lecture 9 [endocrine + cerebral dysfunctions] Flashcards
1
Q
what is the dx for T1DM?
(4)
A
- glycosuria
- polyuria
- history of wt loss
- metabolic acidosis
2
Q
what are the s/s of T1DM?
(7)
A
- polyuria
- polyphagia
- polydipsia
- flushed/ dry skin
- confusion
- wt loss
- retinopathy
3
Q
what is the treatment for T1DM?
A
replace insulin (child is unable to produce insulin on their own)
4
Q
what is the MOA of insulin?
A
- aids in transporting carbs, fats, & protein into the cells
- transports glucose into muscle & fat cells
- stores glucose as glycogen in the liver & muscle
5
Q
what is the Dawn phenomenon?
A
a spike of glucose between 5am & 6am due to the release of GH during the night
6
Q
how can you counteract Dawn phenomenon?
A
use long-acting insulin
insulin glargine
7
Q
what is the treatment for hypoglycemia?
A
15grams of carbs & glucagon
8
Q
what are the nursing actions after treating hypoglycemia w/ 15g carbs & glucagon?
A
- recheck glucose 15mins after until levels are 70mg/dL or above
- continue to monitor for 2hrs
9
Q
what causes insulin levels to be extremely low or absent in T1DM?
A
islet cell destruction from presence of antibodies
islet cells produce insulin
10
Q
what is the HgbA1c level for hyperglycemia?
A
6.5%
11
Q
what is the fasting BG level for hyperglycemia?
A
126mg/dL or above
12
Q
what is the Somogyi effect?
A
hyperglycemia in the morning in response to child having hypoglycemia during the night
13
Q
how can you prevent Somogyi effect?
A
bedtime snack w/ proper insulin administration the night before
14
Q
what are the characteristics of T1DM?
(4)
A
- genetic predisposition
- lack of beta cells that produce insulin
- body is unable to obtain adequate glucose
- starvation response
15
Q
what is the starvation response in T1DM?
A
fatty acid is broken down (to obtain more energy from the body) and in the process produced ketone bodies
16
Q
starvation response over a prolonged period of time can lead to which complication?
A
diabetic ketoacidosis
17
Q
what are the s/s of DKA?
A
- Kussmaul respirations
- fruity breath
18
Q
what are the characteristics of a patient with T2DM?
(6)
A
- hx of exposure to gestational DM
- insulin resistance
- sedentary lifestyle
- obesity
- HTN
- older age
19
Q
what are the functions of the endocrine system?
(5)
A
- energy production
- growth
- fluid balance
- response to stress
- sexual reproduction
20
Q
what are the hormones secreted by the anterior pituitary gland?
A
- FSH
- LH
- GH
21
Q
what are the hormones secreted by the posterior pituitary gland?
A
- ADH
- oxytocin
22
Q
what is the role of follicle stimulating hormone?
A
- stimulates secretion of estrogen & progesterone
- produces seminiferous tubules to produce sperm
23
Q
what is the role of luteinizing hormone?
A
- stimulates ovulation
- stimulates secretion of testosterone in males
24
Q
what is the role of growth hormone?
A
- promotes growth
- maintain glucose levels
- promotes bone & soft tissue growth
25
what is the function of *ADH (vasopressin)*?
stimulates distal loop of kidney to reabsorb water & sodium
26
what is the function of *oxytocin*?
* stimulates uterine contractions
* stimulates let-down reflex in breast-feeding women
27
what are the manifestations of *hypopituitarism*?
| GH deficiency
* delayed bone growth
* weight-height ratio disparity
28
what is the condition associated with *hypopituitarism*?
achondroplasia
29
how is *hypopituitarism* diagnosed?
* endocrine tests
* skeletal surveys
* absence of GH
30
how is *hypopituitarism* treated?
***Somatropin***
(GH replacement)
31
what are the conditions associated with *hyperpituitarism*?
* acromegaly
* gigantism
32
when do *growth hormones* surge for ***gigantism***?
*BEFORE* epiphyseal shafts close
| BEFORE puberty
33
when do *growth hormones* surge for ***acromegaly***?
