ENDOCRINE/ METABOLIC DISORDER Flashcards
(24 cards)
1
Q
GROWTH HORMOME DEFICIENCY
A
- Children cannot grow to full size
- production of human growth hormone (GH, or somatotoprin) is deficient.
- If not treated, most will not reach more than 3 or 4 feet in height
-In most children with hypopituitarism the cause of the defect is unknown
2
Q
GROWTH HORMOME DEFICIENCY: PATHOPHYSIOLOGY
A
Deficient production of GH may result from a nonmalignant cystic tumor of embryonic origin that places pressure on the pituitary gland or from increased intracranial pressure as a result of trauma.
3
Q
GROWTH HORMOME DEFICIENCY S/Sx
A
- child with deficient production of GH is usually normal in size and weight at birth
- first few years of life however, the child begins to fall below the third percentile of height and weight on growth charts
- face appears infantile because the mandible is recessed and immature
- nose is usually small
- Child’s teeth may be crowded in a small jaw
- Child’s voice is high pitched
- delayed onset of pubic, facial, and axillary hair and genital growth
4
Q
GROWTH HORMOME DEFICIENCY THERAPEUTIC MANAGEMENT
A
- administration of intramuscular(IM) recombinant human growth hormone(rhGH) two or three times a week
- Somatoprin (Nutropin, Humatrope)”.
- usually given at bedtime, the time of the day at which GH normally peaks.
5
Q
DIABETES INSIPIDUS
A
- decreased release of antidiuretic hormones(ADH) by the pituitary gland
- may reflect an X-linked dominant trait, or it may be transmitted by an autosomal recessive gene.
- may result from lesion, tumor, or injury to the posterior pituitary
- may have an unknown cause
6
Q
DIABETES INSIPIDUS S/Sx
A
- experience thirst
(polydipsia) that is relieved only by drinking water, not breast milk or formula - polyuria
- Parents may notice polyuria first as bedwetting in a toilet trained child - Weight loss occurs because of the large loss of fluid
- 3 P’s
- Polydipsia
- Polyuria
- Polyphagia
7
Q
DIABETES INSIPIDUS THERAPEUTIC MANAGEMENT
A
1.If tumor is present
- Surgery
- If the cause is idiopathic
- condition can be controlled by the administration of desmopressin (DDAVP).
8
Q
DIABETES INSIPIDUS NURSING INTERVENTIONS
A
- Teach about Long Term Therapy
- Help the family establish a routine to ensure that the child receives adequate fluid
- access to bathroom facilities possibly more frequently than others. - Encourage communication
- always notify health care providers that the child has diabetes insipidus.
- Help the child and family plan frequent bathroom stops and adequate fluid intake
9
Q
CONGENITAL HYPOTHYROIDISM
A
- result of an absent or nonfunctioning thyroid gland in a newborn baby.
- cause of the disorder is usually unknown
- woman with hyperthyroidism can cause the fetal thyroid not to fully develop
10
Q
CONGENITAL HYPOTHYROIDISM S/Sx
A
- early sign: excessive sleep
- tongue becomes enlarged, causing respiratory difficulty, noisy respirations, or obstructions.
- neck appears short and thick
- extremities appear short and fat
- hypotonic muscles giving the infant a floppy, rag-dull appearance
- Overall the skin is dry and perhaps scaly, and the child does not perspire
11
Q
CONGENITAL HYPOTHYROIDISM THERAPEUTIC MANAGEMENT
A
- oral administration of synthetic thyroid hormone
- sodium levothyroxine. - Supplemental vitamin D
- given to prevent the developments of rickets when, with the administration of thyroid hormones. - Helping parents administer medication over a long period is major nursing role.
- Ensure parents know the rules for long term medication administration with children, particularly the rule about not putting medicine in large amount of food
- thyroxine tablets must be crushed and added to food or small amount of formula or breast milk
12
Q
ACQUIRED HYPOTHYROIDISM (HASHIMOTO’S THYROIDITIS)
A
- MOST common form of acquired hypothyroidism.
- occurs more often in girls than boys at the age of 10 to 11 years.
