Chapter 28 Review: Endocrine Dysfunction

Question 1

What is hypopituitarism?

Answer 1

growth hormone deficiency where growth of all cells in the body is inhibited proportionately (shorter stature with proportional H&W)

Question 2

How is hypopituitarism diagnosed?

3 diagnoses

Answer 2

• 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

Question 3

How is hypopituitarism treated?

2 treatments

Answer 3

• biosynthetic growth hormone injections
• other hormone replacements as needed

Question 4

What are some nursing considerations for hypopituitarism?

5 considerations

Answer 4

• 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

Question 5

What is syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

Answer 5

hypersecretion of posterior pituitary, resulting in excessive ADH production

Question 6

How do children with SIADH usually present?

9 manifestations

Answer 6

• 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)

Question 7

How is SIADH managed?

4 treatments

Answer 7

• I&Os
• observe for signs of fluid overload
• seizure precautions – d/t build-up of toxins in body
• ADH-antagonizing medications

Question 8

What s/s is common in both DI and SIADH?

Answer 8

excessive thirst

Question 9

What do the 3 cells of the pancreas produce?

Answer 9

• alpha cells – glucagon
• beta cells – insulin
• delta cells – somatostatin

Question 10

What is diabetes mellitus?

Answer 10

• total or partial deficiency of insulin
• most common endocrine disorder of childhood
• peak incidence is early adolescence – 10 - 15 y.o.

Question 11

What is type 1 diabetes?

Answer 11

destruction of beta cells, causing an absolute insulin deficiency

Question 12

What is type 2 diabetes?

Answer 12

arises d/t insulin resistance

Question 13

What is ketoacidosis?

Answer 13

• 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

Question 14

What are Kussmal respirations?

Answer 14

hyperventilation characteristic of metabolic acidosis – it is the body’s attempt to eliminate excess CO2

Question 15

What is diabetic ketoacidosis?

Answer 15

• progressive deterioration with dehydration, electrolyte imbalance, acidosis, and coma
• may cause death
• pediatric emergency

Question 16

How is diabetic ketoacidosis treated?

6 treatments

Answer 16

• 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

Question 17

What are some education topics for children with type 1 DM?

Answer 17

• nutrition
• exercise
• management of hypoglycemic episodes
• illness management
• management of DKA
• glucose monitoring

Question 18

What are the types of rapid acting insulin, when do they start working, and what is their peak?

Answer 18

– 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

Question 19

What are the types of intermediate acting insulin, when should it be administered, and when does it peak?

Answer 19

– NPH & Humalin
* administer in the AM
* peak = 6 - 8 hours

Question 20

What is the name for long acting insulin, when should it be taken, and when does it peak?

Answer 20

– Lantus
* administer at dinner
* peak = no peak