Podcast
Questions and Answers
What is the primary purpose of administering somatropin at bedtime for children with hypopituitarism?
What is the primary purpose of administering somatropin at bedtime for children with hypopituitarism?
- To minimize potential side effects during waking hours.
- To coincide with the natural peak of growth hormone secretion during sleep. (correct)
- To improve absorption rates compared to daytime administration.
- To reduce the frequency of required injections.
Which of the following interventions is most important when handling a plaster cast that has become wet?
Which of the following interventions is most important when handling a plaster cast that has become wet?
- Apply direct heat to dry the cast quickly.
- Use a fan to circulate air around the cast.
- Cover the cast with a waterproof material.
- Use the palms of your hands to handle the cast. (correct)
A child with talipes equinovarus is undergoing serial casting. What is the primary goal of this intervention?
A child with talipes equinovarus is undergoing serial casting. What is the primary goal of this intervention?
- To strengthen the bones of the foot.
- To prevent further deformation of the foot.
- To immediately correct the deformity with a single cast application.
- To gradually stretch the foot muscles over time. (correct)
How frequently should the straps of a Pavlik harness be checked and adjusted?
How frequently should the straps of a Pavlik harness be checked and adjusted?
A positive Trendelenburg sign indicates weakness in which muscle group?
A positive Trendelenburg sign indicates weakness in which muscle group?
Which of the following is the most common causative organism in osteomyelitis resulting from an external source?
Which of the following is the most common causative organism in osteomyelitis resulting from an external source?
When reading a journal article about pediatric hypopituitarism, you note the researchers mention 'bone age'. What is bone age most closely correlated with in children with growth hormone deficiency?
When reading a journal article about pediatric hypopituitarism, you note the researchers mention 'bone age'. What is bone age most closely correlated with in children with growth hormone deficiency?
What specific advice should be given to parents regarding massaging their child's ankle after talipes equinovarus correction?
What specific advice should be given to parents regarding massaging their child's ankle after talipes equinovarus correction?
A child is diagnosed with osteomyelitis. Which assessment finding is most indicative of the condition?
A child is diagnosed with osteomyelitis. Which assessment finding is most indicative of the condition?
For a child receiving somatropin, which injection site requires extra caution?
For a child receiving somatropin, which injection site requires extra caution?
What is the recommendation for brace wear after surgical correction of talipes equinovarus?
What is the recommendation for brace wear after surgical correction of talipes equinovarus?
Which of the following nursing interventions is most important immediately following cast application?
Which of the following nursing interventions is most important immediately following cast application?
A child presents with a suspected growth hormone deficiency. Which diagnostic test is most appropriate to confirm this diagnosis?
A child presents with a suspected growth hormone deficiency. Which diagnostic test is most appropriate to confirm this diagnosis?
What is the primary reason for elevating a casted extremity during the initial 24-48 hours after application?
What is the primary reason for elevating a casted extremity during the initial 24-48 hours after application?
A child with a Pavlik harness is brought in for a checkup. Which of the following indicates proper harness application?
A child with a Pavlik harness is brought in for a checkup. Which of the following indicates proper harness application?
What is the appropriate action to take if a parent reports increased warmth and drainage from under their child's cast?
What is the appropriate action to take if a parent reports increased warmth and drainage from under their child's cast?
A radiograph reveals a child's bone age is significantly delayed. Which deficiency is most likely?
A radiograph reveals a child's bone age is significantly delayed. Which deficiency is most likely?
A child is diagnosed with osteomyelitis of the tibia. Besides fever and pain, what additional symptom is most likely?
A child is diagnosed with osteomyelitis of the tibia. Besides fever and pain, what additional symptom is most likely?
Which long-term complication is LEAST associated with the use of a Pavlik harness for developmental dysplasia of the hip (DDH)?
Which long-term complication is LEAST associated with the use of a Pavlik harness for developmental dysplasia of the hip (DDH)?
Which assessment finding would be most concerning in a child who has just had a cast placed?
Which assessment finding would be most concerning in a child who has just had a cast placed?
A 2-month-old infant is diagnosed with talipes equinovarus. What is the typical initial intervention?
A 2-month-old infant is diagnosed with talipes equinovarus. What is the typical initial intervention?
What should parents be taught regarding skin care when their infant is in a Pavlik harness?
