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Module 5 > Endocrine Dysfunction of The Child > Flashcards

Endocrine Dysfunction of The Child Flashcards

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1
Q

diminished secretion of one or more pituitary hormones

A

hypopituitarism

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2
Q

what are the causes of hypopituitarism

A

tumors
genetic
r/t GH deficiency

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3
Q

over production of anterior pituitary hormone

A

hyperpituitarism

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4
Q

what are CM of hyperpituitarism

A

gigantism (excess growth hormone)
hyperthyroidism
hypercortisolism
precocious puberty

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5
Q

what are CM of growth hormone deficiency

A

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

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6
Q

how is growth hormone deficiency dx

A 
family hx
physical exam
x-ray/MRI
endocrine studies
growth chart
genetic testing
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7
Q

what is the therapeutic treatment for GH deficiency

A

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

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8
Q

CM of GH EXCESS before closure of epiphyseal shafts

A

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

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9
Q

CM of GH EXCESS after closure of epiphyseal shafts

A

acromegaly
increased facial hair
thickened skin
increase for hyperglycemia and DM

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10
Q

who is GH excess dx

A

hx of excess growth
increased levels of GH
enlargement of bones

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11
Q

what is the therapeutic mngmt of excess GH

A

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

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12
Q

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

A

Diabetes Insipidus (DI)

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13
Q

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

A

DI; cerebral

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14
Q

what are the cardinal signs of diabetes insipidus

A

polyuria and polydipsia

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15
Q

what are CM of DI in older children

A

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

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16
Q

what are CM of DI in infants

A

irritability relieved with feeding of WATER not milk

prone to dehydration

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17
Q

what is the therapeutic mngmt of DI

A

hormone replacement of desmopressin

* remember it is LIFELONG treatment

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18
Q

what is important teaching for DI

A 
DI is different form DM
tx is lifelong
correct admin of desmopressin
child should wear med alert ID
carry desmopressin nasal spray with them
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19
Q

hyper function of posterior pituitary and over secretion of antidiuretic hormone

A

syndrome of inappropriate antidiuretic hormone (SIADH)

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20
Q

SIADH results in _____ intoxication and ______

A

water; hyponatremia

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21
Q

what are CM of SIADH

A 
anorexia
nausea
vomiting
stomach cramps
irritability 
personality changes
progressive decrease in sodium (stupor, seizures)
serum sodium levels 120mEq/L
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22
Q

what is the therapeutic mngmt of SIADH

A 
fluid restriction (brain starts to swell from excess water)
correction of underlying disorder
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23
Q

what is the nursing care for SIADH

A 
early recognition of S/S
I&O
daily weight
watch for fluid overload
seizure precautions
educate regarding fluid restriction
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24
Q 
decrease levels of ADH
increase urine output
increase serum sodium
dehydrated
lose too much fluid
A

Diabetes Insipidus (DI)

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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 ```

Module 5 (18 decks)

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