Nursing 2Nd Semester: Peds Exam 3: Endocrine Alteration

Front 1

The endocrine system is composed of various tissues that produce and secrete chemicals called _______. The endocrine system and the ______ nervous system function together to regulate what 3 things?

Back 1

hormones

autonomic
growth, reproduction, and metabolism

Front 2

The endocrine system is less developed at birth than any other body system. Hormonal control of many body functions is lacking until what age? As a result, infants may manifest imbalances in concentration of fluids, electrolytes, glucose, and trace substances.

Back 2

12-18 months

Front 3

Phenylketonuria(PKU) is a genetic metabolic disorder resulting from ____ damage from toxic levels of amino acid? Is this disorder autosomal dominant, recessive, or x-linked?

Back 3

CNS
phenylalanine
autosomal recessive

Front 4

Infants should be tested for PKU as part of the newborn screening. Signs of PKU may not be present until the infant is about 3 months old. What is usually the first sign? What are some other signs.

Back 4

1st sign- digestive problems with vomiting
musty/mousy odor to urine
eczema
hypertonia
hyperactive behavior
Older children may have hypopigmentation of hair, skin, eyes- usually blonde with blue eyes.

Front 5

How is PKU diagnosed?

Back 5

serum phenalanine greater than 20mg/dl
(need follow up testing to confirm)
normal is about 2mg/dl

Front 6

What is the therapeutic management of PKU?

Back 6

lifelong dietary modifications
Avoid high protein foods such as meats, fish, eggs, cheese, milk, legumes.
Encourage low-protein breads, cereals, and pastas. Dietary staples are vegetables, fruits, and starches.

Front 7

What is a long term consequence of untreated PKU?

Back 7

mental retardation

Front 8

What are glucocorticoids?

Back 8

steroid hormones-
cortisol and aldosterone

Front 9

The group of inherited disorders of the adrenal glands is known as what?

Back 9

Congenital Adrenal Hyperplasia

Front 10

In Congenital Adrenal Hyperplasia, the adrenal glands produce too much/not enough glucocorticoids.

Back 10

not enough

Front 11

In Congenital Adrenal Hyperplasia, the adrenal glands don't produce adequate glucocorticoids (coritsol and aldosterone) which prompts increased production of what? This leads to the production of excess what? This overproduction causes the child to have too much ____ characteristics.

Back 11

ACTH
androgens

male

Front 12

Congenital Adrenal Hyperplasia effects boys, girls, or both?

Back 12

both

Front 13

What are some clinical manifestations of Congenital Adrenal Hyperplasia?

Back 13

newborn girl- ambiguous genitalia
newborn boy- enlarged genitalia
boy may also me muscular, excess pubic hair, deep voice etc.
low serum sodium
high serum potassium
hypovolemia

Front 14

What are the 2 crises that a patient with Congenital Adrenal Hyperplasia may go through?

Back 14

salt wasting crisis
hypotensive crisis

Front 15

True or False: Congenital Adrenal Hyperplasia can be mild to severe and these people may or may not be able to reproduce.

Back 15

true

Front 16

The goal in treating Congenital Adrenal Hyperplasia is to return hormone levels to normal (especially cortsol). What is the therapeutic management?

Back 16

Lifelong glucocorticoid therapy
-hydrocortisone acetate
-cortisone acetate
If salt wasting type-->
-fludrocortisone (mineralocorticoid)

Front 17

If a chld with Congenital Adrenal Hyperplasia is ill, has a broken bone, or is undergoing surgery, may need a ____ dose of additional gluococorticoids.

Back 17

stress

Front 18

____ surgery is often considered for treating Congenital Adrenal Hyperplasia,

Back 18

plastic

Front 19

True or False: Congenital Hypothyroidism is developed after birth.

Back 19

false. It is present at birth.

Front 20

Congenital Hypothyroidism is when the thyroid gland does not produce sufficient ____ ______. It can cause ___ ____ if not treated.

Back 20

thyroid hormone
mental retardation

Front 21

Thyroid gland controls e____.