What should parents be taught regarding skin care when their infant is in a Pavlik harness?
A child with known osteomyelitis reports increased pain. Which intervention is the priority?
A child with known osteomyelitis reports increased pain. Which intervention is the priority?
A child is scheduled for GH stimulation testing. What pre-test instruction should be implemented?
A child is scheduled for GH stimulation testing. What pre-test instruction should be implemented?
What is a critical step to prevent complications when administering somatropin?
What is a critical step to prevent complications when administering somatropin?
When is surgical repair or tendon tenotomy typically considered for a child with talipes equinovarus?
When is surgical repair or tendon tenotomy typically considered for a child with talipes equinovarus?
What is the key finding indicative of a positive Trendelenburg sign?
What is the key finding indicative of a positive Trendelenburg sign?
Which symptom is LEAST likely to be observed in a child with osteomyelitis?
Which symptom is LEAST likely to be observed in a child with osteomyelitis?
A child has a cast on her lower leg. How can moleskin be best used to increase her comfort?
A child has a cast on her lower leg. How can moleskin be best used to increase her comfort?
For a child diagnosed with clubfoot, what does treatment focus on in the weeks immediately following birth?
For a child diagnosed with clubfoot, what does treatment focus on in the weeks immediately following birth?
A child is being evaluated for developmental dysplasia of the hip (DDH). What would be the primary purpose of performing the Trendelenburg test?
A child is being evaluated for developmental dysplasia of the hip (DDH). What would be the primary purpose of performing the Trendelenburg test?
A child exhibiting signs of osteomyelitis is admitted. What is the anticipated first line of treatment, assuming no contraindications?
A child exhibiting signs of osteomyelitis is admitted. What is the anticipated first line of treatment, assuming no contraindications?
A child with hypopituitarism is on GH therapy. Aside from linear growth, what other metabolic effect can be anticipated?
A child with hypopituitarism is on GH therapy. Aside from linear growth, what other metabolic effect can be anticipated?
A child presents with acute osteomyelitis following a puncture wound. Based solely on the information provided, what is the most likely causative organism in this scenario?
A child presents with acute osteomyelitis following a puncture wound. Based solely on the information provided, what is the most likely causative organism in this scenario?
A child with developmental dysplasia of the hip (DDH) is being treated with a Pavlik harness. How often should parents remove the harness?
A child with developmental dysplasia of the hip (DDH) is being treated with a Pavlik harness. How often should parents remove the harness?
An adolescent with a history of clubfoot, corrected in infancy, now presents with persistent pain and stiffness in the affected foot. Which long-term complication should be suspected?
An adolescent with a history of clubfoot, corrected in infancy, now presents with persistent pain and stiffness in the affected foot. Which long-term complication should be suspected?
A pediatric patient presents with suspected hypopituitarism. After initial lab work, it's determined that a GH stimulation test is necessary. Considering the nuances of GH secretion, at what SPECIFIC time range should the baseline blood sample ideally be obtained for maximal diagnostic accuracy?
A pediatric patient presents with suspected hypopituitarism. After initial lab work, it's determined that a GH stimulation test is necessary. Considering the nuances of GH secretion, at what SPECIFIC time range should the baseline blood sample ideally be obtained for maximal diagnostic accuracy?
Flashcards
GH stimulation testing
GH stimulation testing
Stimulation testing to check for GH deficiency
Prior to GH stimulation
Prior to GH stimulation
No eating/drinking, activity limitations 10-12 hours. Baseline blood sample: 0600-0800
During GH stimulation
During GH stimulation
Administer medicine to trigger GH release; collect blood samples every 15-30 minutes for 3 hours
Skeletal maturity
Skeletal maturity
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Skull films
Skull films
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Hypopituitarism impact
Hypopituitarism impact
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Somatropin
Somatropin
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Somatropin injection sites
Somatropin injection sites
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Administer at bedtime
Administer at bedtime
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Cast care
Cast care
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First 24 hours of cast care
First 24 hours of cast care
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Cast infection signs
Cast infection signs
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Handling plaster casts
Handling plaster casts
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Talipes Equinovarus
Talipes Equinovarus
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Clubfoot treatment
Clubfoot treatment
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Braced Denis Browne bar
Braced Denis Browne bar
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Pavlik Harness
Pavlik Harness
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Pavlik Harness checks
Pavlik Harness checks
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Skin care with Pavlik Harness
Skin care with Pavlik Harness
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Trendelenburg sign
Trendelenburg sign
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Positive Trendelenburg sign
Positive Trendelenburg sign
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Osteomyelitis
Osteomyelitis
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Osteomyelitis manifestations
Osteomyelitis manifestations
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Study Notes
Hypopituitarism Diagnosis
- Growth hormone (GH) stimulation testing is necessary for children exhibiting low levels of Insulin-like Growth Factor 1 (IGF-1) and Insulin-like Growth Factor Binding Protein 3 (IGFBP-3), along with short stature.
