Ch 48 PrepU: Nursing Care of a Family when a Child has an Endocrine or a Metabolic Disorder

A 2-year-old client is at the office for a follow-up visit. The client has had excessive hormone levels in recent bloodwork and the parents question why this was not found sooner. What is the best response by the nurse?

"As endocrine functions become more stable throughout childhood, alterations become more apparent." The endocrine glands are all present at birth; however, endocrine functions are immature. As these functions mature and become stabilized during the childhood years, alterations in endocrine function become more apparent. Thus, endocrine disorders may arise at any time during childhood development.

A young couple seeks pregnancy counseling in the women's health clinic. They tell the nurse performing a focused health history that they are of Jewish descent and are worried about conceiving a baby with Tay-Sachs disease. No known metabolic disorders exist in the family medical history. What is the nurse's best response to this couple's concerns?

"Carrier testing is warranted for couples who have an elevated risk for Tay-Sachs disease due to their ethnic origin." Prevention, when it is possible, is the first intervention for metabolic disorders, such as Tay-Sachs. For some diseases such as Tay-Sachs disease, mild hyperphenylalaninemia, and Gaucher disease, carrier testing (heterozygote screening) is possible. Carrier testing is warranted for people who may have elevated risk because of their ethnic or national origin. The nurse has an important role in providing genetic counseling to families who are suspected or known carriers of a metabolic disorder.

A nurse is educating the family of a small child with phenylketonuria about meal choices. Which meal choice by the parents indicates to the nurse that they understand the dietary management of this disease?

a bowl of dry cereal with strawberries and apple juice The nurse is able to evaluate parental understanding of meal choices by having the parent select appropriate meals. The nurse confirms understanding when the parent selects foods low in phenylalanine, which include vegetables, fruits, juices, some breads, and some cereals. Steak and aspartame are high in phenylalanine and should be avoided. Hamburger may have high phenylalanine levels. Dairy products are high in phenylalanine and should be avoided. Mashed potatoes, if made from scratch, and orange juice are acceptable foods.

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. In caring for a child that has issues with the anterior pituitary, the nurse knows that this child has issues with which hormone?

growth hormone Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. The posterior lobe is called the neurohypophysis because it is formed of neural tissue. It secretes antidiuretic hormone (ADH; vasopressin) and oxytocin. Usually, several target organs are affected when there is a disorder of the pituitary gland, especially the adenohypophysis.

When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which finding in the child's fasting glucose levels?

A fasting blood sugar result of 200 mg/dL or more almost certainly is diagnostic for diabetes when other signs, such as polyuria and weight loss despite polyphagia, are present.

The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with this disorder?

The parents report that their son "can't drink enough water." Unquenchable thirst (polydipsia) is a common finding associated with diabetes mellitus, type 1 and 2. However, reports of flu-like illness and Kussmaul breathing are more commonly associated with type 1 diabetes. Blood pressure is normal with type 1 diabetes and elevated with type 2 diabetes.

A child who has a history of adrenal gland insufficiency has had cold/flu-like symptoms and has stayed home from school. The mom calls the nurse line at the doctor's office to ask what she should do. Which nursing action should the nurse advise the mother to take first?

"Give your reserve dose of cortisol, and bring your child straight to the office." Infections and cold or flu symptoms could be life threatening to a child with adrenal insufficiency. All families should keep a reserve dose of cortisol for emergencies. The first advice should be to give this dose and see a doctor immediately. An extra dose of cortisol will not harm the child.

The nurse is providing client education to an adolescent newly diagnosed with type 1 diabetes mellitus. Which statement by the adolescent indicates that the nurse's teaching has been effective?

"If I take my insulin, I can eat any kind of carbohydrate I want." Insulin doses in type 1 diabetes mellitus are based on blood glucose levels and carbohydrates to be eaten, so it is true that a carbohydrate could be any carbohydrate. Snacks should always be consumed before exercise, not afterward. A child with or without diabetes mellitus should have the same nutritional needs. Weight loss usually occurs before the diagnosis of type 1 diabetes mellitus. Clients with type 2 diabetes mellitus must manage weight loss.

