Peds Final Review - Metabolic and Endocrine Disorders Flashcards Preview

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Flashcards in Peds Final Review - Metabolic and Endocrine Disorders Deck (21)
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1


CONGENITAL HYPOTHYROIDISM

Description: A congenital condition resulting from inadequate thyroid tissue development in utero.

Mental retardation and growth failure occur if it is not detected and treated in early infancy.

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CONGENITAL HYPOTHYROIDISM

Nursing Assessment

Newborn screening reveals low T4 (thyroxine) and high TSH (thyroid-stimulating hormone).

Symptoms in the newborn:
--Long gestation (>42 weeks)
--Large hypoactive infant
--Delayed meconium passage
--Feeding problems (poor suck)
--Prolonged physiologic
jaundice
--Hypothermia

Symptoms in early infancy

Large, protruding tongue
Coarse hair
Lethargy, sleepiness
Flat expression
Constipation

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CONGENITAL HYPOTHYROIDISM

NCLEX Hint: An infant with hypothyroidism is often described as a good, quiet baby by the parents.

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CONGENITAL HYPOTHYROIDISM

Nursing Diagnoses:

Delayed growth and development related to

Deficient knowledge of medication program related to

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CONGENITAL HYPOTHYROIDISM

Nursing Interventions:

--Perform newborn screening programs before discharge.

--Assess newborn for signs of congenital hypothyroidism.

Teach family about replacement therapy with thyroid hormone:

Explain that child will have a lifelong need for the therapy
Tell parents to give child a single dose in the morning

Teach family to check child’s pulse daily before giving thyroid medication

Signs of overdose include rapid pulse, irritability, fever, weight loss, and diarrhea

Signs of underdose include lethargy, fatigue, constipation, and poor feeding

Periodic thyroid testing is necessary

6

PKU (Phenylketonuria)

An autosomal recessive disorder in which the body cannot metabolize the essential amino acid phenylalanine.

The buildup of serum phenylalanine leads to CNS damage, most notably mental retardation.

Decreased melanin produces light skin and blond hair.

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PKU (Phenylketonuria)

Nursing Assessment:

Newborn screening using the Guthrie test; positive result: serum phenylalanine level of 4 mg/dL

Frequent vomiting, failure to gain weight

Irritability, hyperactivity

Musty odor of urine

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PKU (Phenylketonuria)

Nursing Diagnoses:

Delayed growth and development related to

Deficient knowledge of disease process and diet related to

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PKU (Phenylketonuria)

Nursing Interventions:

---Perform newborn screening at birth and again at about 3 weeks of age

Teach family dietary management.

Stress the importance of strict adherence to prescribed low-phenylalanine diet

Instruct family to provide special formulas for infant: Lofenalac, Phenex-1
Instruct family to provide phenyl-free milk substitute after the age of 2 years

Teach family to avoid foods high in phenylalanine-- that is high-protein foods, such as meat, milk, dairy products, and eggs.

Teach family to offer foods low in phenylalanine, that is vegetables, fruits, juices, cereals, breads, and starches

Encourage family to work with nutritionist

Teach that diet must be maintained at least until brain growth is complete (6 – 8 yr) or for life

Refer for genetic counseling

10

PKU (Phenylketonuria)

NCLEX Hint: NutraSweet (aspartame) contains phenylalanine and should not therefore be given to a child with PKU

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PKU (Phenylketonuria)

NCLEX Hint: NutraSweet (aspartame) contains phenylalanine and should not therefore be given to a child with PKU

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Idiopathic hypopituitarism

Nursing Assessment:

Short

Delayed bone age

Permanent tooth eruption delayed

Sexual maturity delayed

Skin fine with delicate features

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Idiopathic hypopituitarism

Nursing Interventions:

Management of replacement therapies such as growth hormone, thyroid hormone, cortisol, and sex hormones.

Family teaching to treat child as chronological age. Child will be younger looking than peers.

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Central Precocious puberty

Nursing Assessment:

Defined as manifestation of sexual development before 9yr for boys

Before 7yr for Caucasian girls

Before 6yr for African-American girls

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Central Precocious puberty

Nursing Interventions:

Teach family about leuprolide injections.

Child will look much older than chronological age.

Urge family to treat child and dress child age-appropriately.

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DIABETES – INSULIN-DEPENDENT DIABETES MELLITUS, OR TYPE 1 DIABETES

This is a metabolic disorder in which the insulin-producing cells of the pancreas are nonfunctioning

Heredity, viral infections, and autoimmune processes are implicated in diabetes mellitus.

Diabetes causes altered metabolism of carbohydrates, proteins, and fats.

Insulin replacement, dietary management, and exercise are the treatments.

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DIABETES – INSULIN-DEPENDENT DIABETES MELLITUS, OR TYPE 1 DIABETES

Nursing Assessment:

Classic three “P’s”
--Polydipsia
--Polyphagia
--Polyuria, enuresis (bedwetting in a previously continent child)

Irritability, fatigue

Weight loss

Abdominal complaints, nausea, and vomiting

Usually occurs in school-age children but can occur even in infancy

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DIABETES – INSULIN-DEPENDENT DIABETES MELLITUS, OR TYPE 1 DIABETES

Nursing Diagnoses:

Imbalanced nutrition: less than body requirements related to

Deficient knowledge related to

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DEPENDENT DIABETES MELLITUS, OR TYPE 1 DIABETES

Nursing Interventions:

Assist with diagnosis – a fasting blood sugar >120 mg/dL glucose

If child is in ketoacidosis, provide care for seriously ill child (may be unconscious)

Monitor vital signs and neurologic status

Monitor blood glucose, pH, serum electrolytes

Administer IV fluids, insulin, and electrolytes as prescribed. Regular insulin is used for intravenous infusions and is mixed with normal saline

Assess hydration status

Maintain strict I&O

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DEPENDENT DIABETES MELLITUS, OR TYPE 1 DIABETES

Nursing Interventions:

Initiate home teaching program as soon as possible; involve child and family

Teach insulin administration
Teach dietary management – carbohydrate counting

Teach about exercise

Regular, planned activities

Diet modification; snacks before and during exercise

Teach about home glucose monitoring and urine testing

Teach signs and symptoms of hyperglycemia and hypoglycemia

Glucagon administration can cause vomiting – position on side

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DEPENDENT DIABETES MELLITUS, OR TYPE 1 DIABETES

Nursing Interventions:

Initiate program for school-age child, as appropriate.

Identify issues specific to school

Physical education class and exercise

Scheduled times for meals and snacks

Cooperation with teachers and school nurse

Need to be like peers

Teach that a school-age child should be responsible for most management

Instruct the child to wear a MedicAlert ID bracelet