Pediatric Nursing: Nervous & Endocrine Care
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Questions and Answers

Which manifestation is NOT typically associated with diabetes insipidus?

  • Loss of weight
  • Increased appetite (correct)
  • Polydipsia
  • Polyuria

    • Which of the following types of diabetes is primarily diagnosed during pregnancy?

  • Type I Diabetes Mellitus
  • Type II Diabetes Mellitus
  • Latent Autoimmune Diabetes in Adults
  • Gestational Diabetes (correct)

    • What is a common complication if diabetic ketoacidosis (DKA) remains untreated?

  • Hypoglycemia
  • Insulin resistance
  • Lactic acidosis
  • Diabetic coma (correct)

    • Which of the following tests is NOT used for diagnosing diabetes mellitus?

    <p>Lipid panel</p> Signup and view all the answers

    What is one of the main goals in the treatment of children with diabetes?

    <p>Maintain normal growth and development through metabolic control</p> Signup and view all the answers

    What is the HgbA1c level required for a diagnosis of Type 2 Diabetes Mellitus?

    <p>6.5% or higher</p> Signup and view all the answers

    Which of the following is a treatment option for Type 2 Diabetes Mellitus?

    <p>Lifestyle change</p> Signup and view all the answers

    What condition is classified as a Class III obesity according to BMI measurements?

    <p>40+</p> Signup and view all the answers

    What happens to the symptoms of diabetes mellitus in children compared to adults?

    <p>They appear more rapidly</p> Signup and view all the answers

    What should not be provided to children with diabetes according to current guidelines?

    <p>Sugar substitutes like sorbitol</p> Signup and view all the answers

    How might preschool-aged children perceive injections?

    <p>As punishment for their actions</p> Signup and view all the answers

    What is a common emotional response of school-aged children towards their treatment regimen?

    <p>Rebellion and defiance</p> Signup and view all the answers

    What is a significant concern for adolescents with diabetes during puberty?

    <p>They feel embarrassed and out of control</p> Signup and view all the answers

    What should patients with diabetes wear for identification?

    <p>Identification indicating their diabetes condition</p> Signup and view all the answers

    Which dietary factor may precipitate type 2 diabetes mellitus?

    <p>Lipid-rich diet</p> Signup and view all the answers

    What is indicated by the term 'obese' in the context of BMI?

    <p>A BMI of 30 or higher</p> Signup and view all the answers

    What health monitoring should be conducted after surgery in patients with diabetes?

    <p>Close monitoring of glucose levels</p> Signup and view all the answers

    What is a common sign of insulin resistance in patients?

    <p>Acanthosis nigricans</p> Signup and view all the answers

    What is the primary hormone affected in hypothyroidism?

    <p>Thyroxine (T4)</p> Signup and view all the answers

    Which of the following is a manifestation of hyperparathyroidism?

    <p>Spontaneous fractures</p> Signup and view all the answers

    What treatment is recommended for diabetes insipidus?

    <p>Vasopressin</p> Signup and view all the answers

    What is the main concern in treating a child with Tay-Sachs disease?

    <p>Providing palliative care</p> Signup and view all the answers

    Which hormone is deficient in adrenal cortical insufficiency (Addison's disease)?

    <p>Cortisol</p> Signup and view all the answers

    What is a common manifestation of hyperpituitarism?

    <p>Gigantism</p> Signup and view all the answers

    What symptom could indicate overdose of levothyroxine in a pediatric patient?

    <p>Hyperactivity</p> Signup and view all the answers

    In the context of metabolic conditions, what does SIADH stand for?

    <p>Syndrome of Inappropriate Antidiuretic Hormone</p> Signup and view all the answers

    What is a common treatment for hyperadrenalism (Cushing’s disease)?

    <p>Tumor removal</p> Signup and view all the answers

    Which condition is associated with increased levels of parathyroid hormone?

    <p>Hyperparathyroidism</p> Signup and view all the answers

    What is one of the main reasons children are more prone to insulin shock?

    <p>Children's activities are more irregular.</p> Signup and view all the answers

    What is the purpose of a continuous glucose monitoring system?

    <p>To measure blood glucose levels at intervals.</p> Signup and view all the answers

    Which of the following describes the Dawn Phenomenon?

    <p>Hyperglycemia occurs without preceding hypoglycemia.</p> Signup and view all the answers

    What nutritional composition is typically recommended for managing diabetes?