A 13-year-old adolescent with hyperthyroidism who takes antithyroid medication has a sore throat and a fever. The parent calls the nurse and asks what to do. Which is the best response from the nurse?

"Please take your child straight to the emergency department." A side effect of antithyroid medications is leukopenia. Signs and symptoms that include fever and sore throat need to be seen immediately. These instructions should be reviewed with parents upon discharge. The question includes information about Graves disease, so ibuprofen would not be the treatment. The question centers around drug therapy, not the child's fluid status.

The nurse is teaching parents about the pattern of heredity of metabolic conditions. The nurse realizes that further teaching is needed when the parent makes which statement?

"The pattern of heredity for all metabolic conditions is dominant." The pattern of heredity for many metabolic conditions is recessive. The statement that all are dominant conditions is false, because some conditions may be caused by a dominant gene. Not all metabolic conditions are evident during the neonatal period. Some manifest themselves in early childhood.

From which pair of metabolic disorders must the nurse instruct the parents to eliminate breast and cow's milk from the diet?

Both phenylketonuria and galactosemia are hereditary disorders in which the body cannot have milk. Maple syrup urine disease is an inborn error of metabolism of the branched chain amino acid. Congenital hypothyroidism is an error with the thyroid gland.

A child is brought to the clinic experiencing symptoms of nervousness, tremors, fatigue, increased heart rate and blood pressure. Based on this assessment, the nurse would suspect a diagnosis of which condition?

Children who develop Graves disease experience nervousness, tremors, and increased heart rate and blood pressure cause by overstimulation of the thyroid gland. Cushing syndrome, hypertension, and hypothyroidism are not associated with these symptoms.

The nurse is teaching the mother of a child with phenylketonuria (PKU) about diet and realizes the mother needs further instruction when she makes which statement?

Clients with PKU need to avoid high-protein foods including meats, fish, poultry, eggs, cheese, milk, nuts, beans, peas, and flour. The food exchange list includes vegetables, fruits, breads, cereals, fats, and miscellaneous "free foods" allowed on the diet.

The nurse knows that which condition is caused by excessive levels of circulating cortisol?

Cushing syndrome is a characteristic cluster of signs and symptoms resulting from excessive levels of circulating cortisol. Addison disease is caused by autoimmune destruction of the adrenal cortex, which results in dysfunction of steroidogenesis. Graves disease is the most common form of hyperthyroidism. Turner syndrome is the deletion of the entire X chromosome.

A 15-year-old girl is brought to the clinic by her mother because the girl has been experiencing irregular and sporadic menstrual periods and excessive body hair growth. Polycystic ovary syndrome is suspected. Which additional assessment finding would help to support this suspicion?

Darkened pigmentation around the neck area Acanthosis nigricans (darkened, thickened pigmentation, particularly around the neck or in the axillary region) is associated with polycystic ovary syndrome. Serum levels of free testosterone typically are elevated with polycystic ovary syndrome. With polycystic ovary syndrome, body mass index indicates overweight or obesity. Short stature typically is associated with growth hormone deficiency.

An adolescent is having an annual physical. The adolescent has a documented weight loss of 9 lb (4.08 kg). The parent states, "He eats constantly." Exam findings are normal overall, except that the child reports having trouble sleeping, and the child's eyeballs are noted to bulge slightly. Which interventions would the nurse perform based on these findings?

Discuss preparing for a thyroid function test. The child exhibits signs and symptoms of Graves disease (hyperthyroidism). A thyroid function test would show an elevation in T4 and T3 levels caused by overfunctioning of the thyroid. Neither a neurology consult nor an eye exam would be needed. A fasting blood glucose test is used to test for Cushing syndrome and diabetes mellitus.

The nurse is obtaining a health history from parents whose 4-month-old boy has congenital hypothyroidism. What would the nurse most likely assess?

During the health history, the parents may state that it is difficult to keep the child awake. Physical examination would reveal that the child is below weight and height, that his skin is pale and mottled, and that he is lethargic and irritable.

The nurse is preparing a teaching plan for a 10-year-old girl with hyperthyroidism. What information would the nurse include in the plan?

