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ADN005 Pediatrics > Week 7 Chapter 48 > Flashcards

Week 7 Chapter 48 Flashcards

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1
Q

Composed of glands, tissues, or clusters of cells that produce and release hormones in a negative feedback system involving the hypothalamus and nervous system

A

Endocrine System

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2
Q

Influences all physiologic processes
Growth and Development
Metabolic processes related to fluid and electrolyte balance and energy production
Sexual Maturation and reproduction
Body response to stress
Maintenance of internal homeostasis

A

Endocrine System

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3
Q

Most endocrine glands develop in the

A

1st trimester but still incomplete at birth

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4
Q

Complete hormonal control is lacking during early years of life

A

Means infant can not

Balance fluid concentration, electrolytes, amino acids, and glucose

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5
Q

Endocrine and nervous system work together to maintain optimal internal environment for the body

A

Homeostasis

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6
Q

Organs or tissues of the Endocrine System

A

Pituitary Gland
Hypothalamus
Parathyroid glands
Adrenal Glands
Gonads
Islets of Langerhans of the Pancreas

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7
Q

Water Deprivation Study

A

Child is deprived of fluids for several hours and serum sodium and urine osmolarity are monitored

Used to diagnose Diabetes Insipidus

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8
Q

Used to evaluate presence of tumors, cysts, or structural abnormalities

A

Imaging

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9
Q

Lab and Diagnostic Testing

A

Newborn Metabolic Screening
Serum Chemistry
Random and timed serum hormone testing
Growth Hormone Stimulation Testing
Blood Glucose
Hemoglobin A1c
Genetic Testing
water Deprivation Study
Bone Age Radiographs
Imaging Studies

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10
Q

Common Medical treatments for Endocrine Disorders

A

Dietary Interventions
Glucose Monitoring
Insulin Delivery
Irradiation- Increase hormone secretion
Administration of radioactive iodine
Surgery- Removal of cysts

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11
Q

Oral glipizide, glyburide, metformin and injectable insulin

A

Hypoglycemics

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12
Q

Hormone Therapy

A

Growth hormone and levothyroxine

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13
Q

Hormone Suppression Therapy

A

Octreotide
Methimazole

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14
Q

Mineral corticoid

A

Florinef- Adrenal Insuffciency

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15
Q

Corticosteroids

A

Dexamethasone
Hydrocortisone

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16
Q

Desmopressin Acetate

A

DI

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17
Q

Treatment goals for endocrine disorders

A

Decreasing excessive hormone production or replacing diminished hormones

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18
Q

Pituitary Disorders

A

Growth Hormone Deficiency
Precocious Puberty
Delayed Puberty
DI
SIADH

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19
Q

Complications of GH Deficiency and Therapy

A

Altered carb, fat, and protein metabolism
Hypoglycemia
Glucose Intolerance/ Diabetes
SCFE
Pseudotumor Cerebri
Leukemia
Recurrence of CNS Tumors
Infection at the Injection Site
Edema and Sodium Retention

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20
Q

Develops sexual characteristics before usual age of puberty

A

Precocious Puberty

Age 8 or less- girls
Age 9 or less- boys

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21
Q

Breasts not developed in girls by age of 12

No testicular enlargement or scrotal changes of boys by age 14

A

Delayed Puberty

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22
Q

Educating the child and family about the physical changes the child is experiencing

Teach how to use meds correctly

Help child with self esteem issues

Promote age appropriate physical development and pubertal progression

A

Goals of Nursing Management of Precocious or Delayed Puberty

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23
Q

DI

A

High and Dry
Increased Urination
Hypernatremia
Serum Osmolarity>300
Urine Specific Gravity <1.005
Decreased Urine Osmolarity
Dehydration, Thirst

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24
Q

SIADH

A

Low and Wet
Decreased urination
Hyponatremia
Serum Osmolarity <280
Urine Specific Gravity >1.030
Increased Urine Osmolarity
Fluid Retention and weight gain; Increased BP