*AFTER* epiphyseal shafts close
| AFTER puberty
34
how is *hyperpituitarism* diagnosed?
* family Hx
* GH levels
* x-rays/ MRI
* endocrine tests
35
what are the treatments for *hyperpituitarism*?
* surgery
* irradiation
36
**tumors/ brain lesions** can commonly occur with abnormal levels of *GH*
true
37
what is *precocious puberty*?
early sexual development due to premature activation of the *hypothalamic-pituitary-gonadal axis*
38
what is *diabetes insipidus*?
under secretion of ADH leading to diuresis
39
what are the urine characteristics of *diabetes insipidus*?
* increased urine output
* diluted urine
40
what are the actions to diagnose*diabetes insipidus*?
restrict fluid intake then observe fluid output *(amount & color)*
| water deprivation test
41
what is the treatment for *diabetes insipidus*?
* vasopressin tannate *(Desmopressin)*
* stict I&O
42
what is the ***first sign*** of *diabetes insipidus*?
bedwetting
43
what are the common s/s of *diabetes insipidus*?
* polyuria
* polydipsia
44
what is *syndrome of inappropriate ADH (SIADH)*?
excess secretion of ADH, leading to kidneys reabsorbing fluid & returning it to central circulation
45
what are the manifestations of *SIADH*?
* fluid retention
* hyponatremia
* elevated urine osmolality
* hypotonicity
46
what does *elevated urine osmolality* indicate?
elevated solutes in a solution, indicating a ***darker urine***
47
what is the priority nursing action for *SIADH*?
monitor for fluid overload
48
which medications help with *hyponatremia* in ***SIADH***?
* Declomycin
* sodium supplements
49
what are the labs that nurses need to check for *SIADH*?
* BUN
* electrolytes
* urine & serum osmolality
50
what is *hypothyroidism*?
deficiency of thyroid hormone
51
what are the manifestations of *hypothyroidism*?
* growth cessation
* developmental delays
* problems w/ memory, attention, & visuospatial processing
52
what is the most common endocrine problem among children?
hypothyroidism
53
how long does treatment for *hypothyroidism* last?
4-8 weeks
54
what are the s/s of *hyperthyroidism*?
* irritability
* hyperactivity
* ***exophthalmos***
* goiter
* wt loss
55
what is *Grave's disease*?
a form of ***hyperthyroidism*** that is usually an autoimmune response to TSH receptors
56
*hyperthyroidism* is more common in girls *(at least 5x more likely)*
true
57
what are the s/s of ***Grave's disease***?
* fever
* enlarged thyroid gland
* exophthalmos
* urticaria
* vasculitis
* agranulocytosis
58
what are the common s/s of neurological impairment in children?
* bulging fontanels
* altered LOC
* clonus
* jittery
* pupillary changes
59
# definition
persistent vegetative state
lost function of cerebral cortex
60
# definition
obtunded
only responds to pain
61
# definition
stupor
responds to vigorous stimulation or patient is in a deep sleep state
62
children can become *hyperthermic* or *hypothermic* when in a ***toxic coma***
true
63
*blood pressure* is the last sign to change in ***neurologic dysfunctions***
true
64
when do respirations slow in pediatric neurologic dysfunctions?
* deep sedation
* post-ictal state
* cerebral infections present
65
what do nurses need to examine on the skin for neurologic dysfunctions?
* petechiae *(meningococcal infections)*
* bites
* ticks
66
# indication: pupilary response
pinpoint
poisoning
67
# indication: pupilary response
widely dilated
| reactive to light
post-ictal state
68
# indication: pupilary response
bilateral fixation for 5 minutes
brainstem damage
69
# indication: pupilary response
***sudden*** fixed & dilated
emergency
| can lead to death
70
what does ***decorticate posturing*** indicate?
cerebral cortex/ brainstem dysfunction *(may be due to tumor)*
71
what does ***decerebrate posturing*** indicate?
midbrain to brainstem dysfunction *(due to stroke)*
72
what does a nurse observe for in a child's motor movement?