Back 21

energy

Front 22

In Congenital Hypothyroidism, either there is an absent or underdeveloped thyroid gland or there is a hypothalmic or hypopituitary disorder. This causes insufficient or an absence of ____

Back 22

thyroxine or T4

Front 23

thyroxine or T4 is essential for growth, development, and especially _____ development.

Back 23

brain

Front 24

Children with Congenital Hypothyroidism may be asymptomatic . What are some clinical manifestations of Congenital Hypothyroidism?

Back 24

lethargy
large fontanel
large tongue
skin mottling
slow reflexes, hypotonia
prolonged jaundice
umbilical hernia
distended abdomen
cool skin
feeding problems, constipation
hoarse cry

Front 25

The therapeutic management of Congenital Hypothyroidism includes lifelong thyroid hormone replacement, such as ______. Assessments of growth and development are important as well as teaching the family and patient about s/s of hypothyroid and hyperthyroid (from too much medication.

Back 25

levothyroxine

Front 26

Acquired hypothyroidism can be caused by or include Hashimoto's _______, surgical ______, radioactive _____ therapy for hyperthyroid, _____ therapy for malignancy, and excessive ____ ingestion.

Back 26

Acquired hypothyroidism includes Hashimoto's thyroiditis, surgical thyroidectomy, radioactive iodine therapy for hyperthyroid, radiation therapy for malignancy, and excessive iodine ingestion.

Front 27

Hashimoto's Thyroiditis is also known as what?

Back 27

chronic lymphocytic thyroiditis

Front 28

True or False: Hashimoto's Thyroiditis is the most common cause of acquired hypothyroidism, especially in children and adolescents.

Back 28

true

Front 29

Hashimoto's Thyroiditis is a ______ response and is usually associated with ______. It involves the destruction of the thyroid gland.

Back 29

autoimmune
goiter

Front 30

Maternal intake of propylthiouracil (PTU) during pregnancy to control maternal ______ can cause transient ______ to the infant

Back 30

hyperthyroidism
hypothyroidism

Front 31

What organ regulates the metabolic rate of the body?

Back 31

thyroid gland

Front 32

The therapeutic management for hypothyroidism involves _____ replacement therapy. ______ is the most common, and least expensive. When is it best taken? Patients and families need to be taught the s/s of both hyperthyroidism an hypothyroidism. Are the adverse affects from hypothyroidism acquired after 2 years of age permanent or reversible?

Back 32

thyroid
levothyroxine
best in morning on an empty stomach
reversible

Front 33

Grave's disease is the most common cause of hyperthyroidism in children, which is an ______ condition in which excessive thyroid hormones are produced by an enlarged thyroid gland.

Back 33

autoimmune

Front 34

Neonatal Graves is associated with maternal HYPERthyroidism commonly or uncommonly?

Back 34

uncommonly

Front 35

The therapeutic management for hyperthyroidism involves antithyroid therapy and radioactive ____ for children of what age? What are some antithyroid medications

Back 35

radioactive iodine in an oral solution for children > 10 y

Antithyroid therapy:
Propylthiouracil
Methimazole

Front 36

Sometimes a partial thyroidectomy is indicated for children with hyperthyroidism. What needs to be monitored in these children?

Back 36

calcium levels
(surgery presents a risk of injury to parathyroid glands resulting in hypocalcemia)

Front 37

Tiredness/Fatigue is symptom of hyperthyroidism or hypothyroidism?

Back 37

hypo

Front 38

Nervousness and anxiety is a symptom of hyperthyroidism or hypothyroidism?

Back 38

hyper

Front 39

Prominent eyes (exophthalmos) is a symptom of hyperthyroidism or hypothyroidism?

Back 39

hyper

Front 40

Constipation is a symptom of hyperthyroidism or hypothyroidism?

Back 40

hypo

Front 41

Cold intolerance is a symptom of hyperthyroidism or hypothyroidism?

Back 41

hypo

Front 42

Heat intolerance is a symptom of hyperthyroidism or hypothyroidism?

Back 42

hyper

Front 43

Diarrhea is a symptom of hyperthyroidism or hypothyroidism?

