Week 10 Pediatric Endocrine Disorders PDF

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Week 10 Pediatric Endocrine Disorders...

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Week 10 Endocrine Disorders Chapter 28 ATI Chapters 33, 34, 38 and 42

-Pituitary gland is controlled by the hypothalamus. Pituitary gland is divided into two lobes, posterior and anterior. -Anterior PG is 80% of the gland and produces 7 hormones: growth (bones), TSH (thyroid stimulating hormone, targets thyroid, targets tissues), corticotrophin (adrenal), FSH (ovaries and testes), luteinizing (ovaries and testes), prolactin (ovaries and breast), melanocyte (skin) -Posterior makes up 20% of the PG. Serves as a storage unit for ADH (targets renal function), vasopressin (uterus), oxytocin (breasts) Hypopituitarism: Growth Hormone Deficiency -Inhibits somatic growth in all cells of the body -Primary site of dysfunction appears to be in the hypothalamus -Children generally have higher levels of growth hormone than adults Risk Factors: tumors, trauma, structural defects, surgery, hereditary, idiopathic Clinicals Manifestations: usually by 1st year of age they are in 3rd percentile in growth chart, grow less than 2” per year, youthful facial features, high pitch voice, delayed detention, delayed sexual maturation Diagnostic Testing: general skeletal survey of children younger than 3 yo, x-rays of hand and wrist to get bone age, MRI of brain to rule out tumors, evaluate the growth curve, growth hormone stimulating testing Treatment: replacement therapy, replace with growth hormone called somatropin these children will get SQ injections 6-7x per week for several years until their growth is complete, 16 years old for boys and 14 for girls Nursing Management: Educate parents on injections, height and weight will be measured and plotted, teach the family members how to give the injections, rotate the sites, side effects, compliance, provide lots of support, there is no cognitive delays with children who have this problem

Hyperpituitarism: Growth Hormone Excess Excessive secretion of growth hormone before the closure of the growth plate, over growth in the long bones, if the secretions continue after they close its called acromegalia, there will be a delay in the fontanelle closure, rapid growth Clinical Manifestations: typical facial features, overgrowth of head, lips, nose, tongue, jaw, perinasal and mastoid sinuses, Diagnosis: based on hx of excessive growth in childhood, MRI may reveal a tumor, endocrine studies to confirm excess hormone Treatment: depends on what the cause is, surgery, radioactive implants, pharmacology, external radiation Precocious Puberty -Defined as sexual development before age 9 years in boys; before age 7 years in Caucasian girls; or before 6 years in African-American girls. -Occurs more frequently in girls Three types -Central precocious puberty (CPP) 80% -Peripheral precocious puberty (PPP) -Incomplete precocious puberty (IPP) Treatment Lupron injections monthly will slow the growth down, treatment is discontinued at age when normal puberty starts Diabetes Insipidus The principal disorder of the posterior pituitary gland Results from under secretion of antidiuretic hormone (ADH) In 20% of pituitary gland. Causes: familial or idiopathic, trauma, tumors, infections, or aneurisms Cardinal signs: Polyuria and polydipsia Clinical manifestations: infants will present with irritability, water will relieve it, dehydration often occurs, frequent weight checks Diagnosis: Therapeutic Management: hormone replacement, desmopressin, which stops the polyuria and polydipsia, treatment is lifelong, for emergency children should wear medical alert bracelet Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) This disorder is excessive ADH Cause: CNS infection, brain tumors, lung disease, trauma, lung disease, long term ventialtion or medication use. Clinical Manifestations: fluid and electrolyte imbalance, decreased urine output, increased BP, weight gain. Lethargy, confusion, altered LOC, seizures, coma as Na levels continue to drop. Treatment: fluid restriction, antibiotics, diuretics, hypertonic saline Nursing Management: monitor I/O, daily weight, educate on fluid restriction, wear bracelets as well

Disorders of Thyroid Function Thyroid hormone regulates the basal metabolic rate (BMR) Secretes two types: T3 & T4 They may have hypo or hyper thyroidism Secreted in the anterior of the thyroid. Juvenile Hypothyroidism Congenital -Congenital hypoplastic thyroid gland Acquired -Partial or complete thyroidectomy for Cancer or Thyrotoxicosis. -Following irradiation for Hodgkin disease or other malignant disease. What to look for: infant may sleep more than usual, present with a horse cry, older children show signs of lethargy and stunted growth, mental decline, periorbital edema, sparse thin hair What test tell you: that T3 and T4 levels are low How its treated: lifelong therapy, synthetic hormone levothyroxine (Synthroid’s) supplemental vitamin D to prevent Rickets disease Hyperthyroidism and Graves’ Disease Increased thyroid levels Graves’ disease most common cause. Autoimmune disorder Familial incidence What to look for: excessive irritability, child may also exhibit hyperactivity, insomnia, tremors, weight loss despite appetite, skin will be warm and flush, exothalamus (bulging of eyes) What test tell you: thyroid scan How it’s treated: end goal is to decrease T3/T4; antithyroid drugs, subtotal thyroidectomy, ablation with radioactive iodine Thyrotoxicosis “crisis” “storm” p. 945 Acute onset of Severe irritability, restlessness, vomiting, diarrhea Will also present with HTN, tachycardia, palpitations, may be rapid delirium, coma or death

