N303 - Endocrine System

Front 1

What is the function of the endocrine system?

Back 1

Controls or regulates metabolic processes

Front 2

What is the mechanism of action of the endocrine system?

Back 2

1. Gland sends chemical message (hormone) via bloodstream to a target

2. Hormone exerts physiologic response at a target cell, tissue and/or organ

3. Control of hormone secretion via negative feedback

Front 3

What are the neuroendocrine interrelationships?

Back 3

1. Assists in maintaining homeostasis

2. Autonomic transmits via neural impulses (ST; local)

3. Endocrine transmits via blood (LT; widespread)

4. ANS transmits to CNS which transmits to endocrine

Front 4

What is the master endocrine gland?

Back 4

Pituitary gland

Front 5

What are the primary hormones of the anterior pituitary gland?

Back 5

1. Growth hormone [bone]

2. ACTH [adrenal cortex]

3. TSH [thyroid gland]

4. FSH/LH [gonads]

5. MSH [skin]

6. PRL [mammary glands]

Front 6

What are the primary hormones of the posterior pituitary gland?

Back 6

1. Oxytocin [uterus, mammary]

2. ADH [kidneys]

Front 7

What is most common cause craniopharyngioma?

Back 7

Panhypopituitarism

Front 8

What is panhypopituitarism?

Back 8

A state in which secretion of the anterior pituitary hormones is inadequate or absent as a result of destruction of the anterior pituitary gland

Front 9

What are the clinical manifestations of panhypopituitarism?

Back 9

Hyposecretion of GH, TSH, ACTH, ADH

Front 10

What is the diagnostic evaluation of growth hormone deficiency?

Back 10

1. Rule out organic cause of short stature

2. Assess bone age to determine if growth is delayed or not

3. Endocrine Studies

4. Multiple growth measurements compared against genetic potential

Front 11

What is the management of growth hormone deficiency?

Back 11

1. Treat any underlying disease

2. Growth Hormone replacement

3. Best results if begun early

4. Address emotional, school performance issues if present

Front 12

What are the clinical manifestations of growth hormone deficiency?

Back 12

1. Appear normal at birth, then slow <3rd%

2. Short stature

3. Appear healthy, well nourished

4. Idiopathic – may have TSH, ACTH deficiencies

5. Not same as constitutional growth delay

6. Male > female

Front 13

What is precocious puberty?

Back 13

Manifestations of premature sexual development (<9y males; <7y Caucasian & <6y African-Am females)

Front 14

What is the usual indication of sexual development in females?

Back 14

Breast buds

Front 15

What are the possible causes of precocious puberty?

Back 15

1. Trauma
2. Radiotherapy
3. Neoplasms
4. Inflammatory (i.e. encephalitis, meningitis, abscess, granulomatous disease)
5. Adrenal tumors

Front 16

What are the treatments of precocious puberty?

Back 16

1. LH to regulate pituitary gonadotropin secretion

2. GH

3. Anticipatory guidance

Front 17

What are the portions of the adrenal glands?

Back 17

1. Adrenal cortex
2. Adrenal medulla

Front 18

What is the function of the adrenal glands?

Back 18

Metabolic regulation and stress adaptation

Front 19

What are the hormones of the adrenal cortex?

Back 19

1. Glucocorticoids
2. Mineralcorticoids
3. Sex Steroids

Front 20

What is the most important glucocorticoid?

Back 20

Cortisol

Front 21

What are the functions of cortisol?

Back 21

1. Control ACTH

2. ↑ glucose, adipose, protein, gastric, Na retention

3. ↓ inflammatory response, suppressed WBC

4. Diurnal secretion - ↓ bedtime

5. Triggers - surgery, sepsis, high emotion

Front 22

What is the most important mineralocorticoid?

Back 22

Aldosterone

Front 23

What are the functions of aldosterone?

Back 23

Na+ retention, ↑B/P

Front 24

What are the types of sex hormones?

Back 24

1. Testosterone
2. Estrogen and progesterone

Front 25

What are the functions of sex hormones?

Back 25

Puberty, effect bone growth

Front 26

What are the hormones of the adrenal medulla?

Back 26

The catecholamines = epinephrine and norepinephrine

Front 27

What are the functions of catecholamines?

