FOCUS Growth Hormone, Precocious Puberty, Type 1 Diabetes
Endocrine glands
Key tal away:
Chuldsren endocrine system focusues on gorwth, development and puberty
Adults endocrine system stabilzes
Some glands shrink GH, sex homrones
Feedback control in hormone production
Hypothalamus secretes TRH causing pituitary to relase TSH
TSH causes thyroid to secrete t3 and t4
Then when baby has enough T3 and T4 are relased feedback to halt the stop
Growth Hormone Defiency
Occurs whenthe pituatary doesnt receive enoguh
Clincal Manifestation: At or below 3rd percentile in height
Delayed epiphyseal closure
Prominent subcutaneous deposit on abdomen
Child like face with large prominent forehead
High pitch voice
Delay sexyalt matuerity, altered dentition, skeltal matuiion
Underdeveloped jaw
Decrease muscel mass
Increase insulin sensitivity
Treatment: Growth hormone repalcement therapy is the primary treaemtn and has to eb carefully manage
Subq injection and take home
Monitoring and adjustment
Supportive care
Physcial therapy, dietary consult
Psychosocial support
Treatment usualy stops when the growht plate is closed
Diabetes
Type 1: Deficency in inuslin
Type 2: Insulin resistance
Diabetes can be secondary to certain conidtions such as CF, glucostieord
Gestational Diabetes
Type 1 Diabetes Mellitus
S/S Polydipsia, polyuria, polyphagia, unexplained weight loss, fatigue, blurred vision, slow healing of wounds or infection, fruity scented breath ( ketoacidiosis)
Goals
Achieve nomral growth adn devloeplet
Promote optimal serum glucose control including fuild and electroyles and near normal hemoglobin A1C
Prevent complication
Promoting positve adjsutment to teh disease with abulty to self manage in the home
VERY IMPORTANT: Medication managment diabetes → Insulin
Type
Rapid acting
Aspart Novolog
Lispro HUmlog
Glulisin Aprida
Short acting
Regular
Complication of Diabetes
Faulure to grow, delay sexual maturation, poor wound healing, recurrent infection, vascular complicaiton, peripheral bascualr disease, neuropathy, nephropathy, retinopathy, cerebrovacualr dsiease, caridovasuclar disease
Diabeteic Acidosis
Clincal Manifestation
Anorexia, nausea, vomiting, lethary, stupor, altereed level of consiousness, confusion, Kusssmaul respiration, decrease skin tuorgor, abdominal pain, fruity smell, presnece of ketones in urine and blood, tahcycardia, if left untreated will go into coma and die
Education for Diabetes
Self measurement of blood glucose
Urine ketone testing
Medication use
S/S and treatment of hypo/hyperglycemia
monitroing and managing complication such as a wound
Sick Day instructions
Laboratory testing and follow up care
Diet and excercise as part of DM maangmenet
Create a log/diary
Precocious Puberty: Fast onset of pubertiy; chuld develops sexual cahcteristic before hte usual age of pubertal onset whihc can occur when the gonads. produce an increased amount of sex hormone
Goals of Managing Precocios Puberty
Education: Physical changes the child is experiencing
Teaching: how to correcly use the prescibed medication
Helping: Help child deal with self esteem issues realred to rate of grwoth
Promoting: Age appropriate physical development adn pubertal progression