* response to pain
* spotaneous movement
73
what are the normal reflexes of infants?
* Moro reflex
* tonic neck
* withdrawal reflexes
* positive Babinsky
74
what are the ***absence of reflexes*** that are associated with *severe brain damage*?
* corneal reflex
* tonic neck
75
what are the major causes of *cerebral trauma*?
| (3)
* falls
* MVA
* bicycle injuries
76
what are the complications of *cerebral trauma*?
* hemorrhage
* cerebral edema
* infection
* hernia
77
a patient sustained a ***cerebral edema*** that caused them to *lose consciousness & vomit three times*, what is the priority nursing action?
initiate hyperosmolar therapy STAT
78
what are the condtions that come with a *near-drowning* incident?
* hypoxia
* aspiration
* hypothermia
79
how long does it take for neurons to irreversibly deteriorate due to hypoxia from near-drowning?
4-6 minutes
80
what are the conditions that the child can acquire from aspiration during near-drowning?
* pulmonary edema
* atelectasis
* airway spasm
* pneumonitis
81
what is the etiology of *bacterial meningitis*?
an acute inflammation of the meninges and CSF
82
which vaccine prevents *meningitis*?
Hib vaccine
83
which bacteria causes *meningitis*?
group B strep
84
adhesions of pus or fibrin from infection in *meningitis* can obstruct the flow of CSF
true
85
what are the s/s of *meningitis*?
* abrupt onset fever
* vomiting
* photophobia
* HA
* inability of neck flexion
86
what is the diagnostic procedure for *meningitis*?
lumbar puncture
87
what are the CSF characteristics for ***bacterial*** *meningitis*?
* elevated WBC
* cloudy color
* elevated protein
* decreased glucose
* ***(+) Gram stain***
88
what are the CSF characteristics for ***viral*** *meningitis*?
* clear color
* elevated WBC
* normal protein content
* normal glucose
* ***(-) Gram stain***
89
what kind of positioning does a child with *meningitis* adopt?
* Brudzinsky sign
* Kernig's sign
* Nuchal rigidity
90
what is *encephalitis*?
inflammation of the brain
91
what causes *encephalitis*?
* MMR
* varicella
* herpes
* West Nile virus
92
how is *rabies* transmitted?
through saliva of infected animal
93
what is the treatment for *rabies*?
* inactivated rabies vaccine
* globulins containing preformed antibodies
94
how many doses of the vaccine for *rabies* need to be given?
5
| 0, 3, 7, 14, 28
95
what is *Reye syndrome*?
a neurological dysfunction that affects the liver & brain causing liver dysfunction & cerebral edema
96
which medication is the cause for *Reye syndrome* heavily associated with?
Aspirin
97
***Reye syndrome*** typically follows a viral illness such as *flu or varicella*
true
98
what is the pathophysiology of *seizures*?
abnormal electrical discharges in the brain
99
what are the categories of *seizures*?
* generalized
* partial
100
what are the types of *partial seizures*?
* simple w/ motor
* simple w/ sensory
* complex *(psychomotor)*
101
what are the phases of *tonic-clonic*?
* tonic
* clonic
* postictal
102
what are the types of *generalized seizure*?
* tonic-clonic
* absence
* myoclonic
* atonic/ akinetic *(drop attacks)*
103
what are the treatments for *seizure*?
| (6)
* Ketogenic diet
* antiepileptic drugs
* vagus nerve stimulation
* focal resection
* hemispherectomy
* corpus callostomy
104
what is *status epilepticus*?
seizures that may last for 30 minutes that lead to *respiratory failure* or *death*
105
what are the emergent measures for *status epilepticus*?
| (5)
* airway
* oxygen
* suction
* IV ativan
* thermoregulation
106
what causes *hydrocephalus*?
impaired CSF absorption
107
what are the manifestations of *hydrocephalus*?
| (5)
* bulging fontanel
* wide head circumference
* ***Cri du chat*** *(high-pitched cry)*
* sunsetting eyes
* sluggish pupils
108
what are the treatments for *hydrocephalus*?
* endoscopic fenestration
* externalized shunt