Explaining about the radioactive iodine procedure would be part of the teaching plan for a child with hyperthyroidism because this is a less invasive type of therapy for the disorder. Describing surgery to remove an anterior pituitary tumor would be included for a child with hyperpituitarism. Teaching a parent to give injections of growth hormone would be appropriate for a child with a growth hormone deficiency. Showing parents how to give DDAVP intranasally is appropriate for a child with diabetes insipidus.

A pediatric nurse is discharging a 1-month-old infant. The infant was diagnosed with congenital hypothyroidism on this admission and will be treated with levothyroxine. The nurse knows it is important to teach the parent about medication administration. Which process will the nurse include in the teaching?

Give the crushed medication in a syringe mixed with a small amount of formula. The medication should be mixed in a small amount of food to make sure the infant receives the whole dose. It should not be placed in a whole bottle because the infant may not drink the entire bottle. This medication is prescribed for daily use, and hypothyroidism is a lifelong condition.

The school nurse observes an 8th grader at school who suddenly is losing weight, is not participating in gym, and is in poor academic standing. The nurse takes a history and notes that the child seems very nervous. The nurse notifies the parent, who explains that the child has just been seen by the family health care provider and tested low for thyroid-stimulating hormone (TSH). For which condition will the nurse devise a plan of care?

Graves disease is hyperthyroidism and would result in a low TSH level, noted weight loss, and nervous behavior. Hashimoto thyroid disease is a hypothyroid disease, which would result in a high TSH level. Hypothyroidism would also show a high TSH level. Diabetes mellitus involves the pancreas.

A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is:

Hyperthyroidism occurs less often in children than hypothyroidism. Graves disease, the most common cause of hyperthyroidism in children, occurs in 1 in 5,000 children between 11 and 15 years of age. Hyperthyroidism occurs more often in females, and the peak incidence occurs during adolescence.

A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered?

Intravenous calcium gluconate is used to treat acute or severe tetany. Hydrocortisone is used to treat congenital adrenal hyperplasia and Addison disease. Desmopressin is used to control diabetes insipidus. Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism.

A child was recently diagnosed with type 1 diabetes. The nurse is preparing to teach the child and their parents about the insulin therapy the health care provider has prescribed. What should the nurse ensure is included in this training?

It is normal for the growing child to require an increase in insulin; this does not mean their condition is getting worse. Children show a decreased need for insulin shortly after glucose control has been established, which is referred to by some as the "honeymoon phase" and should be described to parents so that they do not get any false hope that the child does not need insulin. As children grow, they will require increased doses of insulin to maintain glucose control, and not all children need to receive two types of insulin. Insulin treatment should be based on each individual child.

A nurse is reviewing the diagnostic test findings of a client with a metabolic disorder. Which finding is indicative of galactosemia?

Laboratory findings indicative of galactosemia include galactosuria, elevated blood galactose level, low glucose level, positive Benedict test of urine, deficiency of G-1-PUT in red and white blood cells and liver cells, and elevated SGPT/SGOT and bilirubin.

A nurse caring for patients with metabolic disorders is aware that lactate is elevated in which disorder type?

Lactate is elevated in disorders of carbohydrate and energy metabolism. Ammonia is markedly elevated in urea cycle defects.

The nurse is teaching a child with PKU about his or her special diet during a checkup visit. It would be appropriate to teach the child that he can eat which of the following foods? Select all that apply.

PKU (phenylketonuria) is the result of an inherited autosomal recessive trait. The enzyme phenylalanine hydroxylase is missing, and this prevents the breakdown into essential amino acids. Therefore, phenylalanine builds in the bloodstream, causing permanent damage to brain tissue. Foods high in phenylalanine include meats, eggs, and milk. Foods lows in phenylalanine include orange juice, bananas, potatoes, peas, lettuce, and spinach. Lofenalac is used in place of milk products.

The nurse is caring for an 11-year-old child who has type 2 diabetes mellitus. The child has been vomiting for 48 hours and the breath has a fruity odor. The nurse notes that respirations are deep and rapid with a temperature of 102°F (38.9°C). Which intervention would be most appropriate?