Cushing Syndrome Disorder of adrenal hyperfunction Cause: excessive levels of adrenocortical hormones particularly cortisol; adrenal tumor, excessive or prolonged steroid therapy, abrupt withdrawal of steroids Tests: blood test to see cortisol levels, x-rays for osteoporosis How its treated: with drug therapy, surgery, radiation, lifelong hormone replacement if both glands are removed Diabetes Mellitus Type 1 Type 1: destruction of pancreatic beta cells which produces insulin Clinical Manifestations Polyuria, Polydipsia and Polyphagia, Irritable, dehydration, restlessness, Bed-wetting in children who previously did not wet the bed during the night, Extreme hunger, Unintentional Weight loss, Fatigue, Blurred vision Diagnostic Criteria Fasting Blood Glucose- 126mg/dL or more. Hemoglobin A1C-target is 7.5-8.5 Oral Glucose Tolerance Test of 200 mg/dL or more in the 2-hour sample. Random Blood Glucose of 200 mg/dL with manifestations of diabetes. Treatment Insulin:4 types Rapid acting-Insulin lispro-Humalog Short acting-Regular insulin Intermediate-acting-NPH insulin Long-acting insulin- Insulin Glargine Insulin Pumps Diabetic Nurse Educator for Nutritional management, Exercise and Psychosocial support. Diabetes: Complications Diabetic Ketoacidosis (DKA) DKA is acute, life-threatening condition Children with new onset diabetes may present with DKA. Clinical Manifestations: Dangerously high blood sugar levels. Greater than 300 mg/dL. Dehydration, abdominal pain, excessive thirst, fatigue, weakness, fruity breath, tachycardia, shortness of breath, mental confusion.

DKA Treatment -Child admitted to ICU -Isotonic IV fluids and electrolytes to treat dehydration and acidosis -When serum glucose levels approach 250 mg/dL, glucose added to fluids to maintain blood glucose levels between 120-240 mg/dL -Insulin drip at 0.1unit/kg/hr -Glucose levels monitored hourly -Electrolytes and acid base status monitored frequently -Potassium shifts into cells as insulin and fluids administered, causing hypokalemia -Continuous monitoring of vital signs, respiratory status, perfusion and mental status -Cerebral Edema most common complication of DKA -Most common cause of death in children with diabetes Diabetes Type 1—Sick Day Rules -Stay on Track-keep your child’s routine. -Test urine and blood glucose every 3 hours. -If tests show your child has ketones, they will need extra insulin to clear their ketones. -Stay extra hydrated- Drink every hour-beverages such as water or other sugar free fluids-will prevent dehydration and flush out the ketones. -Avoid drinks with caffeine. Call health care provider if: -blood glucose is greater than 240 mg/dl. -Rapid respirations -Unable to drink or tolerate fluids -Vomiting many times or if vomiting doesn’t stop -Disorientation -Develop symptoms which could be indicative of their developing DK or Diabetic Ketoacidosis Hypoglycemia Blood glucose less than 60 mg/dL Clinical Manifestations: Hunger, shakiness, headache, anxiety, irritability, pallor, cool skin, tachycardia, palpitations, change in LOC, slurred speech, blurred vision, seizures. Treatment: 15 grams of carbohydrate, if child becomes unconscious, administer injection of glucagon. Snack ½ hour before activities needs to be given for this child 15 grams carbs = 1 unit of insulin

Teach manifestations of hypoglycemia (tremors, diaphoresis, anxiety, nervousness, chills, headache, confusion, labile, difficultly focusing, hunger, dizziness, pallor, and palpitations) Treat with 10-15g simple carbohydrates (1 tbsp sugar) Examples are 3-6oz orange juice, 8oz milk, or 6 oz regular soft drink [ATI pg. 216] Hunger, shakiness, headache, anxiety, irritability, pallor, cool skin, tachycardia, palpitations, change in LOC, slurred speech, blurred vision, seizures; treatment: snack ½ hour before activities needs to be given 15g carbs, if child becomes unconscious administer injection of glucagon [NOTES] HIV/AIDS children who are HIV+ have continuous bacterial infections such as otitis media; What causes it: CD4 helper T cells; incubation period averages 17 months; s/s resemble that of an adult, initially have flu like symptoms then remain asymptomatic for years What to look for: Diagnosing HIV/AIDS: diagnostic testing; use in infants younger than 18 months; age 14-21 days old get tested if they have been exposed; diagnostic testing at birth if they believe or expect infant is at high risk for infection; ELISA test is done and is confirmed by the western blot test How its treated: no cure; antiretrovirals are used to treat the disease and prolong life; treatment protocols are 3 or more drugs to help treat Nursing Care: balanced diet, high in calories and protein, nutritional supplements, stay with immunizations (pneumococcal and influenza), administer meds as prescribed, provide education to family members, refer them to family counselors and agencies that can help them cope with; standard precautions for HIV/AIDS patients Categories of Infection ATI pg. 243 Category N-Not symptomatic; shows no signs or only have one of the conditions listed Category A-Mildly symptomatic; may have 2 or more symptoms Category B-Moderately symptomatic Category C-Severely symptomatic Phenylketonuria (PKU) page 277-278 Diagnosis: caused by absence of amino acid phenylalanine, screening is required in all 50 states at birth, done by heel stick, Guthrie blood test, early screening allows treatment after birth Clinical Manifestations: musty odor to their body and urine, hyperactive, irritable, eczema rash on skin, may have vomiting, may have seizures Treatment: treatment can help but not cure; placed on special formula and diet low in phenylalanine, high protein foods contain HIGH amounts of phenylalanine so avoid these foods; patient family education, genetic counseling, and followed by a registered dietician...