Endocrine & metabolic Part 2

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jessem30
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202812
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Endocrine & metabolic Part 2
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2013-03-05 00:47:29
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Spc Nursing Endocrine Metabolic part
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SPC nursing pedi rotation, Endocrine & Metabolic Part 2
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  1. What is Precocious Puberty?
    Refers to early onset of puberty usually before the age of 8 years in gils and 9 years in boys.
  2. Precocious Puberty
    • Early onset of puberty in girls before
    • age 8 and boys before 9 years

    • The child will have secondary sex
    • characteristics, accelerated growth rate, and advanced bone maturation

    Diagnosed through H&P, labs, xrays

    • Treated with GnRH
    • agonists monthly IM or intranasally to suppress

    • At risk for child sexual abuse—encourage
    • parents to promote friendships with peers of the same age
  3. What causes premature appearance of secondary sexual charactristics accelerated growth rate and advanced bone maturation?
    Precocious puberty.
  4. What is the major consequence of precocious puberty?
    Rapid bone growth which causes early growth plate fusionn and ultimately short stature in adulthood.
  5. What is the definitive test to diagnose between central and peripheral Precocious puberty?
    The gonadotrpoin releasing hormone (GnRH)
  6. What is the aim of treatment in PP?
    To stop or reverse the development of secondary sexual characteristics and to maximize adult height.
  7. Why are girls with PP at greater risk for sexual abuse?
    Because of their mature apperance.
  8. Even though a child with PP looks older how should they be treated?
    According to their chronologic age.
  9. What is growth hormone deficiency?
    Deficiency that results from inadequate production or secretion of GH. Causing poor growth and short stature
  10. What may manifest in GH deficiency?
    Hypoglycemia
  11. Growth hormone deficiency?
    Due to inadequate GH

    • Symptoms include short stature (below 5th percentile), poor growth,
    • immature/cherubic faces, delayed puberty, hypoglycemia, diminished muscle mass

    Incidence in US is 1:4000

    • Confirmed over 6-12 months and if
    • persists, treatment with synthetic GH
  12. What are some other disorders associated with short stature that may respond to GH therapy?
    • Turner syndrome
    • Prader-Willis syndrome
    • Renal disease
    • inflammatory bowel disease.
  13. What is the criteria for suspecting growth hormone Deficiency?
    Consistently poor growth (less than 5 cm per year)

    Growth rate more that 2 standard deviations below the mean for age

    Downward deciation from the previous growth rate.
  14. at the time of Diagnosis what percentage of beta cells are still producing insulin in DM2?
    50%
  15. Type 2 diabetes Mellitus
    • Similar
    • to adult     
    • presents with       
    • obesity and insulin    
    • resistance
  16. How do you manage DM2?
    • Nutritional interventions
    • regular exercise
    • insulin therapy- may switch to oral agents.
    • Glucose monitoring
  17. WHat are the goals for treating DM2?
    Achieving near normal glycemic control

    reasonable weight for height

    normal blood glucose levels

    prevention of hyperlipidemia/hypertension

    decrease the frequency of microvascular and cardiovascular complications.
  18. What is the only oral drug approved for children with DM2 under 10 years old?
    Metformin
  19. What is Type 1 DM?
    results when the pancrease is unable to produce and secrete and adequate amount of insulin.
  20. WHat is the most common childhood endocrine disorder?
    type 1 DM
  21. Type 1 diabetes?
    • Pancreas
    • cannot produce and secrete insulin

    • Results
    • from autoimmune process that destroys insulin-secreting cells of pancreas

    • Genetic
    • predisposition plus environmental or viral trigger initiate process
  22. Incidence of type 1 DM
    Increase of 40% from 1997-2010

    • Diagnosed in 1:400-500
    • children/adolescents

    Median age of onset 7-15 yrs

    • Average age of onset--school-aged
    • children

    • Presents with polyuria, polydipsia,
    • polyphagia, weight loss, fatigue, and/or blurred vision
  23. Management goals for Type 1 DM?
    • Appropriate
    • growth

    • Age-appropriate
    • lifestyle

    • Near
    • normal glycosated
    • hemoglobin (HgbA1c)

