1
Q
Which part of the pituitary gland is considered the “master gland”?
A
anterior pituitary (controlled by the hypothalamus)
2
Q
What is hypopituitarism?
A
growth hormone deficiency where growth of all cells in the body is inhibited proportionately (shorter stature with proportional H&W)
3
Q
How is hypopituitarism diagnosed?
3 diagnoses
A
- observation of familial growth patterns for comparison
– look at H&W growth trends – these children tend to fall off growth charts - definitive diagnosis = absence of or subnormal reserves of pituitary GH
- skeletal survey in children < 3 y.o. – look for ossification of bones
4
Q
How is hypopituitarism treated?
2 treatments
A
- biosynthetic growth hormone injections
- other hormone replacements as needed
5
Q
What are some nursing considerations for hypopituitarism?
5 considerations
A
- early identification is key – better chance that treatments will help them mimic normal growth pathways
- familial growth trends compared to child’s growth trends
- child’s body image
- daily injections
- expensive treatment
6
Q
What is hyperpituitarism?
A
AKA acromegaly; excessive production of GH before the closure of epiphyseal shafts –> overgrowth of long bones
7
Q
How do children/pts with hyperpituitarism usually present?
8 presenting factors
A
- height may be >8 feet
- delays in fontanel closure d/t enlargment of head circumference
- vertical growth with rapid and increased muscle development
- weight is generally in proportion to height
- overgrowth of the head, lips, nose, tongue, jaw, and sinuses disproportionately to face
- separation and malocclusion of teeth
- increased facial hair
- thickened, deeply creased skin
8
Q
How is acromegaly diagnosed?
2 diagnoses
A
- radiologic studies for masses that may apply pressure to pituitary
- endocrine studies
9
Q
How is acromegaly treated?
4 treatments
A
- surgical treatment to remove tumor
- irradiation
- radioactive implants
- hormone replacement therapy after surgery
10
Q
What are some nursing considerations for acromegaly?
2 considerations
A
- early identification – excellerated growth rate stresses out body quite a lot
- child’s body image
11
Q
What is precocious puberty?
A
sexual development (before age 9 in boys or before age 7 in girls) d/t body’s inability to regulate hormones or an overproduction of hormone
12
Q
What are the 3 types of precocious puberty?
A
- central precocious puberty: sex hormones are released too early; 80% of cases
- peripheral precocious puberty: results from problems with the reproductive organs, adrenal glands, or from hormone exposure from the environment
- incomplete precocious puberty: child only has a few signs of early puberty (ie. breast development or body hair)
13
Q
How is precocious puberty treated?
3 treatments
A
- treat cause if etiology is known (ie. removal of mass)
- central – Lupron Depot (leuprolide acetate) – slows prepubertal growth to normal rates and is discontinued at age when normal pubertal changes would occur
- girls with precocious puberty may start birth control to regulate hormones
14
Q
What is diabetes insipidus?
A
the principle disorder of the posterior pituitary gland that causes an undersecretion of antidiuretic hormone (ADH) –> uncontrolled or excessive diuresis
15
Q
What are some causes for diabetes insipidus?
A
- primary causes – familial or idiopathic
- secondary causes – trauma, tumors, granulomatous disease, infections, aneurysm
16
Q
What are the clinical manifestations of diabetes insipidus?
6 manifestations
A
- polyuria
- polydipsia
- enuresis and insatiable thirst – usually the first sign
- irritability in infants relieved with water feedings
- dehydration
- urine output 4+ mL/kg/hr – usual for peds is 1 mL/kg/hr
– hallmark sign = high volume, low concentration urine (low specific gravity)
17
Q
What are some treatments for diabetes insipidus?
A
- daily hormone replacement of vasopressin/desmopressin
- if unresponsive to vasopressin/desmopressin –> nephrogenic DI – a renal problem is the cause for inability to regulate fluid filtration
18
Q
What is syndrome of inappropriate antidiuretic hormone secretion (SIADH)?
A
hypersecretion of posterior pituitary, resulting in excessive ADH production
19
Q
How do children with SIADH usually present?
9 manifestations
A
- fluid retention, usually in belly
- hypotonicity
- anorexia d/t feeling full
- N/V
- irritability
- personality changes
- peripheral edema
- coarse breath sounds
- low urine output less than 1 mL/kg/hr – low volume, high concentration (high specific gravity)
20
Q
How is SIADH managed?
4 treatments
A
- I&Os
- observe for signs of fluid overload
- seizure precautions – d/t build-up of toxins in body
- ADH-antagonizing medications
21
Q
What s/s is common in both DI and SIADH?
A
excessive thirst
22
Q
What is the difference between congenital and acquired hypothyroidism?
A
- congenital hypothyroidism: congenital hypoplastic thyroid gland (immature size)
- acquired hypothyroidism: d/t partial or complete thyroidectomy or following irradiation for Hodgkin disease
23
Q
What are the clinical manifestations of juvenile hypothyroidism?
5 manifestations
A
- decelerated growth
- myxedematous skin changes – dry, swollen, waxy skin; sparse hair; periorbital edema
- constipation
- sleepiness
- mental decline
24
Q
What is lymphocytic thyroiditis?
A
- AKA Hashimoto disease or chronic autoimmune thyroiditis
- results in a mix of presentations – oscillating between hypothyroidism and hyperthyroidism
- most common cause of thyroid disease in children and adolescents
- occurs more frequently after 6 y.o.
25
What is the usual treatment for Hashimoto disease?
hormone replacement
26
What is Graves disease?