Back 43

hyper

Front 44

Emotional liability is a symptom of hyperthyroidism or hypothyroidism?

Back 44

hyper

Front 45

Muscle hypertrophy is a symptom of hyperthyroidism or hypothyroidism?

Back 45

hypo

Front 46

Dry, thick skin is a symptom of hyperthyroidism or hypothyroidism?

Back 46

hypo

Front 47

Decreased growth is a symptom of hyperthyroidism or hypothyroidism?

Back 47

hypo

Front 48

Muscle weakness is a symptom of hyperthyroidism or hypothyroidism?

Back 48

hyper

Front 49

Accelerated linear growth is a symptom of hyperthyroidism or hypothyroidism?

Back 49

hyper

Front 50

Decreased activity & energy is a symptom of hyperthyroidism or hypothyroidism?

Back 50

hypo

Front 51

Smooth, velvety skin is a symptom of hyperthyroidism or hypothyroidism?

Back 51

hyper

Front 52

Edema of face, eyes, and hands is a symptom of hyperthyroidism or hypothyroidism?

Back 52

hypo

Front 53

Decreased heart rate is a symptom of hyperthyroidism or hypothyroidism?

Back 53

hypo

Front 54

Increased heart rate is a symptom of hyperthyroidism or hypothyroidism?

Back 54

hyper

Front 55

Weight gain is a symptom of hyperthyroidism or hypothyroidism?

Back 55

hypo

Front 56

Weight loss but increased appetite is a symptom of hyperthyroidism or hypothyroidism?

Back 56

hyper

Front 57

Coarse, dull hair is a symptom of hyperthyroidism or hypothyroidism?

Back 57

hypo

Front 58

Fine hair is a symptom of hyperthyroidism or hypothyroidism?

Back 58

hyper

Front 59

True or False: Goiter is only present with hypothyroidism.

Back 59

False. Goiter is a symptom of both hyperthyroidism or hypothyroidism

Front 60

True or False: Autoimmune thyroiditis resulting in either hypothyroidism or hyperthyroidism is always permanent.

Back 60

False, it may be transient or permanent.

Front 61

Diabetes Insipidus is a _______ _____ dysfunction (hypofunction).

Back 61

posterior pituitary

Front 62

Diabetes Insipidus is the inability to _______ urine due to a _________ of what hormone? This causes increased ______.

Back 62

concentrate
deficiency
ADH /vasopressin
diuresis

Front 63

What can Diabetes Insipidus result from? (5)

Back 63

ITCHI
Infection
Tumors
Cranial Surgery
Head Trauma
Idiopathic - no known cause

Front 64

What are the clinical manifestations of Diabetes Insipidus?

Back 64

polyuria
polydipsia
nocturia
dehydratrion

Front 65

Diabetes Insipidus presents with some similar symptoms to diabetes mellitus but there is no connection. How are the symptoms of Diabetes Insipidus different from diabetes mellitus?

Back 65

Diabetes Insipidus does not present with hypoglycemia, polyphagia, and urine is not sweet.

Front 66

How is diabetes insipidus diagnosed?

Back 66

symptom- polyuria
hypernatremia (>150 mEq/L)
low urine specific gravity <1.005
water deprivation tests

Front 67

What is involved in water deprivation tests?

Back 67

no water for 7-8 h
measure changes such as body wt., urine output, urine composition
requires hospital setting, close monitoring

Front 68

The key to diagnosing diabetes insipidus is frequent, _____ urine.

Back 68

dilute

Front 69

What is the therapeutic management of diabetes insipidus?

Back 69

maintain fluid balance
administer vasopressin
Desmosspressin acetate (DDAVP)
IV, SQ, intranasally
Monitor sodium levels, watch for hyponatremic seizures.

Front 70

Signs of need for the DDAVP

Back 70

increased thirst
polyuria
dehydration

Front 71

Signs of excessive DDAVP

Back 71

decreased urine output
headache
water retention

Front 72

Nursing considerations for the management of diabetes insipidus include educate the family about the disease process, teach about medication administration, teach about signs to watch for (i.e. dehydration) and one more thing....

Back 72

wear a medic alert bracelet.