HOC final exam

what are the functions of the endocrine system

controls cell activity with hormones, regulates growth and body metabolism, differentiation of the reproductive and CNS systems in fetus, enables sexual reproduction, maintains optimal hormone levels, maintains internal homeostasis in a constantly changing external environment

what are the pediatric differences in the endocrine system

prior to puberty, productions of sex hormones is low… during puberty gonads secrete increased sex hormones (estrogen and testosterone), adrenarche (adrenal androgen production begins and stimulates development of acne, pubic hair, and body odor), menarche (onset of menstruation; around 12 yrs old)

name the endocrine glands

pituitary (anterior and posterior), hypothalamus, thyroid, parathyroid, adrenal, pancreas (islets of langerhan), gonads (ovaries and testes)

what hormones are produced by the anterior pituitary (master gland)

growth hormone, TSH, adrenocorticotropic hormone, FSH, luteinizing hormone, prolactin

what hormone is released by the posterior pituitary

ADH (regulates fluid balance)

what hormone is produced by the posterior pituitary

oxytocin (stimulates uterine contractions and breast milk letdown reflex)

what is the function of growth hormone

stimulates linear growth and bone mineral density, stimulates growth of all body tissues, stimulates synthesis of proteins in the liver (helps to reproduce and use glucose)

what is growth hormone deficiency caused by

decreased activity in the pituitary gland, infarction of the pituitary gland, CNS disease, tumors of the pituitary or hypothalamus, brain tumors, traumas, cranial irradiation, chemo

what is growth hormone deficiency characterized by

below third percentile at 1 year, hypoglycemic seizures, hyponatremia, neonatal jaundice, pale optic discs, micropenis, undescended testes

what are the clinical manifestations of growth hormone deficiency

appear “cherubic” (youthful facial features), higher pitched voice, delayed dentition (don’t get teeth when expected), delayed skeletal maturation, ripply abd fat, decreased muscle mass, delayed sexual maturation

how is growth hormone deficiency diagnosed

evaluate for short stature, anyone 2-3 standard deviations below mean height for age or falling off growth chart is evaluated; wrist x-ray (does chronological age match bone age), provocative growth hormone testes (meds stimulate release of GH, confirmation of GH deficiency based on two failures of this test), IGF-1 (low level of insulin like growth factor)

how is growth hormone deficiency treated

daily SQ injection of GH (given at night, several years, replacement is expensive

what are the nursing considerations of growth hormone deficiency

monitor and plot growth, provide teaching for injections, educate regarding medication side effects, treat child by chronological age and not size, promote positive self image, encourage realistic height expectations

what are the side effects of growth hormone replacement

slipped capital femoral epiphysis- hip or knee pain with a limp , call the doctor

inability of the kidneys to concentrate urine in response to not enough ADH or ADH and the kidney’s aren’t working together properly

diabetes insipidus

what is central diabetes insipidus and what are the causes

inadequate production of vasopressin; caused by brain tumors, brain trauma, CNS infection, and neurosurgery

what is nephrogenic diabetes insipidus and what are the causes

ineffective action of vasopressin on kidneys; caused by drug toxicity, adverse drug reactions, illness

what are the clinical manifestations of diabetes insipidus

polyuria, polydispia, enuresis, irritability, dehydration

what will we see in labs for kids with diabetes insipidus

dilute urine, hypernatremia

what diagnostic tests will be done with diabetes insipidus

serum electrolytes, urinalysis (specific gravity and osmolality decreased), CT scan or MI to r/o tumor, water deprivation test

what is the treatment of diabetes insipidus

goal is to reduce urine output, central DI- DDAVP (causes hyponatremia in infants), nephrogenic DI- thiazide diuretics (promote Na excretion, stimulate water reabsorption), indomethacin and amiloride (help preserve K+)

what are the nursing considerations with diabetes insipidus

assist with diagnosis, daily weights, monitor I&O, check urine specific gravity, monitor for dehydration, teach parents medication administration, child should wear ID bracelet, school age children need unlimited access to the bathroom

early appearance of secondary sexual characteristics (girls before 8, idiopathic and boys before 9, neurologic)

precocious puberty

what causes precocious puberty

the hypothalamus is activated to secrete GnRH prematurely, caused by tumor of ovary/adrenal gland, rare genetic condition McCune-Albright syndrome

what are the clinical manifestations of precocious puberty

advanced bone age, appear unusually tall, growth ceases prematurely, mood swings, emotional lability

what are the isolated signs of premature sexual development that often need no treatment

breast development, vaginal bleeding without other sexual characteristics (early menarche increases risk for breast cancer), some pubic hair

what are the diagnostic tests used for precocious puberty

lab tests of LH, FSH, sex hormones, and gonadotropins, GnRH stim test confirms diagnosis, radiologic images of brain, bone age test

what is the treatment for precocious puberty

goal is to determine cause, decrease growth rate, stabilize secondary sexual characteristics, and promote natural growth. If the cause is a tumor; surgery, radiation, chemo. GnRH analog IM injections or SQ implant replaced yearly, treatment continues until a more normal age for puberty is reached

what are the nursing management points of precocious puberty

knowing and doing tanner staging (sexual maturity ratings of breasts and genitals), plot and monitor height, provide emotional support and teach consent, promote growth and development