    <p>55% carbs, 30% fat, 15% protein</p> Signup and view all the answers

    What symptom is NOT associated with the Somogyi phenomenon?

    <p>Increased insulin requirements</p> Signup and view all the answers

    How should insulin be administered to avoid complications?

    <p>Rotating the injection sites regularly.</p> Signup and view all the answers

    What component is essential in the nursing management for infants diagnosed with diabetes?

    <p>Understanding the impact of anxiety.</p> Signup and view all the answers

    Which glycemic index value indicates foods that rapidly increase blood glucose levels?

    <p>Above 70</p> Signup and view all the answers

    What role does the insulin pump play in diabetes management?

    <p>It functions in a closed loop system with a glucose monitor.</p> Signup and view all the answers

    What is a common effect of the Somogyi phenomenon during the night?

    <p>Severe hypoglycemia</p> Signup and view all the answers

    Study Notes

    Terminal Learning Objective

    • Determine nursing care required for a pediatric patient.

    Enabling Learning Objective

    • The Nervous and Endocrine System and disorders and dysfunctions of the Endocrine System.

    Integration of the nervous and endocrine systems

    • Nervous system and endocrine system are interdependent.
    • Endocrine regulates metabolic processes.

    Tay-Sachs Disease

    • Pathophysiology: Deficiency of lysosomal-beta-hexosaminidase.
    • Ashkenazi Jewish population.
    • Manifestations: None until 5-6 months, Head lag, Inability to sit, Cherry-red deposits on optic nerve (blindness), Mental retardation.
    • Treatment: Nursing care.

    Hypothyroidism

    • Pathophysiology: Deficiency in thyroid gland secretions.
    • Thyroid controls metabolic rate.
    • Thyroxine (T4) and triiodothyronine (T3).
    • Manifestations: Sluggish, Large tongue, Dry skin.
    • Treatment: Levothyroxine sodium (Synthroid, Levothroid).
    • Nursing Care: Medication education (timing), Signs of overdose, Signs of inadequate dose.

    Anterior Pituitary

    • Problem: Decreased - hypopituitarism
    • Hormone: Growth hormone
    • Manifestation: Dwarfism
    • Therapy: Synthetic growth hormone replacement
    • Problem: Increased - hyperpituitarism
    • Hormone: Growth hormone
    • Manifestation: Gigantism or acromegaly
    • Therapy: cryosurgery, irradiation, radioactive implants
    • Manifestation: Sexual precocity
    • Therapy: Monthly hormone injections to control secretions until puberty

    Posterior Pituitary

    • Problem: Decreased - hypopituitarism
    • Hormone: Antidiuretic hormone
    • Manifestation: Diabetes insipidus
    • Therapy: Vasopressin by injection or nasal spray
    • Provide adequate fluids.

    Parathyroid

    • Problem: Decreased - hypoparathyroidism
    • Hormone: Parathyroid hormone
    • Manifestation: Decreased blood calcium and increased phosphorus levels, causing tetany and laryngospasm
    • Therapy: Calcium gluconate, vitamin D supplements
    • Problem: Increased - hyperparathyroidism
    • Hormone: Parathormone
    • Manifestation: Elevated blood calcium and lowered phosphorus levels, causing spontaneous fractures and CNS problems
    • Therapy: Restore calcium balance, excise tumor, vitamin D, low-phosphorus diet

    Adrenal

    • Problem: Decreased – adrenal cortical insufficiency (Addison's disease)
    • Hormone: Decreased steroids, sex steroids, epinephrine
    • Manifestation: Craving for salt, seizures, neurological and circulatory changes, decreased sexual development
    • Therapy: Replace cortisol and aldosterone, genetic sexual assessment
    • Problem: Increased – hyperadrenalism (Cushing's disease)
    • Hormone: Cortisol
    • Manifestation: hyperglycemia, electrolyte problems, pheochromocytoma
    • Therapy: Depends on cause, tumor removal, and hormone replacement

    Diabetes Insipidus

    • Pathophysiology: Posterior pituitary hypofunction, decreased vasopressin resulting in uncontrolled diuresis.
    • Manifestations: Polydipsia, polyuria, loss of weight and growth failure.
    • Treatment: Hormone replacement of vasopressin
    • Nursing Care: Fluids, identification and education

    Diabetes Mellitus

    • Pathophysiology: Body is unable to use carbs leading to impairment of glucose transport.
    • Types: Type 1, Type 2, Gestational.

