Peds test #2-Endocrine
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Peds test #2-Endocrine
Peds test #2-Endocrine
Incidence of 1 in 4000; Screening measures levels of thryoid simulating hormone
Incidence 1 in 13,000; deficiency in phenylalanine hyroxylase
S/S of congenital hypothyroidism
Poor feeding, lethargy
S/S of PKU
vomiting, irritability, hyperactivity
incidence of 1 in 30,000; absencse of galactose-phosphate uridyl transferase; S/S cataracts, weight loss; treat with lactase formula
PKU must be tested after ingestion of what?
What signifies a positive Guthrie test for PKU?
Treatment for PKU includes:
Restrict dietary protein, keep phenylalanine in a safe range (2-8 mg/dl); begin diet before 3 weeks of age; maintain low protein diet for life
What is the master gland that is responsible fo regulating other glands?
The anterior pituitary gland produces what hormones?
GH, sex hormones, TSH
The posterior pituitary gland produces what hormones?
Pituitary gland is controlled by hormones that are produced by the ___
Inhibits somatic growth; primary site of dysfunction is hypothalamus; most common causes is pituitary tumors/hypothalamic tumors
Growth Hormone Deficiency
What are some clinical manifestations of GH deficiency?
Appears younger than age; bone age is retarded; permanent teeth are delayed; sexual development is delayed
Daily treatment of ___ to ___ ug/kg of biosynthetic growth hormones is needed in GH deficiency until acceptable height is achieved
25 to 50
Nursing considerations for hormone replacement therapy for GH deficiency includes: (3)
administer at bedtime; administer 6 of 7 days; encourage self management in school age children
Excessive growth hormone before closure of the epiphyseal shafts results in:
overgrowth of long bones
excess GH after epiphyseal closure is ___
Typical facial features of acromegaly
Separation, malocclusion of teeth, prominent forehead, increased facial hair
Therapeutic management of acromegaly (3)
Surgery to remove tumor, radiation, hormone replacement therapy after surgery
Nursing considerations for acromegaly (4)
identify children with excessive growth rates early; early treatment; emotional support; body image concerns
Sexual developments before age 9 in boys/8 in girls
Isolated appearance of breast development
Early appearance of pubic hair
What does the medication Lupron treat?
Peripheral Precocious Pseudopuberty; slows prepubertal growth to normal rates; discontinue at puberty!!
the principal disorder of the posterior pituitary
Diabetes Insipidus (DI)
Results from hyposecretion of ADH; produces uncontrolled diuresis
Secondary causes of DI includes (4)
trauma, tumors, CNS infection, aneurysm
Some clinical manifestations of DI include: (7)
Polyuria, polydipsia, enuresis (usually 1st sign), irritability, dehydration, hypernatremia, sometimes fever
DI needs a daily hormone replacement of ___
Drug of choice for DI
Nursing considerations for DI: (5)
Identify disorder, I&O, observe for s/s of fluid overload, seizure precautions, administer ADH antagonizing meds
SIADH stands for:
Syndrome of Inappropriate Antidiuretic Hormone
produced by hypersecretion of the posterior pituitary (increased ADH)
S/S of SIADH (5)
Fluid retention, hypotonicity, decreased sodium, anorexia, iriitability, personality changes
Treatment of SIADH (3)
Fluid restriction, Seizure precautions, long term ADH antagonizing medications
Thyroid hormone regulates what?
Thyroid hormone secretes what 2 hormones?
Thryoid hormone (T4/T3) and thyrocalcitonin (which maintains blood calcium levels)
What hormone stimulates the thyroid?