Prepare for IV insertion. The child needs nursing interventions rapidly to change his or her diabetic status. This child should be given an IV with fluids and electrolytes to improve and restore tissue perfusion. Fruity breath and deep and rapid respirations are signs of ketoacidosis (hyperglycemia), which occurs before oral rehydration. The urine may show ketones, but checking the urine is not the priority in this risky situation.

A 4-year-old child is undergoing a radioimmunoassay of T4 and T3 to determine whether the thyroid is functioning properly. Which factor could abnormally elevate the child's iodine level and thus invalidate the test?

Recent consumption of large amounts of cough medicine Radioimmunoassay of T4 and T3 is a specific blood study to determine how much protein-bound iodine (PBI) is present in serum. Ask if a child has recently taken large amounts of cough medicine containing iodide before the study or the PBI level may be abnormally elevated. The small amount of iodine ingested from iodized salt does not affect PBI levels. Children who have low circulating albumin levels can have abnormally low PBI levels, because iodine is carried bound to protein. Phenytoin, a common anticonvulsant medication prescribed for children with recurrent seizures, may displace thyroxine from binding globulin and further contribute to low PBI levels.

A nurse is teaching the parents of an infant with congenital adrenal hyperplasia about the signs and symptoms of adrenal crisis. The nurse determines that the teaching was successful when the parents correctly identify what sign of adrenal crisis?

Signs and symptoms of acute adrenal crisis include persistent vomiting, dehydration, hyponatremia, hyperkalemia, hypotension, tachycardia, and shock.

The parents of a child with congenital adrenal hyperplasia bring the child to the emergency department for evaluation because the child has had persistent vomiting. What finding would lead the nurse to suspect that the child is experiencing an acute adrenal crisis?

Signs and symptoms of an acute adrenal crisis include hyperkalemia, hyponatremia, tachycardia, hypotension, persistent vomiting, dehydration, and shock.

The nurse is working in the labor and delivery area with a laboring parent who is a genetic carrier for galactosemia. Following birth, which change in the plan of care occurs until it is confirmed that the neonate does not have galactosemia?

The neonate will be given a soy-based formula. Galactosemia is a rare autosomal recessive disorder that is an inborn error of carbohydrate metabolism. The enzyme galactose-1-phosphate uridyltransferase is missing, and this prevents galactose from being changed to glucose. Galactose builds up in the bloodstream, possibly causing cataracts, liver failure, and renal tube problems. Treatment consists of removing all lactose-containing foods, including breast milk. Soy protein is the preferred formula diet. Skin-to-skin contact is encouraged after birth. Glucose water may or may not be offered. Phototherapy is only initiated if and when it is needed.

A 6-year-old boy has a moon-face, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. What is the most likely cause of this condition in this child?

Tumor of the adrenal cortex Cushing syndrome is caused by overproduction of the adrenal hormone cortisol; this usually results from increased ACTH production due to either a pituitary or adrenal cortex tumor. The peak age of occurrence is 6 or 7 years. The overproduction of cortisol results in increased glucose production; this causes fat to accumulate on the cheeks, chin, and trunk, causing a moon-faced, stocky appearance. Cortisol is catabolic, so protein wasting also occurs. This leads to muscle wasting, making the extremities appear thin in contrast to the trunk, and loss of calcium in bones (osteoporosis). Other effects include hyperpigmentation (the child's face is unusually red, especially the cheeks).

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. Which is the priority intervention for this child?

check vital signs Central diabetes insipidus is a disorder of the posterior pituitary. The fluid status of the child can be assessed first by assessing the vital signs. The large amounts of fluid loss can cause fluid and electrolyte imbalance that should be corrected. Urine output is important but not the priority. Encouraging fluids will not correct the problem, and weighing the client is not necessary at this time. Diabetes insipidus is managed by decreasing the protein and sodium in the diet and daily replacement of the antidiuretic hormone.

Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of:

diabetic ketoacidosis. Insulin deficiency, in association with increased levels of counter-regulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis (DKA), a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glucosuria is glucose that is spilled into the urine.