    Diagnostic Blood Tests

    • Blood glucose
    • Fasting blood glucose
    • Glucose tolerance test
    • Glycosylated hemoglobin test (HgbA1c)

    Diabetic Ketoacidosis

    • DKA is also referred to as a diabetic coma.
    • Can be due to infections, even minor ones
    • Metabolic rate changes
    • Result if untreated can be ketoacidosis

    Treatment

    • Three main goals: Ensure normal growth and development through metabolic control; enable the child to cope with a chronic illness, have a happy and active childhood, and be well integrated into the family; Prevent complications.
    • Maintain BG WNL
    • Education
    • Family impact
    • Nursing management
    • Teaching plan

    Blood Glucose Self Monitoring

    • Test at home
    • Sliding Scale dosage
    • Equipment
    • Preferred site

    Continuous Glucose Monitoring

    • Sensor pad under the skin
    • Transmits glucose levels every 10-60 seconds
    • Can be used by children 7 and older

    Insulin Administration

    • Insulin pump
    • Closed loop system
    • Glucose monitor
    • Insulin pump
    • Wireless
    • Intermittent injections
    • Measured in units
    • Special syringes
    • Subcutaneous injections
    • Site rotation
    • Lipoatrophy and lipohyperthrophy
    • Glucose sensor
    • Algorithm

    Types of Insulin

    • Details of each type of Insulin (chart included): Onset, peak, duration.

    Insulin Shock

    • Also known as hypoglycemia
    • Children are more prone due to: The condition itself is more unstable in young people, Children are growing, Children's activities are more irregular.
    • Symptoms
    • Treatment

    Somogyi Phenomenon

    • Rebound hyperglycemia
    • Hypoglycemia at night and hyperglycemia in the morning
    • Body response to lowered blood glucose: Epinephrine, Cortisol, Glucagon
    • Rapid rise in blood glucose
    • Symptoms: May awaken at night, Frequent nightmares, Early morning sweating, Headaches
    • Treatment: Less insulin

    Dawn Phenomenon

    • Hyperglycemia in the morning
    • NO preceding hypoglycemia
    • Response to growth hormone secreted at night
    • Testing blood glucose levels

    Nutrition Management

    • Triad of diabetes management: Well-balanced diet, Precise insulin administration, Regular exercise
    • Ensure normal growth and development
    • Caloric intake based on BSA
    • 55% carbs, 30% fat, 15% protein
    • Dietetic v diabetic

    DM Home management

    • Exercise
    • Skin Care
    • Foot Care
    • Infections
    • Emotional Upsets

    Nursing Interventions

    • Age Group (infant, toddler, preschool, school age, puberty)
    • Trust versus mistrust
    • Autonomy versus shame and doubt
    • Initiative versus guilt
    • Industry versus inferiority
    • Issues related to onset and diagnosis of diabetes, and nursing care considerations in each age group

    Urine Checks

    • Replaced by glucose blood monitoring
    • Still used if urine acetone levels
    • Glucose-insulin imbalances
    • Pt should wear identification
    • Know about hyper v hypo
    • Travel
    • Time changes may affect meals
    • Bring additional supplies
    • Follow up care
    • Regularly
    • Illness or surgery
    • Close monitoring
    • Stress hormones
    • Long Term complications
    • Microvascular
    • macrovascular

    Type 2 Diabetes Mellitus

    • Insulin resistance and reduced insulin secretion
    • Precipitated by: Obesity, Low physical activity, Lipid rich diet
    • Risk Factors: Family history of type 2 diabetes, Signs of insulin resistance, Acanthosis nigricans, Hypertension, Increased lipids, Repeated vaginal monilial infections, Obese BMI
    • Diagnosis: HgbA1c of 6.5% or higher, Obesity
    • Treatment: Lifestyle change, Antidiabetic medication

    Diet Therapy in Pediatric Metabolic Disorders

    • Phenylketonuria (PKU), Celiac Disease, Cystic Fibrosis, Lactose Intolerance, Galactose Intolerance, Fructose Intolerance, Maple Syrup Urine Disease, Urea Cycle Defect, Acidemia, Diabetes insipidus, Diabetes mellitus.
    • Include considerations for inborn errors of metabolism.

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    Child Needing Nursing Care II PDF

    Description

    This quiz focuses on the nursing care required for pediatric patients with conditions related to the nervous and endocrine systems. Topics include Tay-Sachs disease and hypothyroidism, emphasizing pathophysiology, manifestations, and treatment. Test your understanding of essential nursing interventions for these disorders.

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