Endocrine Dysfunction of The Child Flashcards Preview

Module 5 > Endocrine Dysfunction of The Child > Flashcards

Flashcards in Endocrine Dysfunction of The Child Deck (69):
1

diminished secretion of one or more pituitary hormones

hypopituitarism

2

what are the causes of hypopituitarism

tumors
genetic
r/t GH deficiency

3

over production of anterior pituitary hormone

hyperpituitarism

4

what are CM of hyperpituitarism

gigantism (excess growth hormone)
hyperthyroidism
hypercortisolism
precocious puberty

5

what are CM of growth hormone deficiency

normal growth during 1st year but slowed after
primary teeth appear at normal age but permanent teeth delayed
teeth over crowded
delayed sexual development

6

how is growth hormone deficiency dx

family hx
physical exam
x-ray/MRI
endocrine studies
growth chart
genetic testing

7

what is the therapeutic treatment for GH deficiency

correct underlying disease or give GH replacement (expensive but 80% successful)

8

CM of GH EXCESS before closure of epiphyseal shafts

proportional overgrowth of the long bones
rapid/increased muscle development
weight increase in proportion with height
proportional head enlargement

9

CM of GH EXCESS after closure of epiphyseal shafts

acromegaly
increased facial hair
thickened skin
increase for hyperglycemia and DM

10

who is GH excess dx

hx of excess growth
increased levels of GH
enlargement of bones

11

what is the therapeutic mngmt of excess GH

removal of tumor/lesion if present
external radiation or radioactive implants
meds

12

hypo function of the posterior pituitary and under secretion of antidiuretic hormone

Diabetes Insipidus (DI)

13

____ is an early sign of some other ______ thing going on

DI; cerebral

14

what are the cardinal signs of diabetes insipidus

polyuria and polydipsia

15

what are CM of DI in older children

excessive urination accompanied by compensatory insatiable thirst (1st sign is bedwetting= enuresis)

16

what are CM of DI in infants

irritability relieved with feeding of WATER not milk
prone to dehydration

17

what is the therapeutic mngmt of DI

hormone replacement of desmopressin
* remember it is LIFELONG treatment

18

what is important teaching for DI

DI is different form DM
tx is lifelong
correct admin of desmopressin
child should wear med alert ID
carry desmopressin nasal spray with them

19

hyper function of posterior pituitary and over secretion of antidiuretic hormone

syndrome of inappropriate antidiuretic hormone (SIADH)

20

SIADH results in _____ intoxication and ______

water; hyponatremia

21

what are CM of SIADH

anorexia
nausea
vomiting
stomach cramps
irritability
personality changes
progressive decrease in sodium (stupor, seizures)
serum sodium levels 120mEq/L

22

what is the therapeutic mngmt of SIADH

fluid restriction (brain starts to swell from excess water)
correction of underlying disorder

23

what is the nursing care for SIADH

early recognition of S/S
I&O
daily weight
watch for fluid overload
seizure precautions
educate regarding fluid restriction

24

decrease levels of ADH
increase urine output
increase serum sodium
dehydrated
lose too much fluid

Diabetes Insipidus (DI)

25

increase levels of ADH
decrease urine output
decrease serum sodium
over hydrated
retain too much fluid

SIADH

26

acquired from partial/complete thyroidectomy
following radiation tx for malignancy
infectious process
dietary iodine deficiency

juvenile hypothyroidism

27

CM of juvenile hypothyroidism

decelerated growth
myxedematous skin
constipation
sleepiness
lethargy
mental decline
delayed puberty
excessive weight gain

28

therapeutic tx for juvenile hypothyroidism

oral thyroid replacement
prompt tx in infants to help brain growth
*lifelong treatment

29

juvenile autoimmune thyroiditis

hashimoto disease (Lymphocytic thyroiditis)

30

CM of hashimoto's

enlarged thyroid
some have symptoms of hypothyroid or hyperthyroid

31

how is hashimoto's dx

normal thyroid function test
serum antibody titiers to thyroid antigents

32

what is the therapeutic mngmt of hashimoto's

goiter regresses spontaneously within 1-2 years
oral thyroid hormone replacement
sx contraindicated

