EAQ: pediatric endocrine
The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and instead take pills as an uncle does. What is the most appropriate response by the nurse? "The pills only work with an adult pancreas." "The drugs affect fat and protein metabolism, not sugar." "Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." "Perhaps when your child is older the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."
"Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." In type 1 diabetes, the beta-cells have been destroyed. It is necessary to supply the insulin no longer produced by these cells. The oral medications have different modes of action that supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes and are primarily used in type 2 diabetes mellitus. Oral hypoglycemics can supplement insulin production by the pancreas, decrease insulin resistance, or affect the liver production of glucose. In type 1 diabetes, without a pancreatic beta-cell transplant, it is unlikely that insulin would be produced.
An infant presents with hypospadias, micropenis, and no palpable gonads. How should the nurse document these findings? Atrophy Cushing syndrome Ambiguous genitalia Adrenal insufficiency
Ambiguous genitalia The condition of ambiguous genitalia is marked by hypospadias, micropenis, and no palpable gonads. Cushing syndrome is an endocrine disorder that involves excessive circulating free cortisol. Atrophy and adrenal insufficiency are not associated with hypospadias, micropenis, or palpable gonads.
What should be the priority nursing intervention for a diabetic child with fever and deep, rapid breathing who is admitted to an intensive care facility for management? Administer antibiotics to the child. Administer continuous intravenous insulin. Determine the blood glucose level of the child. Obtain a sample for arterial partial pressure of oxygen.
Determine the blood glucose level of the child. Deep, rapid breathing in a diabetic child may reflect hyperventilation due to metabolic acidosis or diabetic ketoacidosis. Rapid assessment of the child is a priority nursing intervention. The blood glucose level must be determined at the bedside. Antibiotics are administered to the febrile child only after obtaining appropriate specimens for culture. Continuous intravenous insulin is administered after the initial rehydration; it should not be administered until blood glucose and urine ketone levels are obtained. A blood sample needs to be obtained for determining arterial partial pressure of oxygen as part of the rapid assessment of the child; however, the sample is obtained after determining the blood glucose level at the bedside.
The nurse is teaching an adolescent with newly diagnosed type I diabetes ways to minimize discomfort with insulin injections. Which recommendations are helpful in minimizing injection discomfort? Do not reuse needles. Inject insulin when it is cold. Flex or tense the muscle during injection. Remove all bubbles from the syringe before the injection. Do not move the direction of the needle-syringe during insertion or withdrawal.
Do not reuse needles. Remove all bubbles from the syringe before the injection. Do not move the direction of the needle-syringe during insertion or withdrawal. The reuse of needles leads to more discomfort on injection because the needles become dull and this also poses an infection-control problem. Removing bubbles from the syringe will minimize discomfort. Keeping the direction of the syringe constant during the insertion and withdrawal minimizes discomfort. Insulin should be injected at room temperature to minimize discomfort. Flexing or tensing the muscle during injection causes more discomfort.
What information should the nurse include when discussing a child's precocious puberty with the parents? The child is not yet fertile. Sexual interest is usually advanced. Dress and activities should be appropriate to the chronological age. The appearance of secondary sex characteristics does not proceed in the usual order.
Dress and activities should be appropriate to the chronological age Because of the child's early sexual maturation, both the family and child require extensive teaching. Included in this teaching is the information that the child should be engaged in activities according to his or her chronological age. Functioning sperm or ova may be produced, making the child fertile. Heterosexual interest is usually appropriate to the chronological age. Development of the secondary sex characteristics proceeds in the usual order in precocious puberty.
What are the clinical manifestations of juvenile hypothyroidism? Sleepiness, dry skin, diarrhea Dry skin, sparse hair, slowed growth Diarrhea, dry skin, decelerated growth Constipation, dry skin, enlarged thyroid
Dry skin, sparse hair, slowed growth Clinical manifestations of juvenile hypothyroidism include dry skin, sparse hair, decelerated growth, constipation, puffiness around the eyes, sleepiness, and mental decline. Diarrhea and enlarged thyroid are not associated with juvenile hypothyroidism.
