depending)
histrelin implant (1-2 years)**
60
Precocious Puberty Therapy goal
Slow/stop pubertal progression (shorter than peers to reach normal ht)
Allow for normal adult height
61
Precocious Puberty Nursing Considerations
Family Education injections & side effects
Emotional support
Provide **privacy during physical examination (self-conscious)**
Expression of concerns by the child
**Dress = chronological age**
**Reassurance** regarding physiologic changes
Child’s social, cognitive, & emotional development match chronological age
62
What side effects of Lupron Depot injections (1-3 months depending)
mood swings or hot flashes
63
What would you say to a child going through hypopituitarism and precocious puberty if they are self-conscious?
Everything is normal it is just happening at a quicker rate than usual
64
Juvenile Hypothyroidism
is caused by
- Congenital
- Acquired
congenital = **underdeveloped thyroid gland**
acquired =
Partial/complete thyroidectomy
**Following radiation treatment
Infectious processes**
Dietary iodine deficiency
65
Thyroid levels in Juvenile Hypothyroidism in congenital
low T3-4
High TSH
66
Congenital Juvenile Hypothyroidism may not show until
at growth spurts because their body may only have the bare minimum and not ready for more
67
Juvenile Hypothyroidism has a more profound ________ than GH hormone and increases TSH
growth
68
Acquired Juvenile Hypothyroidism S/S
Thyromegaly – **enlarged thyroid gland**
Decelerated growth - later age
Myxedematous skin changes (dry skin, change in hair)
Constipation
Sleepiness
Lethargy
**Mental decline –
Delayed puberty
Excessive weight gain**
69
Congenital Juvenile Hypothyroidism S/S**
thick tongue
jaundice
floppy
umbilical hernia
hoarse cry
constipation
dry skin
large fontanel opening
mental decline
70
Juvenile Hypothyroidism Tx
Oral thyroid hormone replacement - levothyroxine
**Prompt** treatment in infants
**Lifelong** treatment
71
Juvenile Hypothyroidism Edu for Family
Daily **compliance** with medication - provide resources
Periodic blood work monitoring of serum thyroid levels
72
Juvenile Hypothyroidism needs to maintain
compliance with medication
the quicker the Tx the better development (1st 3 months)
73
Alpha cells produce what
glucagon
- raises sugar
74
Beta cells produce what
insulin -lower sugar
75
Delta cells produce what
sumadostatin
- increases glucagon and insulin depending on what is needed
(Balance)
76
Pancreatic Hormone Functions with what system in the pancreas
Islet of Langerhans
77
Islet of Langerhans produce what cells
Alpha
Beta
Delta
78
DM is a
chronic disorder of metabolism
with hypo and hyperglycemia
- can not use food for energy
79
Does DM have a cure?
no
80
What is the PATH of DM?
Sugar stays in the bloodstream due to the insulin not taking it into the cells
- insulin does not block the amount of glucose - causes build up
81
Type 1 DM is the
absolute destruction of pancreatic beta cells
82
Which type of DM has absolute insulin deficiency?
Type 1
83
What are the different forms of T1DM?
Trigger?
Immune-mediated – autoimmune destruction
Idiopathic – Not simply inherited
- Genetic predisposition + trigger event (virus)
84
S/S T1DM
**Polyuria
Polydipsia
Polyphagia**
Hyperglycemia
**Rapid weight loss due to breakdown of fat**
**Dry** skin
Irritability
Drowsiness/fatigue
***Abdominal discomfort***
Ketoacidosis leads to GI s/s
85
T1DM management
Insulin-dependent
Monitor glucose levels
Lifestyle changes
Nutrition
Exercise
Team Approach - family members for education with multiple lessons
86
What animal is used for Diabetes Education in Pediatrics?
Coco the monkey from Disney
- books with it
87
What is the DM for relative insulin deficiency?