Back 27

1. Secretion via stress [hypothalamus] and SNS

2. ↑ cardiac activity, B/P, RR, muscular contraction, BMR

3. Pupils dilate

Front 28

What controls the secretion of catecholamines primarily?

Back 28

The hypothalamus

Front 29

What causes Cushing syndrome?

Back 29

1. ↑ cortisol production

2. ↑ steroid administration (most common pediatric cause)

Front 30

What is the most common cause of Cushing syndrome in pediatric patients?

Back 30

Increased steroid administration

Front 31

How can some effects of increased steroid administration be reversed?

Back 31

Wean patient slowly off the steroids to allow the pituitary to take over ACTH secretion

Front 32

What are the clinical manifestations of Cushing syndrome?

Back 32

1. Physical – moonface, truncal obesity, bruising

2. Physiologic - ↑ blood sugar [DM], osteoporesis, ulcer, thin skin, poor wound healing, ↓ immunity

3. Psychoses – irritable, depression, insomnia

Front 33

What are the physical manifestations of Cushing syndrome?

Back 33

1. Moonface
2. Truncal obesity
3. Bruising

Front 34

What are the physiologic manifestations of Cushing syndrome?

Back 34

1. ↑ blood sugar [DM]
2. Osteoporosis
3. Ulcer
4. Thin skin
5. Poor wound healing
6. ↓ immunity

Front 35

What are the psychologic manifestations of Cushing syndrome?

Back 35

1. Irritability
2. Depression
3. Insomnia

Front 36

What are the treatments of Cushing syndrome?

Back 36

1. Panhypopituitarism with replacement of GH, thyroid extract, ADH, gonadotropin, and/or steroids

2. Administer in AM, alternate dosing

Front 37

What are the other adrenal disorders?

Back 37

1. Congenital Adrenal Hyperplasia
2. Addison Disease
3. Pheochromocytoma

Front 38

What is congenital adrenal hyperplasia?

Back 38

Overproduction of androgens, ACTH

Front 39

What is the clinical manifestation of congenital adrenal hyperplasia?

Back 39

Ambiguous genitalia - in which parents choose to raise as "daughter" because it was "easier"

Front 40

What is the treatment for congenital adrenal hyperplasia?

Back 40

Cortisol

Front 41

What is commonly observed with Addison disease?

Back 41

Inability to deal with stress

Front 42

What is the treatment for Addison disease?

Back 42

Provide exogenous cortisol

Front 43

What is pheochromocytoma?

Back 43

Tumor – often on adrenal gland – that produces norepinephrine and epinephrine and is equivalent to overfunction of the adrenal medulla

Front 44

What are the symptoms of pheochromocytoma?

Back 44

Symptoms r/t ↑catecholamines (epi and norepi) – think "fight vs. flight"

Front 45

What is the treatment for pheochromocytoma?

Back 45

Removal of the tumor

Front 46

What is Type 1 diabetes?

Back 46

Beta cells no longer produce insulin; autoimmune, most common in pediatrics

Front 47

What is Type 2 diabetes?

Back 47

Insulin resistance &/or deficiency, ↑ with obesity & ↓exercise, genetic

Front 48

Which type of diabetes is common in children?

Back 48

Type 1 DM

Front 49

What is the etiology of Type 1 diabetes?

Back 49

1. Genetic predisposition, no actual gene

2. Immune defect that allows to be suspectible to trigger event

3. Autoimmune response destroys

4. Beta cells not producing insulin

5. Possible triggers – cow’s milk, viruses

Front 50

What is the function of insulin?

Back 50

To move glucose into cell from circulating blood, prevent fat mobilization, and storage of glucagon

Front 51

What happens in the body in absence insulin?

Back 51

1. ↑glucose in serum

2. Osmotic gradient into urine [polyuria]

3. Dehydrated [polydipsia]

4. Protein and fat used for energy {starvation} [polyphagia]

Front 52

What are the most common symptoms of diabetes?

Back 52

1. Polyuria
2. Polydipsia
3. Polyphagia

Front 53

What is diabetic ketoacidosis?

Back 53

Use of fat for energy (when glucose is depleted), resulting in ketones creating acidosis, K+ imbalance

Front 54

What are the late complications of Type 1 diabetes?