33

what is the nursing care for hashimoto's

identify thyroid enlargment
reassure it may be temporary
therapy will be life long and take in the morning on an empty stomach (30 min before)

34

most common cause of HYPERthyroidism in children

graves disease

35

excessive motion
gradual weightloss
accelerated linear growth and bone age
muscle weakness
vomiting/frequent stool
cardiac manifestations
dyspnea
warm, moist skin
heat intolerance
unusual fine hair
exopthalmus

CM of graves disease

36

how is graves disease dx

increase t4 and t3
suppressed TSH

37

what is the therapeutic mnmgt of graves disease

when s/s are noted activity should be limited to classwork only
antithyroid drugs
subtotal thyroidectomy
ablation with radio iodine

38

what is important to tell children who take PTU or MTZ

monitor vital signs such as sore throat and fever because these accompany grave complications of leukopenia

39

characterized by hyperglycemia and insulin resistance

Diabetes Mellitus

40

what are the 3 cardinal signs of DM

polyuria
polydipsia
polyphagia

41

destruction of pancreatic beta cells that produce insulin
absolute insulin deficient

type 1 DM

42

relative insulin deficiency
insulin resistant
body fails to use insulin properly

type 2 DM

43

S/S of type 1 DM

3 p's
hyperglycemia
rapid weightloss
dry skin
irritability
drowsiness
abd discomfort
ketoacidosis

44

S/S of type 2 DM

3p's
fatigue
blurred vision
slow healing sores
frequent infections
areas of dark skin (acanthosis nigricans)

45

what is acanthosis nigricans

plaque due to increased insulin levels

46

what is the difference internment between type 1 and type 2 DM

type 1 uses insulin and type 2 uses oral medication (metforman and glucophage)

47

to dx DM what should the 8hr fasting BG level be

greater than or equal to 126mg/dl

48

to dx DM what should the random BG be

greater than or equal to 200 mg/dl with classic s/s of diabetes

49

to dx DM what should the oral glucose tolerance test be

greater than or equal to 200mg/dl in the 2 hr sample

50

to dx DM what should the hemoglobin A1C be

greater than or equal to 6.5%

51

what insulin should you give within 15 minutes of a meal

rapid

52

this insulin is cloudy

intermediate

53

cannot be mixed in a syringe with any other insulin

long acting (Lantus)

54

this insulin is given 30min before a meal

short acting

55

what insulins can be mixed together

rapid/short with NPH

56

what are the 5 insulin injection sites

outer arm
abd
hip area
thigh

57

why is it important to rotate insulin injection sites

to prevent lipoatrophy (pitting)
and lipohyperthrophy (build up of subQ)
-thes both can affect absorption of insulin

58

what are the drawbacks of insulin pumps

they can malfunction and are not cheap

59

when can absorption of insulin be altered

during exercise and an illness so self monitoring is a must

60

what is the goal of BG

80-120 mg/dl

61

what are s/s of hypoglycemia

shaky
hungry
pale
HA
confusion
disoriented
lethargy
change in behavior

62

what is the tx for hypoglycemia

simple carb then follow with complex carbohydrate, then protein

63

what are simple carbs

OJ, apple juice, soda

64

what are complex carbs

PB crackers, meat and cheese sandwich

65

what happens if a pt is unconscious, seizes, or cannot swallow and they are hypoglycemic

give glucagon
IM/SQ

66

hypoglycemia followed by rebound hyperglycemia (more common for type 1)

somogyi effect

67

what is the treatment for smoggy effect

reduce bedtime insulin to prevent early a.m. hypoglycemia

68

during illness how should DM be managed

monitor BG every 3 hrs
monitor urine ketones every 3 hrs or when glucose is > 240
*still have to give insulin even when they are sick

69

how should we manage diabetic ketoacidosis

rapid assessment
adequate insulin
fluids for dehydration
electrolyte replacement (K)
*slowly bring BG down to prevent cerebral edema