A diabetic child who is treated with insulin is trembling and sweating profusely. The nurse learns that the child has skipped lunch. What is the nurse's best action? Administer a glucagon injection. Give the child 3 to 6 oz of orange juice. Give the child insulin injection immediately. Ignore the symptoms because it is a normal finding.
Give the child 3-6 oz of orange juice The symptoms of the patient indicate adrenergic symptoms of hypoglycemia. Therefore the nurse should give the child a simple, high-carbohydrate drink such as 3 to 6 oz of orange juice, which should be followed by a starch-protein snack. Administering a glucagon injection is reserved for hypoglycemic patients who are unconscious, unresponsive, or having seizures. An insulin injection should not be given to this patient, because the symptoms are being caused by low blood sugar. Ignoring the symptoms can lead to further deterioration in the patient's condition and may eventually lead to death.
A neonate with a goiter has just been admitted to the newborn nursery. What is the priority nursing intervention? Positioning the neonate on the left side Having a tracheostomy set at the bedside Suctioning the child at least every 5 to 10 minutes Explaining to the parents how to place the dressing on the goiter
Having a tracheostomy set at the bedside The goiter puts the infant at risk for respiratory failure. Preparations are made for emergency ventilation, including having a tracheostomy set at the bedside. Placing the neonate in a side-lying position is not indicated. Hyperextension of the child's neck may facilitate breathing. There is no indication for suctioning in a neonate with goiter. No dressing is indicated in a neonate who has a goiter.
The nurse should recognize that when a child develops diabetic ketoacidosis (DKA), treatment will be instituted as described in which of the following statements? DKA is best treated at home DKA is best treated at a practitioner's office or clinic Immediate treatment is required because DKA is a life-threatening situation No treatment is required, because DKA is an expected outcome of type 1 diabetes mellitus
Immediate treatment is required because DKA is a life-threatening situation DKA is the complete state of insulin deficiency. It is a medical emergency that must be diagnosed and treated immediately. The child is usually admitted to an intensive care unit for assessment, intravenous insulin administration, and fluid and electrolyte replacement. DKA is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. It is not an expected outcome of type 1 diabetes mellitus. DKA is a medical emergency that requires hospitalization, usually in an intensive care unit.
What changes in the management of the child with type 1 diabetes mellitus should be expected as a result of more exercise? Increased food intake Decreased food intake Decreased risk of insulin shock Increased risk of hyperglycemia
Increase food intake Food intake should be increased when the child is more active. During races and other competitions, more food may be required than during practice to maintain a balance between glucose and exogenously administered insulin. The child will require increased food on days of increased activity. The increased activity lowers the blood glucose level. Blood sugar must be monitored closely to avoid administration of too much insulin during a time of reduced need.
What is the most effective treatment option for children with type 1 diabetes? Diet only Oral agents Insulin and diet Diet and oral agents
Insulin and diet Insulin and dietary changes are the current treatment for children with type 1 diabetes. Dietary changes alone are not effective in treating type 1 diabetes. Oral agents are effective against type 2 diabetes, not type 1. Diet and oral agents are used to treat type 2 diabetes, not type 1 diabetes.
How is the delivery of insulin through an insulin infusion pump different from delivery of insulin through subcutaneous injections? Insulin infusion pump delivers insulin into the thigh muscles. Insulin infusion pump causes less skin infections than injections. Insulin infusion pump delivers fixed amounts of insulin continuously. Insulin infusion pump is less expensive than giving multiple injections.
Insulin infusion pump delivers fixed amounts of insulin continuously. An insulin infusion pump delivers fixed amounts of insulin continuously, similar to the release of insulin from the islet cells of the pancreas. Both the infusion pump and the injections deliver insulin into the subcutaneous tissue of either the abdomen or the thigh and not into the muscles. Because the infusion pump stays in place, skin infections are common. Delivery of insulin through infusion pumps is more expensive than delivery of insulin through injections.
Which statement best describes Cushing syndrome? Treatment involves replacement of cortisol. It is caused by excessive production of cortisol. The major clinical features are exophthalmia and pigment changes. Diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.