Type 2
- resistance and body **failure to use insulin properly**
88
What pts have an increased risk of T2DM?
adults > 45 years of age
overweight
sedentary lifestyle (lack of exercise and poor nutrition)
family history of DM
89
T2DM has an increasing prevalence in
children/adolescents
- eating habits and lack of exercise
90
T2DM S/S
**Polyuria
Polydipsia
Polyphagia**
Fatigue
**Blurred** vision
**Slow-healing** sores
Frequent infections
*Polycystic ovary syndrome*
**Areas of darkened skin (acanthosis nigricans)**
91
acanthosis nigricans
areas of darkened skin
92
T2DM Tx
Lifestyle changes
Nutrition
Exercise
Oral medication - Metaformin
Possibly insulin – if hyperglycemic
Monitor glucose levels
93
What is the oral medication for T2DM
Metformin
- decrease absorption of sugar in the body
- decrease usage of insulin
94
T2DM Dx
**8-hour fasting blood glucose level ≥126 mg/dl**
Random blood glucose ≥ 200 mg/dl with classic signs of hyperglycemia
Oral glucose tolerance test ≥ 200 mg/dl in the 2-hour sample
**Hemoglobin A1C ≥ 6.5%**
95
T2DM if 8-hour fasting blood glucose level
≥126 mg/dl
96
T2DM if random blood glucose is
≥ 200 mg/dl with classic signs of hyperglycemia
97
T2DM if oral glucose tolerance test
≥ 200 mg/dl in the 2-hour sample
98
T2DM if Hemoglobin A1C
≥ 6.5%
99
Mixed insulin is the combination of
intermediate & rapid-acting
100
What are the different types of insulin?
rapid
short
intermediate
long
101
What is the most important need to remember with insulin?
timing of food and insulin
102
With rapid insulin, you need to eat within
15 minutes of food
103
With short insulin, you need to eat within
30 minutes before meal
104
What insulin is cloudy looking?
intermediate
105
What insulin can not be mixed in a syringe with other insulins and must be given separately at a different site?
long-acting
106
When do you dilute insulin?
less than 12 months
and extremely young infants because of small body
107
Conventional mgmt in insulin dosing means
twice daily dosing (before breakfast and supper)
- rapid/short-acting mixed with intermediate
108
Intensive therapy mgmt in insulin dosing means
multiple injections
**Long-acting once or twice daily plus rapid-acting prior to each meal**
- **Better control**, fewer long-term complications
- 20-24 hours: **basal release morning or night**
109
Insulin Administration DM
Subcutaneous administration
- PINCH METHOD WITH LIMITED ADIPOSE TISSUE
Rotate sites
Insulin absorption
Atraumatic care: shot blocker interferes with nerve transmissions
110
What insulin site is the fastest rate of absorption and shortest to stop?
abdomen
111
What insulin site is the longest to activate/absorb and lasts longer?
Buttocks
112
Insulin injection sites
outer arm
abdomen
hip area
thigh
113
Insulin Administration methods
Sub Q injections
Insulin Pen to smart
Insulin Pump (omnipod, i-Port)
114
An insulin pump site changed every
48-72 hours
- up to 75 injections
Atraumatic care
115
What is the drawback of an insulin pump?
tech does not always work
DKA
116
With DM, what is a must
self-monitoring
117
What alters insulin administration absorption?
exercise
illness
118
What is the goal level of blood glucose?
blood glucose 80-120 mg/dl
119
What is the goal level of hemoglobin A1C?
6.5-8% (younger people are able to run higher and older people are able to run lower <7.5%)
- over the last 3 months
120
Finger sticks atraumatic care
Warm the finger (warm water)
Use ring finger and thumb
Puncture side of finger pad
Press the lancet device lightly against the skin
Use a lancet device with adjustable-depth tips
Use glucose monitors that require small samples
121
Continuous Glucose Monitor (CGM) replacement of sensors
every 3-7 days
122
Hyperglycemia caused by
**Too little insulin - missed dose**
Illness/infection/immunizations
Injury
Stress- physical/emotional
Growth
Medications - steroids
Menses
123
Hyperglycemia S/S
Thirst
**Polyuria (early)**
Nausea
Blurred vision
Fatigue
DKA
**Oliguria (later)**
124
Hyperglycemia Tx
Drink fluids
Administer additional insulin
Monitor glucose more closely
125
Hypoglycemia S/S
**Too much insulin**
Diet
Exercise
Alcohol
Growth spurts
Puberty
Illness (esp. with vomiting)
126
In younger children is it okay to give insulin after they eat?
yes, because they won' be honest about when they eat
127
Hypoglycemia S/S
**Shaky/sweaty
Hungry**
Pale
HA
Later=
- Confusion, Disorientation, Lethargy, slurred speech
- Change in behavior (glucose not getting into the brain - dizzy
**cold and clammy need some candy**
128
Hypoglycemia Severe S/S
Inability to swallow
Seizure/convulsion
Unconsciousness
129
Hypoglycemia Tx
Check blood sugar if possible
When in doubt, give 15g of simple carbohydrate (milk or juice)
WAIT and redo after 15 minutes
Followed by complex carbohydrate & protein
- reassess
Glucagon
130
If you cannot differentiate between hypo and hyperglycemia, what do you treat it as if you cannot get a glucose reading?
