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Flashcards in Pedi Endocrine Deck (39)
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1
Q

Endocrine System

Human Growth Hormone

A

somatotropin
naturally occuring substance secreted by pituitary gland
important for normal growth, development, cellular metabolism
deficiency prevents somatic growth throughout body

2
Q

Diabetes Mellitus

A

partial or complete metabolic deficiency of insulin

contributes to development of cardiovascular disease, hypertension, renal failure, blindness, stroke

3
Q

Type 1 Diabetes

Risk factors

A

Genetics

toxins and viruses destroy beta cells

4
Q

Type 2 Diabetes

Risk factors

A

genetics

obesity, physical inactivity, high triglycerides (greater than 250), hypertension

5
Q

Hypoglycemia

Manifestations

A

less than 60mg/dL

Autonomic nervous system responses rapid onset:
hunger, lightheadedness, shakiness
headache
anxiety/irritability
pale, cool skin
diaphoresis
normal/shallow respirations
tachycardia/palpitations
impaired cerebral function gradual onset:
strange/unusual feelings
decreasing level of consciousness
difficulty in thinking and inability to concentrate
change in emotional behavior
slurred speech
headache/blurred vision
seizures/coma
6
Q

Hypoglycemia

Treatments

A

fast acting, simple carbs (15 g)
4 oz juice or regular soda; 8oz of milk; 3 glucose tabs; 1 tube glucose gel; 1 pack of fruit snacks

observe for 10 mins, recheck, goal is greater than 70. exceeds 70 = follow up with solid food snack or next meal.
if no improvement = repeat until above 70

7
Q

Hyperglycemia

Manifestations

A

greater than 250mg/dL

thirst
polyuria (early)
oliguria (late)
N&V, abdominal pain
warm, dry, flushed skin with poor turgor
dry mucous membranes
confusion
weakness
lethargy
weak pulse
diminished reflexes
rapid, deep repirations with acetone/fruity odor due to ketones (Kussmaul respirations)
8
Q

Hyperglycemia

Treatment

A

give water
insulin
test urine for ketones
call MD if symptoms progress

9
Q

Diabetes

Laboratory Tests confirming DM DX

A

8 hour fasting blood glucose of 126 mg/dL or more
Random blood glucose of 200 mg/dL or more with classic signs
Oral glucose tolerance test of 200 mg/dL or more in 2 hr sample

10
Q

Client Education

Fasting Blood Glucose

A

ensure fasting for 8 hr prior to blood draw

antidiabetic meds should be postponed until after level is drawn

11
Q

Client Eduation

Oral glucose tolerance test

A

consume balanced diet for 3 days prior to test
fast for 8 hr prior to test
fasting level drawn at start
consume specific amount of glucose
levels drawn every 30 min for 2 hr
the child must be assessed for hypoglycemia throughout procedure

12
Q

Glycosylated hemoglobin (HbA1c)

A

expected range: 4%-6%
target for child w/ DM: 6.5%-8%
target goal: less than 7%

13
Q

Self-monitored blood glucse (SMBG)

A

before meals and at bedtime

journal record: time, date, serum glucose level, insulin dose, food intake, events that may alter (activity, illness)

14
Q

Diabetes

Nursing Care

A
nair care
foot care
prevention of infection
nutritional guidelines - 15g of carbs=1 carb exchange
techniques for SMBG
exercise plan
15
Q

Diabetes

Sick Plan

A

Monitor blood glucose every 3 hr
continue to take insulin or oral anti-diabetic agents
encourage sugar-free, non-caffeinated liquids to prevent dehydration
meet carb needs by eating soft foods if possible, consume liquids that are equal to usual carb content
test urine for ketones q3h
rest

16
Q

Diabetes

Sick Plan

Call MD

A
blood glucose greater than 240mg/dL
fever is greater than 38.9/102, fever does not respond to acetaminophen or lasts longer than 12 hr
positive ketones in urine
disorientation or confusion
rapid breathing
vomiting occurs more than once
diarrhea occurs more than 5 times or for longer than 24 hrs
liquids cannot be tolerated
illness lasts longer than 2 days
17
Q

Diabetes

Insulin pumps

A

regular insulin, programmed amt on consistent basis
alarm will sound: pump failure, occluded tubing, no insulin,
alarm will not sound if needle becomes dislodged

18
Q

Diabetes

Insulin injections

A

2+ times per day; mixing insulin: rapid-acting and intermediate acting
rotate injection site (prevent lipohypertrophy) within one anatomic site to prevent changes in absorption rate

19
Q

Rapid Acting Insulin

A

Name: Insulin lispro (Humalog)
Onset: less than 15 min
Peak: 0.5-1 hr
Duration: 3-4 hr