Most commonly results from agenesis, dysplasia, ectopy of thyroid; can also becaused by autosomal recessive defects
Clinical Manifestations of Juvenile Hypothyroidism (9)
Decelerated growth, constipation, sleepiness, skin changes, elevated weight, bradycardia, large fontanelles/tongue, delayed dentition, goiter development
Hypertrophy of the thyroid gland
(Congenital) usually results from maternal ingestion of antithyroid drugs during pregnancy
(acquired) result of neoplasm, inflammatory disease, dietary deficiency, increased secretion of pititary thyrotropic hormone
Therapeutic management for goiter (4)
oral thyroid hormone replacement, prompt treatment for brain growth in infant, administer in increasing amounts over 4-8 weeks, compliance
Nursing considerations for Goiter (4)
Thyroid enlargement may compromise airway in infant; may be noticable during periods of rapid growth; large goiters may be obvious upon palpation; TH replacement is necessary!
most common cuase of hyperthyroidism in childhood is what?
Peak incidence of hyperthyroidism is between ___ and ___ years old
12 to 14
Some clinical manifestations of Grave's disease: (8)
Exophthalmos, weight loss, increased appetite, nocturia, palpitations, irritability, sleeplessness, inability to concentrate
PTU specifically inhibits the peripheral conversion of ___ to ___
T4 to T3
Transmitted as autosomal dominant disorder with formation of structurally abnormal insulin with decreased biologic activity
Maturity Onset Diabetes of the Young
The first symptom of DM is usually:
S/S of hypoglycemia (3)
Dizziness, confused, shaky
acute metabolic changes in the body due to lack of insulin; dehydration, acidosis, hyperglycemia
Hyperventilation characteristic of metabolic acidosis resulting from respiratory system's attempt to eliminate CO2 (in DKA)
Rapid acting insulin; what is the onset, peak, and duration?
Insulin lispro (Humalog); onset is 10 to 30 mins, peak is 1-2 hours, duration 2-4 hours; give 15 mins before/after a meal
Short acting insulin; onset, peak, duration?
Regular insulin (Humulin R, Novolin R); onset 0.25 to 1 hr; peak is 1.5 to 4 h; duration 5 to 9 hr
Intermediate acting insulin; onset, peak, duration?
NPH (Humulin N, Novolin N); onset 3-4 hrs; peak 8-14 hrs; duration 16-24 hrs
The adrenal cortex secretes 3 groups of what steriods?
Glucocorticoids (cortisol, corticosterone); Mineralocorticoids (aldosterone); sex steroids (androgens, estrogens, progestins)
Adrenal medulla secretes what? (2)
What kind of tumors are the primary cause of adrenal medullary hyperfunction?
"Adrenal crisis"; caused by hemorrhage from trauma, fulminating infections, abrupt withdrawal from exogenous cortisone, failure to increase cortisone in times of stress
Acute adrenocortical insufficiency
Symptoms of Acute adrenocirtical insufficiency in infants includes: (4)
High temp, tachypnea, cyanosis, seizures
S/s of acute adrenocoritcal insufficiency in children: (5)
irritability, headache, abdominal pain, weakness, diarrhea
nursing considerations for acute adrenocortical insufficiency (6)
Recognize symptoms promptly, monitor vital signs, seizure precautions, monitor fluid therapy/electrolytes, support parents
Rare in children; usually occurs as a result of neoplasm, lesion of adrenal glands, idiopathic cuase
chronic adrenocortical insufficiency
Side effects of this medication are gastric irritation, irritability, sleeplessness, weight gain, depression, euphoria
Glucocorticoids (medication for chronic adrenocortical insufficiency)
Side effects of this medication includes generalized edema, hypertension, headache, cardiac arrhythmias, hypokalemia
Mineralcorticoids (used for chronic adrenocortical insufficiency)
Characteristic group of manifestations caused by excessive circulating free cortisol; may be caused by excessive/prolonged steroid therapy
A person with this appearance has excessive hair growth, moon face, red checks, weight gain, pendulous abdomen with red striae, poor wound healing, ecchymoses
Post op complications of Cushing syndrome: (3)
anorexia, muscle/joint pain, depression
Therapeutic management of cushing syndrome (2)
Bilateral adrenalectomy, replacement of GH, ADH, TH, gonadotropins, steroids