Back 54

1. Neuropathy
2. Nephropathy
3. Retinopathy

Front 55

What is the pathophysiology of Type 2 diabetes?

Back 55

No ketones, immune issues, may need insulin

Front 56

What is the target blood glucose level?

Back 56

80-150 mg/dl

Front 57

How often should diabetics check their blood glucose level?

Back 57

4 to 6 times daily

Front 58

What does glycosated Hgb reflect?

Back 58

Average blood sugar levels over 2-3 months (4-6% normal)

Front 59

What is the primary treatment for Type 1 diabetes?

Back 59

Insulin

Front 60

What are the types of insulin?

Back 60

1. General – regular acting
2. Basal – steady state (long acting)
3. Bolus – rapid acting

Front 61

What is general insulin?

Back 61

Give in adipose, rotate sites, open vial good for 1 month if stored according to manufacturer, do not need alcohol prep

Front 62

What is basal insulin?

Back 62

Long acting insulin

Front 63

What is the commonly used basal insulin?

Back 63

1. Lantus; given at consistent time at bedtime; lasts 24 hr

2. Do not mix w/other insulins, must be clear

3. Onset 1-2 hr

Front 64

What are the commonly used rapid acting insulin?

Back 64

Humalog or Novolog

Front 65

What are the characteristics of rapid acting insulin?

Back 65

1. Clear

2. Onset 10-15 minutes; peaks 1 hr; lasts 3-4 hr

3. Must eat right after injecting

Front 66

What are the others areas to balance in order to treat diabetes?

Back 66

1. Stress and Illness

2. Exercise

3. Diet

Front 67

Why should diabetics manage stress and illness?

Back 67

Can ↑ insulin needs

Front 68

What is the significance of exercise?

Back 68

Can ↓ insulin needs

Front 69

What is the main nutrient that affects blood sugar levels?

Back 69

Carbohydrates

Front 70

What are important teaching points about diet in diabetics?

Back 70

1. “Carb is a carb” to the body, no such thing as a diet

2. Teach carbohydrate counting

3. Meal timing and insulin injections essential

4. As disease stabilizes can provide carb-based insulin dosing

5. Encourage healthy choices

Front 71

What are the extremes of blood sugar levels?

Back 71

1. Hyperglycemia
2. Hypoglycemia

Front 72

What is hyperglycemia?

Back 72

Blood sugar level >300 mg/dL

Front 73

What are the classic signs and symptoms of hyperglycemia?

Back 73

1. Polydipsia
2. Polyuria
3. Polyphagia

Front 74

What needs to be checked with hyperglycemia?

Back 74

Check urine ketones

Front 75

What is the main treatment for hyperglycemia?

Back 75

Administer insulin bolus

Front 76

What is hypoglycemia?

Back 76

Blood sugar level <80 mg/dL

Front 77

What are the signs and symptoms of hypoglycemia?

Back 77

1. Shakiness
2. Irritability
3. Headache
4. Weakness

Front 78

What is the treatment for hypoglycemia?

Back 78

1. Immediately administer Juice, milk, OR glucose tabs

2. Recheck BS in 15 min, repeat above if needed

Front 79

What are the pediatric issues regarding diabetes?

Back 79

1. Type 1 can cause serious consequences in adulthood

2. Need tight blood sugar control

3. Use of pump allows for better control in some children – still need blood sugar monitoring

4. Developmental issues can be major – nocturnal control, celebration events, adolescence

Front 80

What is the nursing care plan for pediatric patients with diabetes?

Back 80

1. Risk for injury r/t insulin deficiency
2. Risk for injury r/t hypoglycemia
3. Headache
4. Dizziness
5. Knowledge deficits

Care involves
1. Assess and control blood glucose levels
2. Administration of insulin
3. Diet counseling/management
4. Teach signs of hypoglycemia

Front 81

What is a major problem among children in the United States?

Back 81

Childhood obesity

Front 82

What is the scope of childhood obesity?

Back 82

1. Increasing incidence – from 5- 15%

2. >incidence in children of color

3. Parental obesity ↑ incidence – 2-3X

4. Highly likely continues into adulthood (50% school age; 70% adol)

5. Experience complications r/t obesity sooner

6. ↑ B/P, respiratory, orthopedic, cholelithiasis, Type 2 DM, adult cancers

7. BMI >90th%

Front 83

What BMI categorizes childhood obesity?