It is caused by excessive production of cortisol. Cushing syndrome is a description of the clinical manifestations caused by too much circulating cortisol. Exophthalmia and pigmentary changes are manifestations of hyperthyroidism, not Cushing syndrome. The treatment for Cushing syndrome involves the reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated. Hypertension and hypokalemia—not hypotension, hyperkalemia, or polyuria—are expected findings with Cushing syndrome.
What kind of activity restrictions should be placed on the child with recently diagnosed type 1 diabetes? Daily exercise is contraindicated. The child may not participate in sports. Swimming is acceptable, but soccer is too strenuous. No activities are restricted unless they are contraindicated because of other health conditions.
No activities are restricted unless they are contraindicated because of other health conditions. Exercise is encouraged for children with diabetes because it reduces blood glucose. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. Participating in sports can be a healthy part of life for a child with type 1 diabetes. Exercise is not contraindicated in children with type 1 diabetes. Swimming is acceptable and so is soccer.
What are the cardinal signs of diabetes insipidus? Vascular anomalies Polyuria and polydipsia Hypotension and dehydration Dehydration and diminished urine output
Polyuria and polydipsia Polyuria and polydipsia are the cardinal signs of diabetes insipidus (DI). Vascular anomalies can be a secondary cause of DI but are not cardinal signs of DI. Hypotension and dehydration are not the cardinal signs of DI. Dehydration and diminished urine output may occur with DI but are not the cardinal signs of DI.
Which manifestation helps the nurse to identify hyperglycemia in a child with diabetes mellitus (DM)? Presence of paleness or pallor Shallow normal respirations Presence of acetone breath Excessive sweating
Presence of acetone breath Fruity, acetone breath is easily identified in the child with hyperglycemia. In the absence of insulin, glucose is unavailable for cellular metabolism. Consequently, fats break down into fatty acids, and glycerol in the fat cells is converted by the liver to ketone bodies. Any excess is eliminated in the urine (ketonuria) or the lungs (acetone breath). The skin appears flushed and shows signs of dehydration. The respiratory system tries to eliminate the excess carbon dioxide by increased depth and rate of breathing, which is known as Kussmaul respirations. Hypoglycemia causes sweating, paleness, and pallor. Respirations are shallow and normal in hypoglycemia.
The parents of a child who is on growth hormone replacement therapy are not satisfied with the outcome of the treatment, because the child's height is not increasing. The child is still shorter than school peers. What is the most appropriate action of the nurse? Increase the dose of growth hormone to the child. Reassure the parents and set realistic expectations. Change the route of administration of growth hormone. Advise the parents to feed the child with high protein diet.
Reassure the parents and set realistic expectations It is important for a nurse to educate the parents about the expected outcomes of growth hormone replacement therapy. The nurse should inform them that these children are likely to attain their eventual adult height slowly when compared to their peers. Therefore parents should set realistic expectations. Increasing the dose is not required at this stage and should not be done without consulting the primary health care provider. Changing the route of administration is of no use, because the therapeutic effect remains the same. Giving a high protein diet to the child will not result in increased growth rate.
Which is a common clinical manifestation of hypopituitarism that occurs due to deficiency of growth hormone (GH) or a deficiency of thyroid stimulating hormone (TSH)? Short stature Delayed dentition Increased insulin sensitivity Delayed epiphyseal closure
Short stature Short stature may be seen due to deficiency of GH as well as due to TSH deficiency. However, a patient with GH deficiency has short stature with proportional height and weight, whereas a patient with TSH deficiency has a short stature with infantile proportions. Delayed dentition is a feature of TSH deficiency. Increased insulin sensitivity and delayed epiphyseal closure occur due to GH deficiency, not TSH deficiency.
Which physiologic alteration is characterized by destruction of pancreatic beta-cells that produce insulin? Type 1 diabetes Type 2 diabetes Gestational diabetes Impaired glucose tolerance
Type 1 diabetes Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic beta cells. Type 2 diabetes is a result of insulin resistance. The insulin-producing pancreatic beta-cells are destroyed in type 1 diabetes and are not associated with impaired glucose tolerance. Gestational diabetes occurs during pregnancy and is not associated with the destruction of pancreatic beta-cells.