    • Prevent
    • complications especially with hypo and hyperglycemia
  24. What is the Etiology of Type 1 DM?
    an inflammatory process in the insulin-secreting islet cells of the pancreas and result from and autoimmune process that cause their eventual destruction.
  25. Insulin Therapy
    • Early
    • disease course is known as the “honeymoon phase” since very little insulin is
    • required This may last from a few weeks to 1 year or longer.
  26. The three classic signs of type 1 Dm?
    Polyuria (or enursis in toilet trained child)

    Polydipsia-excessive thirst

    Polyphagia-excessive hunger

    other signs- weight loss (despite increased food intake)

    fatigue 

    blurred vision
  27. What is the goal of insulin therapy?
    To replace teh insulin the child is no longer able to make in an acceptable physiologic pattern.
  28. Are oral DM agents useful in type 1 DM?
    NO
  29. What is intesive insulin treatment?
    • 3
    • or more injections daily

    Pump

    • Purpose--to
    • mimic physiology
  30. Admin of Insulin injections
    • Avoid
    • giving IM

    • 45
    • degree angle with ½ inch needle

    • 90
    • degree with 5/16 needle
  31. WHy should you rotate insulin injections?
    Prevent adipose hypertrophy
  32. Where is the best absorption of insulin?
    • Most
    • rapid to least rapid

    –Abdomen

    –Arms

    –Hips

    –Thighs

    • Exercise
    • increases absorption
  33. Excercise precations with DM?
    • Avoid
    • working out when insulin is peaking

    • Extra
    • carbohydrates pre-workout (15-30 grams)

    • Monitor
    • glucose frequently

    Hydration

    • Muscles
    • continue to burn energy post exercise—HS snack
  34. When to monintor Glucose?
    • Before
    • meals

    HS

    • With
    • prolonged or new exercise program

    Illness

    • At
    • 0200 if hypoglycemia is suspected

    • Goals
    • for children 80-180mg/dl pre-meal and for infants/toddlers 80-200mg/dl
  35. Infant/toddler developmental
    considerations in DM
    • Consistency
    • with carbohydrates

    • Expect
    • food battles

    • Sense
    • of control with food choices

    • Temper
    • tantrum or hypoglycemia?

    • Rituals
    • and routines
  36. School aged considrations in DM?
    Can understand simple explanations

    Play therapy

    • Diabetes didn’t happen “because you were
    • bad”

    Willing to try new foods

    Often distracted when eating

    • More at risk for hypoglycemia due to
    • activity level
  37. Adolescence with Dm?
    Want to be in control

    Body image

    Peer acceptance

    Desire independence

    • Middle adolescence more prone toward
    • risk-taking and challenging parents—this could mean missed injections, skipped
    • testing, irregular meals, splurging on food
  38. Late adolescence with DM?
    • More
    • future-oriented

    • Abstract
    • thought

    • lParents
    • may have trouble relinquishing care

    • Not
    • motivated by predictions of complications

    • Focused
    • on the here and now
  39. Sick day care in DM?
    Never skip insulin

    Test more often

    Test for ketones

    Hydrate with no calorie drinks

    • If unable to eat, use simple
    • carbohydrates in liquid form

    • ER warnings—”fruity breath”, N/V,  deep and rapid respirations, decreased LOC, +
    • ketonuria,
    • persistent hyperglycemia.
  40. Diabetic ketoacidosis (DKA
    • Slow
    • onset due to too little insulin

    • Abdominal
    • and chest pain, N/V, fruity breath, dehydration, lethargic, decreased LOC, Kussmaul’s
    • respirations, and coma

    • Lab
    • serum glucose > 300, positive ketones, and serum pH < 7.25

    • Treatment
    • with IV fluids, insulin drip, electrolyte replacement, and supportive intensive
    • care.
  41. Hypoglycemia
    • Fast
    • onset due to too much insulin

    • Blood
    • glucose < 70

    • Treated
    • with 15 g carbohydrate

    • If
    • loss of consciousness, give glucagon or IV glucose
  42. Signs and symptoms of
    hypoglycemia
    Adrenergic--