20
Q

Short Acting Insulin

A

Name: Regular insulin (Humulin R)
Onset: 0.5-1 hr
Peak: 2-4 hr
Duration: 5-7 hr

21
Q

Intermediate Acting Insulin

A

Name: NPH insulin (Humulin N)
Onset: 1-2 hr
Peak: 4-12 hr
Duration: 18-24 hr

22
Q

Long Acting Insulin

A

Name: Insulin glargine (Lantus)
Onset: 3-4 hr
Peak: none
Duration: 10.4-24 hr

23
Q

Insulin

Client Education

A

observe child and parent drawing up insulin
do not mix glargine (Lantus) with other insulins due to incompatibility
rotate injection sites to prevent lipohypertrophy
inject at a 90degree angle (45degree if thin)
do not aspirate blood
draw up shorter-acting insulin into syringe first and then longer-acting insulin

24
Q

Diabetic Ketoacidosis

A

life threatening condition defined by hyperglycemia, greater than 300mg/dL
caused by missed dose of insulin or poor insulin administration technique
causes a breakdown of body fat for energy and an accumulation of ketones in blood and urine
onset is rapid and mortality is high

25
Q

Diabetic Ketoacidosis

Causes

A
insufficient insulin (usually failure to take appropriate dose)
acute stress (trauma or surgery)
poor management of acute illness
26
Q

Diabetic Ketoacidosis

Nursing Actions

A

Admit to ICU
provide rapid isotonic IV fluid (0.9% sodium chloride) to maintain perfusion to vital organs, large quantities may be required, monitor for fluid volume excess
follow with IV hypotonic fluid (0.45% sodium chloride) to continue replacing losses to total body fluid
When serum glucose levels approach 250 mg/dL add glucose to IV fluids to minimize risk of cerebral edema associated with drastic changes in serum osmolality
admin Regular insulin 0.1 unit/kg as an IV bolus then follow with continuous infusion of regular insulin at 0.1 unit/kg/hr

27
Q

DKA

Monitor Glucose

A

monitor glucose levels hourly

28
Q

DKA

Monitor Potassium

A

monitor serum potassium
initially will be elevated, insulin will shift potassium into cells and child needs to be monitored for hypokalemia = provide potassium replacement therapy in all replacement IV fluids, make sure urinary output is adequate before administering K
normal range = 3.7-5.2

29
Q

DM

Long-Term Complications

A
nephropathy
retinopathy
neuropathy
cardiovascular disease
altered thyroid function
limited mobility of small joints
30
Q

Growth Hormone Deficiency

A

Human Growth Hormone (GH) somatotropin, secreted by pituitary gland
GH is important for normal growth, development and cellular metabolism

31
Q

Growth Hormone Deficiency

Hormones that Assist GH

A

Adrenocorticotropic (ACTH)
Thyroid stimulating hormone (TSH)
Gonadotropins, Follicle stimulating hormones (FSH)
Luteinizing Hormone (LH)

32
Q

Growth Hormone Deficiency

Risk Factors

A

structural factors (tumors, trauma, structural defects, surgery)
heredity disorders
other pituitary hormone deficiencies (deficiencies of TSH or ACTH)
idiopathic

33
Q

Growth Hormone Deficiency

Manifestations

A
short in stature
delayed epiphyseal closure
increased insulin sensitivity
delayed dentition
underdeveloped jaw
delayed sexual development
34
Q

Growth Hormone Deficiency

Diagnostics - GH Stimulation

A

testing done if low level of IGF-1 and IGFBP-3 and short stature
draw baseline blood between 0600 and 0800
admin meds that trigger release of GH (arginine or GH-releasing hormone)
obtain blood sample every 30 min for 3hr period following med admin
NPO 10-12 hrs before test
limit activity 10-12 hr before test

35
Q

Growth Hormone Deficiency

Diagnostics - Radiological Assessments

A

assess skeletal maturity by comparing epiphyseal centers on x-ray to age-appropriate published standards
perform general skeletal survey in children under 3, or survey hands and wrists in older children
assist in positioning

36
Q

Growth Hormone Deficiency

Diagnostics - CT scan, MRI, skull x-rays

A

identify tumors or structural defects
monitor during procedure
sedate
provide emotional support

37
Q

Growth Hormone Deficiency

Diagnostics - evaluation of growth curve

A

accurately obtain and plot height and weight
assess height velocity or over time
determine height-to-weight relationship
project target height in context of genetic potential

38
Q

Growth Hormone Deficiency

Nursing Care

A

height and weight measured and marked on growth chart
bone age usually matches height
children less than 3 years measure every 6 mos and greater than 3 measure every year
monitor effectiveness of GH replacement
admin other hormone replacements (thyroid hormone)
provide psychosocial support and reassure lack of cognitive delays or deficits

39
Q

Growth Hormone Deficiency

Somatropin

A

replacement for human growth hormone
admin via subcutaneous injections
use cautiously in children receiving insulin