Endocrine Peds Exam 2

A 12-year-old child suddenly experiences an extreme drop in blood pressure following discontinuation of prednisone. The child appears gray and has a weak pulse. Which is the priority nursing intervention in this situation?

- immediate replacement of cortisol acute adrenocortical insufficiency

management of DM

- insulin tx + *adjustments as child grows* - measurement of A1c - glucose monitoring *range 80-120 mg/dL* - urine testing for *ketones* (if BS is >240) or when sick -nutrition/exercise -management of DKA -healthy wt. unique for type 2

different type of endocrine disorders

- pituitary gland disorders: Growth hormone and puberty - thyroid gland disorders - adrenal gland disorders -parathyroid gland disorders adjustment as child grows

Grave's Dx.

= cause of *HYPERthyroidism* -protuberant tongue - fatigued appearance -poor muscle tone - *expothalmos* - increased rate of growth - wt. loss - hyperactivity - *warm/moist skin - *tachycardia + tremors* - enlarged thyroid/goiter

Desmopressin acetate

=synthetic antidiuretic hormone that promotes reabsorption of water action on renal tubules - to control diabetes insipidus

grave's dx

- *hyper*thyroidism - T4/T3 levels cause overfunctioning - eats constantly - eye bulging

endocrine careplan

- *maintain normal growth and development* - monitor appropriate lab values - administer medications as indicated (in addition to) - promote self management, healthy self esteem, and healthy body image (psychosocial) - do want secondary sex characteristics for age

cushing's syndrome

- caused by *overproduction* of adrenal hormone *cortisol*, results from increased ACTH production due to either a *pituitary or adrenal cortex tumor*

type 1 diabetes

- characterized by *destruction of beta cells* = usually leading to absolute insulin deficiency - most DM of childhood is type 1 onset: as early as infancy but usually school-aged and adolescents; can *occur at any age* -insulin dependent

emily video

-likes to Haiwain dance -signs of thirst > hyperglycemia - dx. at 17 mons - had a diabetic trainer= calorie counting -omni pod= continuous insulin -dexcom

when is hormone therapy started (age)?

14

carbohydrate restriction with diabetics

45 grams at each of the three meals of the day

type 2 diabetes

= arises because of *insulin resistance* - may be seen in *obese* pediatric patients - controlled with *oral hypoglycemic + diet* ; may require insulin - increasing frequency in pediatric population

types of insulins, from shortest to longest duration

Aspart (3-5 hrs)> Regular (5-8 hrs)> NPH (10-16hrs)> Glargine (12-24hrs)

excessive levels of circulating cortisol

Cushing Syndrome

tx of HYPOparathyroidism

IV calcium gluconate for acute or severe tetany

tx of HYPERparathyroidism

IV diuretics

Pancreas disorders

Type 1 Diabetes Type 2 Diabetes

diabetic ketoacidosis

acidity of the blood caused by the presence of ketone bodies produced when the body is unable to burn sugar; thus, it must burn fat for energy - life threatening form of ketoacidosis -s/s: insulin deficiency, ^ levles of counterregulatory hormones, and dehydration

diabetes insipidus

characterized by deficient secretion of *antidiuretic hormone* leading to *diuresis* will have abrupt onset of symptoms: polyuria, nocturia, polydipsia - most important to check urine output in children

hypothyroidism

constipation, *wt. gain*, facial edema - *bradycardia*, cool/dray/scaly skin -enlarged posterior fontanel and feeding difficulties common with congenital hypothyroidism

A child with growth hormone deficiency is prescribed growth hormone (GH) by subcutaneous injection. When teaching the child's parents about this drug, the nurse would instruct the parents to administer the drug at which frequency?

daily > 6-7 day a week usually at bedtime

child complains of urinating alot and being really thirsty. What are these symptoms related too?

diabetes insipidus

pelvic ultrasound for possible ovarian cyst

drink plenty of fluids because you need to have a full bladder

chvostek sign

facial muscle spasm demonstrated by tapping the facial nerve

child dx. with low functioning parathyroid. what is tx.?

maintain calcium level at normal level with calcium replacement

hyperthyroidism

manifested by heat intolerance, nervousness/anxiety, diarrhea, wt. *loss*, smooth velvety skin

a 8 y/o child is seen for moodiness/irritability. The child has begun to develop breast and pubic hair. What would the nurse expect?

precocious puberty

glucosuria

spill of glucose into urine

congenital adrenal hyperplasia

syndrome that is inherited as an autosomal recessive trait, which the adrenal glands do not synthesize cortisol will see an *enlarged clitoris* - when salt is not retained= fluid will not be retained in body= *Dehydration* > can cause death within 48-72 hours

Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply.

three P's: - polydipsia - polyuria -polyphagia findings in both DM

humalog administration

within 15-30 mins pt should eat meal to avoid hypoglycemic reaction peak level 30-90 mins