      Trembling

      Sweating

      Tachycardia

      Pallor

      Clammy skin

    Neuroglycopenic--                             

      Personality change

      Irritability

      Appears drunk

      Slurred speech

      Decreased LOC

      Seizure
  43. Hyopglycemia in the neonate is defined as a plasma glucose concetraion of less than
    40mg/l
  44. The neonates who are most likley to experience hypoglycemis are ____infants and infants who are_____?
    Premature/small for gestational age.
  45. List five signs that indicate a neonte is hypoglycemic?
    • Jitterness
    • poor feeding
    • lethargy 
    • seizures
    • hypotonia
    • high pitched cry
    • bradycardia
    • cyanosis
    • temp instability
    • resp alterations
    • apnea
  46. What is teh intervention for a neonate who is hypoglycemcic but asymptomatic?
    feed the infant formula breast milk or d5w monitor response by doing glucose checks.
  47. What assessments are indicated if a neonate is at increased risk for hypoglycemia?
    Gestational age assessment infants weight lenght and head circumfrence plotted on growht curve blood glucose level by 2 hours of age.
  48. What complication can occur when a neonate is receiving IV glucose
    Infiltraion of IV can cause sever extravasation.
  49. Neonatal hypocalcemia is definedas total serum calcium concentration of less than_____?
    7.0mg/dl
  50. Why does neonatal hypocalcemia occur most often in infants of diabetic mother?
    Maternal diabetes causes immature parathyroid function in the neonate.
  51. What is the best time to admin oral calcium supplement?
    Oral supplements are given with feedings because they can cause gastric irritation.
  52. What is the genetic transmission pattern of phenylketonuria?
    Autosomal recessive
  53. Phenylketonuria results in damage to which body system?
    CNS
  54. When should a neonate be screened for PKU?
    After 2 days of birth.
  55. What is the treatment for PKU?
    Special diet that restricts phenylalanine intake
  56. T/F- THe child with galactosemia must be on a lifelong low protein limited amino acid diet?
    False
  57. T/F- Maple syrup urine disease casuse ketoacidosis 2-3 days after birth.
    True
  58. T/F- Tay-sachs disease can be treated through dietary modifications?
    False
  59. In congenital adrenal hyperplasia the adrenal gland is not able to manufacture_____but instead producess excess___?
    Glucocorticoid, androgens
  60. What finding in the newborn infant should raise suspicion of congenital adrenal hyperplasia?
    Ambiguous genitalia
  61. The treatment of congential adrenal hyperplasia involves lifelong________?
    Glucocorticoid therapy
  62. T/F- Newborn screening for hypothyroidism should be done between 10-14 days of age?
    False
  63. T/F- If untreated congenital hypothyroidism can result in intellectual disability?
    True
  64. T/F- Treatment of congenital hypothyroidism requires lifelong thyroid homeone replacement
    True
  65. T/F- The most common cause of acquired hypothyroidism in children is an autoimmune process?
    true
  66. A decreased TSH level is the most sensitive indicator of primary hypothyroidism?
    False
  67. Decreased activity is related to?
    Hyopthyroidism
  68. Nervousness is related to?
    hyperthyroidism
  69. Increased appetite is related to?ro
    Hyperthyroidism
  70. Weight gain is related to?
    Hypothyroidism
  71. Edema of face hands and eyes is related to?
    Hypothyroidism
  72. Cold intolerance is related to?
    Hypothyroidism
  73. THe preferred treatment for a child with hyperthyroidism is___?
    Antithyroid therapy with propylthiouracil or methimazole
  74. THe child receiving propylthiouracil must be monitored for which three significant AR's
    • Neutropenia
    • Hepatoxicity
    • Hypothyroidism
  75. Why may treatment of graves disease be tapered after a few years.
    To determine whether a child has gone into remission.
  76. List two classic manifestations of diabetes insipidus
    Increased urination (polyuria)

    excessive thrist (polydipsia)
  77. Define precocious puberty?
    Premature apperance of secondary sexual characteristics accelerated growth rate and advanced bone maturation.
  78. WhAT is the major consequence of precocious puberty?
    Rapid bone growth whic causes early fusion and ultimately results in short adult stature.
  79. The treatment of precocious puberty?
    Admin of a gonadotropin-releasing hormone GnRH agonist or blocker.
  80. How does the treatment for precocious pueberty inhibit prcocious puberty?
    It inhibits binding of GnRH to the pituitary gland causing a decrease in hormone production this stops sexual development from progressing and slows down bone age advancement

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