The obstetric nurse performs a focused health history on the family of a primigravid client. The father of the fetus tells the nurse that the family comes from Ashkenazi Jewish ancestry and is very concerned about the possibility of Tay-Sachs disease. The father asks, "What is the soonest that we will know if my child has this disease." The nurse will state which time frame?

during pregnancy via amniocentesis It is important to answer the questions of the family and provide definitive answers of when health care providers can first identify if a child has Tay-Sachs disease. Tay-Sachs disease, Gaucher disease, and Niemann-Pick disease occur more frequently among individuals of Ashkenazi Jewish ancestry. Although Tay-Sachs disease occurs in 1 in 3500 to 4000 births, the carrier rate among people with Ashkenazi Jewish ancestry is 1 in 30. All of the options include when Tay-Sachs can be identified; however, the disorder can be first detected in utero via amniocentesis. By identifying the disease early, the parents do not have to worry throughout the pregnancy or can make plans, if needed, in caring for the child or terminating the pregnancy. Following birth, fetal blood can be tested for hexosaminidase. Due to the build-up of lipids in the system, the infant will begin to become developmentally delayed and even regress in meeting developmental milestones.

The nurse is caring for a child with type 1 diabetes mellitus. The nurse notes the child is drowsy, has flushed cheeks and red lips, a fruity smell to the breath, and there has been an increase in the rate and depth of the child's respirations. Which prescription from the primary health care provider will the nurse question?

monitor glucose level every 3 hours The client is experiencing diabetic ketoacidosis (DKA), which is the result of fat catabolism. It is characterized by drowsiness, dry skin, flushed cheeks and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements). The nurse would question only checking the glucose level every 3 hours as it should be assessed at least hourly to ensure the client's level does not fall more than 100 mg/dL (5.55 mmol/L) per hour. A too-rapid decline in blood glucose predisposes the child to cerebral edema. Fluid therapy is given to treat dehydration, correct electrolyte imbalances (sodium and potassium due to osmotic diuresis), and improve peripheral perfusion. Administration of regular insulin, given intravenously, is preferred during DKA. Ketones would be assessed either in the urine or blood to see how much the client is spilling.

A nurse is preparing to discharge a neonate diagnosed with maple syrup urine disease. Which nursing instruction is essential for care of the neonate in the home?

reinforcing the need for the prescribed lifelong dietary regimen Family education goals should focus on reinforcing the need for the prescribed dietary regimen, the importance of follow-up appointments, and sick-day management. This is daily information that needs to be understood. Once routine care is understood, then future care can be addressed. As the child grows, the frequency and severity of crisis events decrease, but lifelong dietary management is still required. When the child is ill, protein intake should be reduced, and caloric intake should be increased from 80 to 120 kcal/kg per day to 120 to 140 kcal/kg per day by encouraging consumption of carbohydrate- and fat-containing foods.

A 9-year-old child with Graves disease is seen at the pediatrician's office reporting sore throat and fever. The nurse notes in the history that the child is taking propylthiouracil. Which of the following would concern the nurse?

The child may have developed leukopenia. Graves disease is defined as an overproduction of thyroid hormones. Propylthiouracil is used to suppress thyroid function. A complication of Graves disease is leukopenia.

The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved?

Antidiuretic hormone Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism.

A nurse is preparing a presentation for a group of parents with children diagnosed with type 1 diabetes. The children are all adolescents. What issues would the nurse address related to their developmental level? Select all that apply.

Deficient decision-making skills Body image conflicts Struggle for independence Adolescents are undergoing rapid physical, emotional, and cognitive growth. Working toward a separate identity from parents and the demands of diabetic care can hinder this. This struggle for independence can lead to nonadherence of the diabetic care regimen. Conflicts develop with self-management, body image, and peer group acceptance. Teens may acquire the skills to perform tasks related to diabetic care but may lack decision-making skills needed to adjust treatment plan. Teens do not always foresee the consequences of their activities. Self-monitoring of blood glucose levels and feelings of being different are issues common to school-age children.

A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin?

Glargine is not to be mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.

A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which method should she recommend to the child for regular doses?

Subcutaneously in the outer thigh Insulin is always injected SC except in emergencies, when half the required dose may be given IV. SC tissue injection sites used most frequently in children include those of the upper outer arms and the outer aspects of the thighs. The abdominal SC tissue injection sites commonly used in adults can be adequate sites but most children dislike this site as abdominal skin is tender.