Back 83

> 90th percentile

Front 84

What complications do children with obesity experience sooner than non-obese children?

Back 84

1. ↑ B/P

2. Respiratory problems

3. Orthopedic (skeletal system) problems

4. Cholelithiasis

5. Type 2 DM

6. Adult cancers

Front 85

What is the pathophysiology of childhood obesity?

Back 85

Multifactorial:

1. Intake of calories > than needed for BMR

2. Low activity level/sedentary lifestyle – TV, video games, computer

3. Genetic factors

4. Food choices

5. Sociocultural

6. Community patterns

7. Psychological influences

Front 86

What are the complications of obesity?

Back 86

1. Type 2 DM
2. Fatty Liver Disease
3. Pulmonary complications
4. Musculoskeletal
5. Social

Front 87

What is the incidence of Type 2 diabetes associated with childhood obesity?

Back 87

1 out of 3 newly diagnosed – adolescent

Front 88

What is seen with Type 2 diabetes r/t obesity?

Back 88

↑ cholesterol and lipid

Front 89

What is the leading cause of chronic liver disease?

Back 89

Fatty Liver Disease

Front 90

What is fatty liver disease?

Back 90

Progressive accumulation of fat in the liver – can lead to cirrhosis, liver failure

Front 91

What pulmonary complications are associated with obesity?

Back 91

1. Sleep apnea
2. Asthma
3. Exercise intolerance

Front 92

What musculoskeletal complication is associated with obesity?

Back 92

Slipped capital femoral epiphysis (SCFE)

Front 93

What is slipped capital femoral epiphysis (SCFE)?

Back 93

A posterior and inferior slippage of the proximal femoral epiphysis on the metaphysis (femoral neck), occurring through the physeal plate during the early adolescent growth spurt. This injury is the most common hip disorder in adolescents, especially those that are obese.

Front 94

What are the social complications associated with obesity?

Back 94

1. Affects social interactions and relationships

2. Self-esteem decreased in adolescence

Front 95

What are the treatments for obesity?

Back 95

1. Dietary counseling
2. Exercise
3. Behavior Modification
4. Bariatric Surgery
5. Group Involvement

Front 96

Which of the following statements best describes hypopituitarism?

A. Skeletal proportions are normal for age.

B. Weight is usually more retarded than height.

C. Growth is normal during the first 3 years of life.

D. Most of these children have subnormal intelligence.

Back 96

A. Skeletal proportions are normal for age

Front 97

Which of the following should the nurse include when discussing a child's precocious puberty with the parents?

A. The child is not yet fertile.

B. Heterosexual interest is usually advanced.

C. Dress and activities should be appropriate to chronologic age.

D. Appearance of secondary sexual characteristics does not proceed in the usual order.

Back 97

C. Dress and activities should be appropriate to chronologic age

Front 98

The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. The acute phase seems to be over when ascending flaccid paralysis occurs. The most appropriate nursing action is which of the following?

A. Prepare family for impending death.

B. Reassure family that this condition is temporary.

C. Prepare family for long-term consequences of paralysis.

D. Reassure family that flaccid paralysis is not problematic.

Back 98

B. Reassure family that this condition is temporary

Front 99

Which of the following statements best describes Cushing syndrome?

A. It is caused by excessive production of cortisol.

B. Treatment involves replacement of cortisol.

C. The major clinical features are exophthalmia and pigmentary changes.

D. Diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.

Back 99

A. It is caused by excessive production of cortisol

Front 100

The parent of a child asks the nurse why home blood glucose monitoring is being recommended for her 10-year-old child with diabetes. The nurse should base the explanation on which of the following?

A. It is an easier method of testing.

B. Parents are better able to manage the diabetes.

C. Children have a greater sense of control over the diabetes.

D. Fewer visits to the primary care provider will be necessary.

Back 100

C. Children have a greater sense of control over the diabetes

Front 101

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, play baseball, and swim. The nurse's response should be based on knowledge that:

A. Exercise is contraindicated.

B. The level of activity depends on the type of insulin required.

C. Exercise is not restricted unless indicated by other health conditions.

D. Soccer and baseball are too strenuous, but swimming is acceptable.

Back 101

C. Exercise is not restricted unless indicated by other health conditions