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25
Rare syndrome occurs when ADH is secreted bin presence of low serum osmolarity because the feedback mechanism that regulates ADH does not function properly
SIADH Decreasing DDAVP, fluid restriction, IV fluids to correct hyponatremia and increase serum osmolarity DI- Give Vasopressin-DDVAP
26
Rare in children Mostly seen in Graves Disease Excessive T3, T4, T3 resin uptake TSH usually low Treated by destruction of thyroid gland
Hyperthyroidism
27
Can be congenital or acquired Certain populations at risk - Down Syndrome, Maternal Hypothyroidism Decreased Thyroid hormones Decreased T3, T4, T3 resin uptake TSH usually elevated Lifelong Thyroid Supplementation
Hypothyroidism
28
Autoimmune disorder causes excessive amounts of thyroid hormone to be released in response to TSI
Graves' Disease
29
Uncommon in children but peak incidence occurs during adolescence Occurs 5x more often in girls than boys and goiter usually develops
Graves Disease
30
Hypothalamus secretes TRH TRH stimulates TSH from anterior pituitary gland TSH stimulates T3 and T4 production in the Thyroid T and T4 exert by feedback on pituitary and hypothalamus
HPTA
31
Nervousness/ Anxiety Diarrhea Heat intolerance Weight Loss Smooth velvety skin
Hyperthyroidism
32
Tiredness/ fatigue Constipation Cold intolerance Weight Gain Dry thick skin, edema on face, eyes, and hands Decreased Growth
Hypothyroidism
33
Sudden release of high levels of thyroid hormones - Progresses to heart failure and shock
Thyroid Storm Immediately report: Acute onset of severe restlessness and irritability Fever Diaphoresis Severe Tachycardia
34
Measure and record growth at regular intervals Measure thyroid levels at recommended intervals -Every 2-4 weeks until the target range is reached on a stabilized dose of medication, then 1-3 months and decreasing in frequency as the child gets older - Monitor for signs of hypo- or hyperfunction, including changes in vital signs, thermoregulation, and activity level - Provide adequate rest periods and meet thermoregulation needs
Promoting Growth for a child with Congenital Hypothyroidism
35
Other Endocrine Disorders include:
Adrenal Gland Disorders - Congenital Adrenal Hyperplasia - Cushing Syndrome - Addison Disease - Polycystic Ovary Syndrome
36
Walnut sized glands that sit atop of kidneys Powerhouse of endocrine system
Adrenals - Stress response - Sleep Patterns - Immune Health - Mood and Mental Clarity
37
Includes the following: -Personality changes - Moon Face - Gynecomastia - Osteoporosis - Fat Deposits on face, back, and shoulders - CNS Irritability - Na and Fluid retention - Thin Extremities - GI Distress - Purple Striae - Bruises - Hyperglycemia
Cushing's Syndrome
38
-Bronze color of skin - Tachycardia - GI disturbances - Weakness - Fatigue - Depression - Hypoglycemia - Weight Loss - Anorexia - Postural Hypotension
Addison's Disease Adrenal Crisis - Profound and fatigue - Dehydration - Vascular Collapse - Low Na - High K
39
Caused by a deficiency of insulin secretion due to pancreatic beta cell damage
Type 1
40
Consequence of insulin resistance that occurs at the level of skeletal muscle, liver, and adipose tissue with different degrees of beta cell impairment
Type 2
41
Diabetes secondary to certain condition such as
Cystic Fibrosis Glucocorticoid Use Down Syndrome Turner Syndrome Klinefelter Syndrome
42
Gestational Diabetes occurs during
Pregnancy
43
Insulin replacement therapy is cornerstone management of
Type 1 DM and administered daily by subq injections into adipose tissue over large muscle masses using a traditional insulin syringe or subcutaneous injector
44
During Pregnancy Goes away after pregnancy May have BIG baby Risk for Type 2
Gestational Diabetes
45
Insufficient Insulin Production Ketoacidosis Adults after 40 most often Familial May need insulin shots
Type 2
45
No insulin produced Most often before age of 15 Was called juvenile diabetes Auto Immune Disorder Familial and Lifelong
Type 1
46
Type and Type 2 Diabetes 3 Ps
Polyuria Polyphagia Polydipsia - Fatigue and UTIs
46
Assessment of Type 1
Decreased weight Increased Thirst Bed Wetting Rapid onset
47
Assessment of Type 2
Increased weight Eye problems Slow onset
48
Dx of diabetes
FBG greater than 126 mg/dl Causal random > 200mg/ dl OGTT hbA1c greater than 6.5%
48
Treatment of DM
Insulin Oral hypoglycemics Diet Less insulin with increased exercise low glucose fluctuation
49
Complications of DM
DKA- Type 1 HHNC - Type 2 Fluid and electrolyte Imbalances
50
Insulin Complications
Hypoglycemia Lipodystrophy Somogyi Effect Allergic Reaction
50
Long Term Complications of Diabetes
Angiopathy PVD Retinopathy Nephropathy Neuropathy Infections
51
Medical Emergency requires early recognition and prompt intervention Increased risk of stress such as illness and infection
DKA
52
S/S of DKA
Anorexia, nausea, vomiting Lethargy, stupor, altered level of LOC, confusion Decreased skin turgor Abdominal pain Kussmaul respirations and air hunger Fruity breath or acetone breath odor Presence of ketones in urine or blood Tachycardia and not treated may lead to coma and death
53
Aspart Lispro Glulisine
Rapid Acting
54
Regular Insulin
Short acting
55
NPH is
Intermediate acting
56
Complications of DM
Failure to grow Delayed sexual maturation Poor wound healing Recurrent infections Retinopathy Neuropathy Vascular Complications Nephropathy Cerebrovascular Disease Cardiovascular Disease PVD
56
Glargine Detemir Degludec
Long Acting
56
Goals of Therapeutic management of DM
Achieve normal growth and development Promoting optimal serum glucose control, including fluid and electrolyte levels and near normal hemoglobin A1c or glycosylated hemoglobin levels Preventing complications Promoting positive adjustment to the disease with the ability to self manage in the home
57
Nursing Diagnoses for Endocrine Disorders
Imbalanced nutrition Deficient or excess fluid volume Risk for delayed development Disturbed Body image Knowledge deficit Ineffective health maintenance Interrupted family processes Risk for caregiver role strain
57
Teaching points for Diabetes Management
Self measurement of glucose Urine Ketone testing Medication Use S/S of hypo or hyperglycemia Monitoring and managing complications Sick Day Lab testing and follow ups Diet and exercise as part of DM management

ADN005 Pediatrics (21 decks)

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