* a form of hyperthyroidism
* appears to be autoimmune -- despite regulation of TSH hormone, the body continues to produce T3 and T4 in excessive amounts even when TSH is low
* most common cause of hyperthyroidism in children
27
How do children with Graves disease usually present?
| 2 presentations
* enlarged thyroid gland
* exophthalmos -- protrusion of one or both of the eyes from the socket
28
What is the peak incidence of Graves disease?
12 - 14 y.o., but may present at birth
29
How is Graves disease diagnosed?
increased levels of T3 and T4 with suppressed TSH
30
How is Graves disease treated?
| 3 treatments
-- goal of therapy is to slow the rate of hormone secretion
* antithyroid drugs
* subtotal thyroidectomy
* ablation with radioiodine
31
What is thyrotoxicosis?
* thyroid crisis/storm
* may occur from a sudden release of hormone
* life-threatening
* may be precipitated by infection, surgery, or a discontinuation of antithyroid therapy
32
How is thyrotoxicosis treated?
| 2 drugs
* antithyroid drugs
* propranolol -- relaxes and slows the storm
33
What is the purpose of the adrenal glands?
-- adrenal glands secrete 3 steroids:
* glucocorticoids
* mineralcorticoids
* sex steroids
34
What is Addison's disease?
* chronic adrenocortical (cortisol) insufficiency
* rare in children
* usually the result of tumor or lesion of the adrenal glands or an idiopathic cause
35
How do children with Addison's disease usually present?
-- symptoms appear gradually after 90% of the adrenal tissue is nonfunctional
* low cortisol
* fatigue
* weight loss
* poor wound healing
* low immunity -- poor infection management
36
How is Addison's disease treated?
| 1 treatment
hormone replacement
37
What is Cushing syndrome?
* excessive circulating free cortisol
* may be caused by an adrenal tumor
* may be caused by excessive or prolonged steroid therapy -- reversible once steroids are discontinued
* abrupt withdrawal of steroids may cause acute adrenal insufficiency -- this is why we do steroid tapers
38
What are some causes of Cushing syndrome?
| 4 causes
* excess adrenocorticotropic hormone (ACTH)
* excess glucocorticoids
* adrenal tumor
* excessive or prolonged steroid use
39
How do children with Cushing syndrome usually present?
| 7 characteristics
* excessive hair growth
* moon face
* red cheeks
* weight gain
* pendulous abdomen with red striae
* poor wound healing
* ecchymosis
40
How is Cushing syndrome diagnosed?
| 6 diagnostics
* confirmed excess cortisol levels
* X-rays for osteoporosis
* skull films for enlargement of sella turcica
* hyperglycemic fasting blood glucose
* serum electrolyte labs
* 24-hour urine
41
How is Cushing syndrome treated?
| 2 treatments
* surgery
* hormone replacement of GH, ADH, TH, gonadotropins, steroids
42
What do the 3 cells of the pancreas produce?
* alpha cells -- glucagon
* beta cells -- insulin
* delta cells -- somatostatin
43
What is diabetes mellitus?
* total or partial deficiency of insulin
* most common endocrine disorder of childhood
* peak incidence is early adolescence -- 10 - 15 y.o.
44
What is type 1 diabetes?
destruction of beta cells, causing an absolute insulin deficiency
45
What is type 2 diabetes?
arises d/t insulin resistance
46
What is ketoacidosis?
* when glucose is unavailable for cellular metabolism, the body begins to break down alternate sources for energy
* breakdown of protein creates ketones
* excess ketones are elimintated in the urine or by respiratrion
* ketones are strong acids and lower blood pH --> ketoacidosis
47
What are Kussmal respirations?
hyperventilation characteristic of metabolic acidosis -- it is the body's attempt to eliminate excess CO2
48
What is diabetic ketoacidosis?
* progressive deterioration with dehydration, electrolyte imbalance, acidosis, and coma
* may cause death
* pediatric emergency
49
How is diabetic ketoacidosis treated?
| 6 treatments
* administer fluids first -- blood is viscous, so fluids dilute it down; 20 mL/kg
* administer insulin -- don't want to change blood sugar too rapidly; no more than 100 mg/dL/hr
* administer glucose and other electrolytes (K+ mostly)
* glucose monitoring -- goal = less than 126 mg/dL
* urine test for ketones
* labs for A1c
50
What are some education topics for children with type 1 DM?
* nutrition
* exercise
* management of hypoglycemic episodes
* illness management
* management of DKA
* glucose monitoring
51
What are the types of rapid acting insulin, when do they start working, and what is their peak?
-- Novolog & Humalog
* starts working in 15 min
* peak = 30 - 90 min
* take immediately prior to meals -- make sure sugar/meal is in front of pt prior to administering
52
What are the types of intermediate acting insulin, when should it be administered, and when does it peak?
-- NPH & Humalin
* administer in the AM
* peak = 6 - 8 hours
53
What is the name for long acting insulin, when should it be taken, and when does it peak?
-- Lantus
* administer at dinner
* peak = no peak
NURS 332
flashcards
Decks in class (13)
# Cards
-
Chapter 6: Communicable and Infectious Diseases32
-
Chapter 18: Cognitive & Sensory Impairment29
-
Chapter 21: Respiratory Dysfunction59
-
Chapter 22: GI Dysfunction35
-
Chapter 26: Genitourinary Dysfunction33
-
Chapter 28: Endocrine Dysfunction53
-
Chapter 23: Cardiovascular Dysfunction22
-
Chapter 24: Hematologic & Immunologic Dysfunction27
-
Chapter 25: Cancer13
-
Chapter 19: Family Centered Care3
-
Chapter 28 Review: Endocrine Dysfunction20
-
Chapter 27: Neurologic Dysfunction36
-
Chapter 29 & 30: Musculoskeletal and Neuromuscular Dysfunction38
