Nursing Care of the Child with an Alteration in Metabolism/Endocrine Disorder

What to know about the endocrine system?

• Influences all physiologic processes

• Growth and development

• Metabolic processes related to fluid and electrolyte balance and energy production

• Sexual maturation and reproduction

• The body’s response to stress

• Maintenance of internal homeostasis

What are the organs or tissues of the endocrine system?

• Pituitary gland and hypothalamus (“control centers”)

• Thyroid gland

• Parathyroid glands

• Adrenal glands

• Gonads (ovaries and testes)

• Islets of Langerhans located in the pancreas

What are the laboratory and genetic testing for endocrine disorders?

• Newborn metabolic screening

• Serum chemistry

• Random and timed serum hormone testing

• Growth hormone stimulation testing

• Blood glucose (fasting, random and OGTT), HgA1C

• Urine testing (ketone, glucose, 24‐hour collections)

• Hemoglobin A1c

• Genetic testing

• Water deprivation study

• Bone age radiographs

• Imaging studies—CT, MRI, nuclear medicine, ultrasonography

What are the common medications for endocrine disorders?

• Hypoglycemics (oral, injectable)

• Hormone therapy (supplemental) (growth hormone; levothyroxine)

• Hormone suppression therapy (Octreotide; Methimazole)

• Corticosteroids and mineralocorticosteroids

• Desmopressin acetate (DDAVP)

What are the complications of growth hormone deficiency and therapy?

• Altered carbohydrate, protein, and fat metabolism

• Hypoglycemia

• Glucose intolerance/diabetes

• Slipped capital femoral epiphysis (SCFE)

• Pseudotumor cerebri

• Leukemia

• Recurrence of CNS tumors

• Infection at the injection site

• Edema and sodium retention

What are the common medical treatments for endocrine disorders?

• Dietary interventions

• Glucose monitoring and insulin delivery via programmable pumps

• Irradiation/administration of radioactive iodine

• Surgery

What are the pituitary disorders?

• Growth hormone deficiency

• Precocious puberty

• Delayed puberty

• Diabetes insipidus

• Syndrome of inappropriate antidiuretic hormone secretion

What are the goals of nursing management of precocious or delayed puberty?

• Educating the child and family about the physical changes the child is experiencing

• Teaching how to correctly use the prescribed medications

• Helping the child to deal with self-esteem issues related to the differences in the rate of growth and development of secondary sexual characteristics compared to peers

• Promoting age-appropriate physical development and pubertal progression

What are the thyroid disorders in children?

• Hyperthyroidism: rare in children

  • Mostly seen as Graves’ disease

  • Excessive T3, T4, T3 resin uptake

  • TSH usually low

  • Treated by destruction of thyroid gland

• Hypothyroidism: can be congenital or acquired

  • Certain populations at risk (Downs, maternal hypothyroidism)

  • Decreased thyroid hormones

  • Decreased T3, T4, T3 resin uptake

  • TSH usually elevated

  • Lifelong thyroid supplementation

What is included in promoting growth for a child with congenital hypothyroidism?

• Measure and record growth at regular intervals.

• Measure thyroid levels at recommended intervals (every 2 to 4 weeks until the target range is reached on a stabilized dose of medication, then every 1 to 3 months and decreasing in frequency as the child gets older).

• Monitor for signs of hypo- or hyperfunction, including changes in vital signs, thermoregulation, and activity level.

• Provide adequate rest periods and meet thermoregulation needs.

What are the signs of thyroid signs?

• Sudden onset of severe restlessness and irritability

• Fever

• Diaphoresis

• Severe tachycardia

What are some other endocrine disorders?

• Adrenal gland disorders

• Congenital adrenal hyperplasia

• Cushing syndrome

• Addison disease

• Polycystic ovary syndrome