Hypoglycemia
- simple and complex carb (milk)
131
In HYPOGLYCEMIA, if the patient becomes unconscious, seizes, or cannot swallow (side lying)
Glucagon
- Mixed and given IM/SQ or Intranasally (baqsimi)
Releases stored glycogen from the liver
Should increase blood glucose in 15 minutes
Can cause nausea/vomiting (side lying)
Protect from aspiration
132
Vascular changes in DM long-term complications
Involves small and large vessels
Nephropathy
Retinopathy
Neuropathy
Cardiovascular
Hypertension
Atherosclerosis
133
Other long-term complications in children with T1DM
Altered thyroid function – at dx and poor controlled
Limited mobility – small joints of the hand (7-8 years old)
134
If the pt has a good control of DM, long term complications will develop in
20+ years
135
See a eye dr when after T1DM
2-3 YEARS AFTER DIAGNOSIS
136
See a eye dr when after T2DM
Initially after dx
137
DM Education
Explanation of diabetes
Meal planning
Administering insulin injections
Monitor hygiene - good health early on
Promote exercise
Record keeping
Observe for complications
Family **support and camps**
138
What does a diabetic always need to carry?
Glucose tablets
Insta-glucose
Sugar cubes
Candy
139
When should you exercise on DM?
WITH GOOD CONTROL
- decreases insulin requirements
140
When should you not exercise on DM?
Illness or With poor control if more than 240+
may stimulate ketoacidosis
141
Nutrition for DM
**Sufficient calories to balance daily expenditure for energy and growth**
**Constant carb** diet-exchange system
Consistent intake
**Timing of food** coincides with time/action of insulin
Total # of calories/proportions of basic nutrients needs to be consistent day-to-day
142
T1DM Education for toddlers and preschoolers needs to allow them to
make food choices and monitor carbs
- temper tantrums are s/s of possible hypoglycemia
snacks during increased activity
143
T1DM illness mgmt
glucose every 3 hours
urine ketones every 3 hours or when glucose is 240+
- always given insulin during illness and intake carbs
144
T1DM illness goals
Maintain normal glucose
Treat urinary ketones
**Maintain hydration**
rest
145
Diabetic Ketoacidosis is the complete state of
insulin deficiency
146
Patho of DKA
**Lack of insulin → glucose unavailable for cellular metabolism → body burns fat for energy → fat breaks down into fatty acids → glycerol in fat cells converted to ketones in liver → excess eliminated in urine (ketonuria) or lungs (acetone breath)
147
Ketonemia
ketones in the blood
- strong acids lowering of pH producing ketoacidosis
148
DKA with cellular death what is released and what are the aftereffects?
**Potassium** released from cells into the bloodstream and excreted by kidneys
Total body potassium decreased even though serum potassium may be elevated **(decreased circulating fluid volume) - keep K in the body**
Alteration in serum and tissue potassium can lead to cardiac arrest
149
If DKA is not reversed by insulin and electrolyte correction, then what will occur
progressive deterioration occurs (dehydration, electrolyte imbalance, acidosis, coma, death)
150
Mgmt of DKA
Rapid assessment
Adequate insulin to reduce elevated level
Fluids
NPO
Monitor renal functions
**Electrolyte replacement (especially potassium)
- need renal function before administering**
151
PICU mgmt of DKA
**IV X2 – cont. insulin drip and K NS, dextrose with insulin
- slowly lower every hour check**
Cardiac monitor bc low K
Labs
NPO
Hourly BG checks
Possible O2
Possible NG (unconscious pt)
Possible antibiotics
152
How do you bring down the blood sugar in DKA?
GRADUALLY and slowly
prevent cerebral edema
153
DKA happens frequently with DM having an
infection