- Patients must maintain NPO status and limit activity for 10-12 hours before GH stimulation testing.
- Obtain a baseline blood sample between 0600-0800 before testing.
- Post baseline blood draw, give medication to trigger GH release
- Collect blood samples every 15-30 minutes for 3 hours after medication administration.
- Skeletal maturity can be assessed by comparing epiphyseal centers to age-appropriate standards.
- Children under 3 receive a general skeletal survey whereas older children receive hand and wrist radiographs.
- Skeletal surveys provide data regarding growth and epiphyseal function.
- Skull films help identify structural abnormalities such as a small sella turcica.
- Bone age in kids with growth hormone deficiency typically aligns with height age.
Nursing Care for Hypopituitarism
- During each visit, make sure to measure and record the child's height and weight on a growth chart.
- Height is more affected than weight in children with growth hormone deficiency.
- Assist parents in maintaining realistic growth expectations.
Somatropin Administration
- Somatropin is a human growth hormone replacement that stimulates bone and skeletal muscle growth.
- Administer somatropin through subcutaneous injections into the abdomen, thigh, buttock, or back of the upper arm.
- Rotate sites to avoid tissue atrophy.
- Administer at bedtime to mimic the natural GH peak during sleep.
- Exercise caution in children receiving insulin.
Cast Care
- Assess and monitor neurovascular status in the affected extremity.
- Elevate the cast above heart level for the initial 24-48 hours to prevent swelling.
- Apply ice to the cast during the initial 24 hours.
- Turn the affected extremity every 2 hours.
- Make sure the affected extremity is supported.
- Monitor for increased warmth/hot spots and drainage in the casted area.
- Assess the skin around the cast.
- Use the palm of the hands when handling plaster casts to prevent denting.
- Use moleskin to prevent friction rub.
- Cover cast areas to prevent soiling from feces.
- Make sure there is proper crutch fitting and usage.
- When wet, use palms of hands when handling; the cast should feel warm, not hot.
- After cast removal, soak off excess material and apply lotion.
Talipes Equinovarus (Clubfoot)
- Clubfoot involves deformity of the ankle and foot involving bone deformity, malpositioning, and soft tissue contracture.
- Parents should massage and rotate the ankle in the correct position 5 times per day.
- Treatment starts at 1-2 weeks old with 5-7 serial casts applied over weeks to months involving weekly stretching of the foot muscles.
- Surgical repair or tendon tenotomy is considered if there is no improvement by 3 months.
- Following surgery, casting is required for 2-3 months followed by bracing.
- After correction, the foot is fitted with a braced Denis Browne bar with special shoes to maintain alignment.
- Wear the brace 23 hours each day for 3 months, and then during nights and naps until 4 years old.
Pavlik Harness
- The Pavlik harness is used for developmental dysplasia of the hip and is worn for 6-12 weeks.
- Make sure that there is proper harness placement.
- Check strap adjustments every 1–2 weeks.
- Encourage holding the child.
- Promote growth and development.
- Place a white cotton t-shirt under the harness to prevent skin issues.
- Perform regular skin checks.
- Only remove the harness for baths.
- Caregivers should demonstrate proper harness application.
Trendelenburg Sign
- Assesses the strength of hip abductor muscles by having the child stand on one leg with the other leg flexed forward.
- A positive sign is indicated by a drop in the pelvis on the side opposite the standing leg.
- The Trendelenburg sign is seen in children with developmental dysplasia of the hip.
Osteomyelitis
- This is a bone infection, usually caused by Staphylococcus aureus, from an outside source.
- Manifestations include preference to not use the affected extremity, appearing ill and irritable, fever, tachycardia, edema, pain, and tenderness at the infection site that worsens with movement.
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