317- Endocrine Disorders

Hypopituitarism

diminished secretion of pituitary hormone -GH

Hypoglycemia

- <60mg/dl - decreased LOC - Slurred speech - Seizures - Blurred vision - Cool/clammy

Hyperglycemia

- >250mg/dl - Three P's - Ketones

Lab tests for Growth Hormone Deficiency

- IGF-1 - IGFBP-3 - The client should fast the night before (radiographs can also be used to assess skeletal maturity

Medications for GH Deficiency

- Somatropin - SC injection - use cautiously in children receiving insulin - Given 6-7 times a week - assists with muscle growth - stop when growth is less than 1 in in a year AND bone age 14 (girls) 16 (boys)

Nutritional guidlines

- count carbs - avoid high fat high carb/sugar foods - do not skip meals - plan meals to match timing of food to activity

Complications from GH Deficiency

- delayed epiphyseal closure - disruption of vertical growth - delayed bone age - premature aging later in life

Nursing actions for DKA

- rapid isotonic fluid - as levels reach 250, add dextrose to fluids - regular insulin IV

Expected findings for GHD

- short-stature - delayed dentition - delayed sexual development

8 hr fasting glucose

126 or more

Random blood glucose

200 or more

Oral glucose

200 or more in 2hr sample

A1C target range

6.5-8.0

Which of the following statements by the child indicates understanding of the teaching about self care a. "I should skip bfast when I'm not hungery" b. "I should increase by insulin with exercise" c. I should drink a glass of milk when I feel irritabile" d. I should draw up the NPH insulin before the regular"

c. milk has carbs

A ten-year old child with Type 1 diabetes is sent to the nurse's office in school with complaints of "feeling dizzy and shaky". The child is diaphoretic, pale, and has visible tremors. The child is conscious and responsive to questions, but his speech seems slurred. Based on this assessment, what does the nurse do next? a. Assess the blood glucose and prepare to administer glucose tablets or juice b. Call the child's mother and tell her to come get the child. c. Assess the blood glucose and prepare to administer insulin d. Call the child's provider and anticipate an order for insulin on a sliding scale.

a

The nurse is caring for a 3-year-old diagnosed with diabetes mellitus. The child's eating patterns are unpredictable. One day the child will eat almost nothing, the next day the child eats everything on her tray. The nurse recognizes that this type of insulin would most likely be used in treating this child? a. Rapid-acting insulin (such as Lispro) b. Long-acting insulin (glargine insulin, such as Lantus or Levemir) c. Regular insulin d. Intermediate acting insulin (NPH)

a

The nurse is caring for a three year old child whose parent has brought her to the pediatrician after an unexpected weight loss. The nurse notes that the child's skin is hot, flushed, and dry to the touch. The mother reports that the child has been lethargic and has been drinking excessive amounts of fluids and urinating frequently. Based on the child's signs and symptoms, which laboratory or diagnostic tests should the nurse anticipate? a. Serum glucose, urinalysis for ketones and glucose b. Complete blood count c. Bone marrow biopsy d. Human Growth Hormone level

a

Which of the following findings indicate a GH deficiency? a. Prop height to weight b. Height proportionally greater than weight c. Oversized jaw d. Early-onset puberty

a

Which statement is true regarding human somatotropin therapy (growth hormone replacement)? a. Treatment with growth hormone replacement will enable the child to reach a normal adult height. b. Expected side effects of growth hormone replacement include joint pain. c. Somatotropin is given as an extended release, oral medication d. Somatotropin replacement therapy must continue througout the lifespan to prevent complications of growth hormone deficiency.

a

Which of the following diagnostic tests should be completed to confirm GH deficiency? SATA a. CT scan of the head b. Skeletal x-rays c. GH stimulation test d. Blood IGF-1 e. DNA testing

a, b, c, d

Which of the following are complications of untreated growth hormone deficiency? SATA a. delayed sexual development b. premature aging c. advanced bone age d. short stature e. increased epiphyseal closure

a, b, d

A child with type 1 diabetes is brought to the emergency department. The nurse suspects diabetic ketoacidosis (DKA) based on which assessment findings? Select all that apply. a. Tachypnea b. Poor skin turgor c. Increased urinary output d. Decreased level of consciousness e. Fruity odor to the breath

a, b, d, e

A nurse is reviewing a sick day management with a parent. Which of the following should the nurse include in teaching? SATA a. Monitor levels every 3 hr b. Discontinue insulin until feeling better c. Drink 8oz of fruit juice every hour d. test urine for ketones e. call provider is levels are greater than 240

a, d, e

Which of the following are manifestations of hypoglycemia a. Increased urination b. hunger c. poor skin turgor d. Irritability e. sweating and pallor f. Kussmaul resp

b, d, e

A nurse is explaining to a parent how long the child will need to take injections for growth delay. a. "Injections are usually continued until age 10 for girls and age 12 for boys." b. Injections continue until your child reaches the fifth percentile of the growth chart." c. " Injections might be stopped once your child grows less than 1in/year" d. "The injections will need to be admin throughout your child's entire life"

c

Which os the following manifestations are of DKA a. glucose 58 b. weight gain c. dehydrations d. mental confusion e. fruity breath

c, d, e

DKA

sugars > 330 - caused by acute stress and drop in insulin - accumulation of ketones in the blood as a result of fat breakdown