A 12-year-old client arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. The client is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder is most associated with these symptoms?

Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin (growth hormone) results in undergrowth; hypersecretion results in overgrowth.

A nurse is educating a family about the Chvostek sign after their teen tested positive for Chvostek sign. Which statements by the caregivers shows the nurse that they understand the Chvostek sign?

The Chvostek sign is a facial muscle spasm that occurs when the facial nerve is tapped. This can indicate heightened neuromuscular activity, possibly caused by hypocalcemia. Hypoparathyroidism may be suspected.

The nurse is assessing an 8-year-old boy who is performing academically at a second-grade level. The mother reports that the boy states feeling weak and tired and has had a weight increase of 6 pounds (13.2 kg) in 3 months. Which additional data would fit with a possible diagnosis of hypothyroidism?

The child states that the exam room is cold. Cold intolerance, manifested by the fact that the child was uncomfortably cold in the exam room, is a sign of hypothyroidism. Delayed dentition, with only two of the four 6-year molars having erupted, is typical of growth hormone deficiency. Complaints of thirst may signal diabetes or diabetes insipidus. A rash can be varied disease processes but is not characteristic in hypothyroidism.

The nurse reviews a 6-year-old client's laboratory results and notes the client's hemoglobin A1C level is 7.7% (0.077). Which action by the nurse is appropriate?

continue to monitor The nurse would continue to monitor the client as this level is within range for this client's age. Hemoglobin A1C provides information regarding the long-term control of glucose levels. This age client should have an A1C less than 8% (0.08). There is no indication the nurse needs to assess the client's current glucose level. The nurse does not administer insulin based on A1C levels. The health care provider does not need to be notified for a normal level.

The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease?

insulin Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted. Glycogen is stored in the liver and muscles. It is released to provide energy when the blood glucose levels fall. Glucagon is also produced by the pancreas. Its job is to force the liver to release stored insulin when the body has a need for more insulin. The adrenocorticotropic hormone is produced by the anterior pituitary. Its function is to regulate cortisol. This is needed so the adrenal glands can function properly. It also helps the body respond to stress.

An 8-year-old child is admitted to a medical-surgical unit with a diagnosis of syndrome of inappropriate antidiuretic syndrome (SIADH). The nurse will closely monitor the client's

sodium, fluid balance, and LOC An increase of antidiuretic hormone causes the body to hold onto fluid. The nurse should monitor fluid balance closely when caring for a child diagnosed with syndrome of inappropriate antidiuretic syndrome (SIADH).Fluid retention and shifts can cause changes in level of consciousness. The nurse should monitor the child's level of consciousness closely.The increase of antidiuretic hormone causes the body to hold onto fluid, causing dilutional hyponatremia (decreased serum sodium). The nurse should monitor the child's serum sodium level closely. Blood glucose and serum potassium are not affected in syndrome of inappropriate antidiuretic hormone (SIADH).

The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes?

recent weight loss Weight loss is unique to type 1 diabetes, whereas weight gain is associated with type 2. Hypertension is consistent with type 2 diabetes. Both type 1 and type 2 diabetes cause delayed wound healing. The increase in blood glucose in diabetes causes damage to the inner lining of the arteries that cause the arteries to develop plaque and harden. These damages to the blood vessels result in a decrease in the ability of oxygen-rich blood to be transported effectively to the tissues to promote wound healing. Loose stools or repeated loose stools (diarrhea) is a common side effect of the oral medication metformin, which is prescribed for clients with type 2 diabetes. Insulin, the treatment for type 1 diabetes, has constipation as one of the side effects.

The neonatal nurse is caring for children with inborn errors of metabolism. Which treatment is recommended for these conditions?

replacing deficient enzymes through intravenous administration Prompt treatment for metabolic disorders may include replacing deficient enzymes through intravenous administration. Other interventions are decreasing substrates preceding the enzymatic block (e.g., avoiding a particular amino acid or carbohydrate), administering a supplement of the deficient product that should have been produced, providing an enzymatic cofactor, using medications to remove accumulated substrates, undergoing liver or bone marrow transplantation to eliminate all deficient enzymes, and providing somatic gene therapy (a future option).