- decrease in the thyroid secretions is caused by the development of an autoimmune phenomenon
13
Q
ACQUIRED HYPOTHYROIDISM (HASHIMOTO’S THYROIDITIS) S/Sx
A
- In infants
- congenital goiter can lead to airway obstruction - In children
- prominent symptoms are obesity, lethargy, and delayed sexual development. - thyroid not only enlarges but may become nodular in response to the over secretion of thyroid-stimulating hormone
- If the nodes are benign
- rapid uptake of radioactive iodine (hot nodes) - If there is no uptake (cold nodes)
- carcinoma is a much more likely diagnose (rare)
14
Q
ACQUIRED HYPOTHYROIDISM (HASHIMOTO’S THYROIDITIS) THERAPEUTIC MANAGEMENT
A
- administration of synthetic thyroid hormone (sodium levothyroxine), the same as foe congenital hypothyroidism
- Disease recognized as early as possible so there is time to stimulate growth before the epiphyseal lines close at puberty
15
Q
HYPERTHYROIDISM (GRAVE’S DISEASE)
A
- over secretion of thyroid hormones by the thyroid gland.
- more common in girls than in boys
- Occurs at the time of puberty or during adolescence
- In children: caused by an autoimmune reaction that results in overproduction of immunoglobulin G (IgG), which stimulates the thyroid gland to overproduce thyroxine.
16
Q
HYPERTHYROIDISM (GRAVE’S DISEASE) S/Sx
A
- Nervousness
- Loss of muscle strength
- Fatigue
- Increased basal metabolic rate
- Hypertension
- tachycardia
- Perspire freely
- They are always hungry, and although they eat constantly.
- Exophthalmos
17
Q
HYPERTHYROIDISM (GRAVE’S DISEASE): ASSESSMENT
A
- Radiography
- bone age appears advanced beyond the chronological age of the child - Ultrasound
- enlarged thyroid gland - Laboratory tests
- elevated T4 and T3 levels and increased radioactive iodine uptake
- Low TSH
18
Q
HYPERTHYROIDISM (GRAVE’S DISEASE): THERAPEUTIC MANAGEMENT
A
- Beta-adrenergic blocking agent (Propanolol)
- to decrease antibody response. - Antithyroid drug: Propylthiouracil (PTU) or Methimazole (Tapazole)
- suppress the formation of thyroxine - Monitor the child for drug side effects such as leukopenia and thrombocytopenia.
- Surgical removal of part or almost all of the thyroid gland – young adult. (thyroidectomy)
- Supplemental thyroid hormone therapy
- for post thyroidectomy
19
Q
TYPE 1 DIABETES MELLITUS
A
- Facts
- disorder that involves an absolute or relative deficiency of insulin
- a.k.a “JUVENILE DIABETES OR INSULIN-DEPENDENT DIABTES”
- occurs at 5-7 years old or at puberty - Etiology
- Immunologic damage to insulin-producing cells in susceptible individuals.
- Environmental factor
20
Q
TYPE 2 DIABETES MELLITUS
A
- “NON-INSULIN-DEPENDENT”
- characterized by diminished insulin secretion and not caused by autoimmune factors, is a separate disease from type 1diabetes.
- occurs common to older adults, now seen in overweight adolescents, termed maturity-onset diabetes of youth. Also to children who have a strong family history.
21
Q
GALACTOSEMIA
A
- disorder of carbohydrate metabolism that is characterized by abnormal amounts of galactose in the blood (galactosemia) and in the urine (galactosuria).
- child is deficient in the liver enzyme galactose 1 phosphate uridyltransferase
- causes galactose to build up in the bloodstream and spills into the urine. Results it to reaching toxic levels in the bloodstream, it destroys body cells.
22
Q
GALACTOSEMIA S/Sx
A
- Lethargy
- Hypotonia
- Diarrhea
- Vomiting
- Cirrhosis: due to liver enlargement
- Jaundice
- Bilateral cataract
23
Q
GALACTOSEMIA DIAGNOSTIC PROCEDURE
A
- made by measuring the level of the affected ezyme in the red blood cells.
- Beutler test
- analyzes the cord blood if a child is risk for the disorder
24
Q
GALACTOSEMIA THERAPEUTIC MANAGEMENT
A
DIET: Free of galactose or formula with milk substitutes such as casein hydrolysates (Nutramigen).
