Endocrine Disorders in the Pediatric Client by o3647G7

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									Endocrine Disorders in
the Pediatric Client



            Susan Beggs, MSN, CPN
Understanding the endocrine
system in children
  Puberty brings many changes
    ↑GH released
    ↑ production of LH and FSH in girls
  Development of sexual characteristics
  Feedback mechanism in place
Collecting data during an
endocrine assessment
    Percentiles on weight and height
    Distinguishing facial features, abd. fat
    Onset of puberty
    Routine NB screening
    Blood glucose levels
    Detection of chromosomal disorders
Pancreatic dysfunctions

    Etiology
    Preclinical stage
    Manifestations
    Diagnosis
Therapy for diabetes in
children
  Diagnosis:
    Under 18?
    Type I diabetes
  Clinical therapy combines:
      insulin
      nutrition
      exercise regimen
      psychosocial support
Insulin therapy
Insulin review

    Rapid (Lispro/Humalog)
    Short acting (regular)
    Intermediate acting (NPH, Lente)
    Long acting (Lantus/Ultralente)
Basal-bolus therapy

  ADA recommendations for children
  Basal insulin administered 1-2x day; bolus of
   rapid acting with each meal and snack
  Method of this therapy:
      Lower glucose levels
      Stabilize glucose levels
      Eliminate ketones
      Insulin dose adjusted to BS readings 4x day
Basal bolus, cont.

  BS monitored 4-8x day; 1x a week at
   midnight and 3AM
  Therapy can be achieved with 3+ insulin
   injections a day or by pump
  There must be consistent carb counts
  Routine exercise
Factors which may affect
insulin dosage in children
    Stress
    Infection
    Illness
    Growth spurts (such as puberty)
    Meal coverage for finicky toddlers
    Adolescents concerned about weight
     gain not wanting to eat AM snack
External insulin infusion
pump in children
    Advantages                      Disadvantages
    Delivers continuous infusion    Requires motivation
    Maintain better control         Requires willingness to be
     # of injection sites           connected to device
    hypo/hyper episodes            Change sites every 2-4 days
    More flexible lifestyle         More time/energy to monitor
    Eat with more flexibility        BS
    Improves growth in child        Syringe, cath changes every
                                      2-3 days
                                     Infection may occur at site
                                     Wt gain common when BS is
                                      controlled
Insulin therapy, cont.

  Monitored every 3 months by hemoglobin
   A1c
  Represents amt of glucose attached to
   hemoglb over period of time
  Roughly 120 days
  Good predictor of levels over 6-8 wks
Nursing Management at
the time of diagnosis
  Child is admitted to hospital
  Nsg assessments directed toward:
      Hydration
      LOC
      Hourly monitoring of BS
      Dietary and caloric intake
      Ability of family to manage
“Sick Day guidelines”

    Days that child is ill
    Attention to glycemic control
    BS levels more often than routine
    DO NOT SKIP INSULIN!
    Factors key to preventing DKA
Home Teaching

    Incorporate into the family lifestyle
    “Honeymoon phase”
    Community resources
    Recognizing the cognitive
      levels at time of teaching
Diabetic Ketoacidosis

  Review of patho
  Causes
  Criteria for diagnosis of DKA
      BS levels> 300
      Serum ketones
      ↓ bicarbonates
      Acidosis (pH <7.3)
Treatment for DKA

    Fluids (boluses)
    Wean off IV insulin when clinical stable
    Oral feedings introduced when alert
    Prevention of future episodes
Type II diabetes in
children
    There is insulin resistance
    Fatty tissue produces hormone
    Hormone desensitized to insulin
    Can result in hyperinsulinism
    Signs and symptoms
Acanthosis nigricans
Inborn errors of
metabolism
    Phenylketonuria
    Galactosemia
    Defects in Fatty Acid Oxidation
    Maple syrup urine disease
Phenylketonuria (PKU)

     Autosomal recessive
     Liver deficiency
     Treatment/education
     Counseling for future pregnancies
Galactosemia

    Carbohydrate metabolic dysfuntion
    Autosomal recessive
    Liver enzyme deficiency
    Implications/symptoms
    Treatment/management
Defects in fatty acid
oxidation
    Defects result in fatty acid oxidation
    Most common of inborn errors
    Most common presentation
    Diagnosis/treatment
Maple syrup urine disease

    (MSUD)
    Disorder of amino acid metabolism
    Diagnosis made by UA
    Treatment/management
Nursing measures for
metabolic disorders
    Genetic counseling
    Dietary teaching.compliance
    Mixing special preparations
    Mainly supportive

								
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