Endocrine and Communicable Diseases

Endocrine

  • Pituitary Gland Function

    • Growth Hormone Deficiency (hypopituitarism)

    • Is the pituitary gland working? Will check labs to determine.

      • If yes- need to discuss plan w/ parents; insurance may not cover

      • If no, still need growth hormone

    • Insurance coverage challenges for FDA-approved treatment

Type 1 Diabetes

  • Manifestations

    • Weight loss, polydipsia, polyuria, fatigue, blurred vision, mood changes

  • EBP Screening and Diagnosis

    • Recommend screening for all family members for Type 1 Diabetes

      • Check for autoantibodies

      • If 2 or more autoantibodies, do A1C

    • Main reason for screening is to prevent Diabetic Ketoacidosis (DKA)

      • DKA= ICU stay for kids; hourly BG checks

      • kids are very sick

  • Preclinical Stages of Type 1 Diabetes Mellitus

    • Stage 1: Presence of beta-cell autoimmunity, but expected glucose-handling

    • Stage 2: Unexpected glucose handling but no clear manifestations

    • Stage 3: Manifestations of lack of insulin

  • New studies using monoclonal antibody therapy in kids Stage 2 diagnosis

  • Principles Insulin Therapy for Type 1 Diabetes

    • Based on blood glucose value, carbohydrate intake, insulin sensitivity factor (how sensitive kid is to insulin & how much bg drops when given insulin)

      • How do you know if a kid is sensitive to insulin?

        • they drop their blood glucose level when receiving insulin

    • Goal of insulin therapy: to mimic body’s natural insulin production

    • Use of insulin pumps for some patients with Type 1 Diabetes (prevent long-term complications

    • So we give rapid-acting & long-acting insulin to do this.

      • Rapid-acting insulin for the spike in BG

      • Long-acting provides basal amount of insulin

        • provides continuous insulin (basal) & also allows patient to administer insulin as needed for high BG or eating (bolus)

          • What to know- it provides really tight control; still has to be managed very carefully.

Health Promotion and Education

  • Insulin Therapy Management

    • Honeymoon phase

      • BIGGEST RISK is HYPOGLYCEMIA

        • Most pt with type 1 diabetes have a period of time after they're diagnosed when their remaining beta cells can pump out enough insulin to control their blood sugar. This is the honeymoon phase. While it lasts, you may not need to take as much insulin.

    • What to do when they are sick

      • insulin needs- bg goes up when sick, check at least every 3 hours when sick. Notify doc if over 250.

      • checking urine ketones

        • not routinely used except to test every void during illness & whenever glucose is >/= 250 mg/dL when illness not present

    • S/S & tx of HYPO & HYPER glycemia

      • HYPOglycemia s/s:

        • Cold & Clammy

        • Tachycardia

        • Shaky

        • Irritable

        • Sweaty

      • HYPERglycemia s/s:

        • Blurred vision

        • Irritable

        • DKA- Kussumal breathing- trying to get rid of CO2

    • Rules for exercise- check bg before exercise & bring a snack incase bg drops

  • Routine Management:

    • Endo visits q 3 months

    • Upload technology

    • Target A1C age dependent

  • Think Developmentally…

    • Infants, toddlers, preschoolers, school-age, adolescents

Communicable Diseases and Vaccinations

  • Herd Immunity (aka Community Immunity)

    • Need to understand what it means to have a low R factor vs high R0 factor & its relation to the percentage of herd community

    • R0 factor is how many people one person can infect

    • High herd community-meaning most of community is vaccinated

    • The higher the R0 factor and the lower the herd community, the more risk there is for infection & spread of disease

  • Vaccine Information

    • Common Contraindications:

      • anaphylactic reaction to eggs, gelatin, neomycin

    • Things needed to know:

      • NO live vaccines for immunocompromised & pregnancy

      • Live Vaccines: MMR, Varicella, Rotavirus & Live Attenuated Influenza

      • Mumps: need to booster at 4 y.o

      • Dtap: given between 2 months & 4 years

      • Tdap: given at age 11

  • Vaccine Info for Caregivers

    • Most vaccines will cause pain & redness at site

    • Varicella vaccine- can develop the vesicles 5-26 days after injection

    • Non-threatening systematic reaction: generalized urticaria (hives)

    • MMR: common to have fever & non-contagious rash 6-12 days after injection

    • We give immunizations for low-grade fever & mild illness

    • Anaphylaxis, hypotension, angioedema- GIVE EPI

  • Addressing Common Concerns:

    • CDC

    • Reflect on own feelings

    • Be curious but non-judgemental

  • Recommendations to help increase likelihood, vaccines are given (and on time)

    • Alert in chart that kid is due for vaccine

    • Give vax when kid has a minor illness (on abx or has low grade fever)

    • Use combination vaccines

    • Give multiple vaccines at same time in separate sites

    • Give medically stable low birth weight infants all vaccines appropriate for chronological age as full-term infants

    • Give vaccines even when a prior dose caused reaction in a family member

    • Directly & compassionately acknowledge parents concerns & educate on importance of vaccine administration

Administration Guidelines

  • Sub Q:

    • use anterolateral thigh in infants < 12 months

    • use outer aspect of upper arm in child

  • IM:

    • Give in vastus lateralis or ventrogluteal muscle & very young children (not walking)

    • Give in deltoid to older child

  • Documentation:

    • Must document: date, route, site of administration

    • Need to include: type, manu & lot #

    • Evidence of informed consent

Subcutaneous

Intramuscular

Fever

  • Pathophysiology review

  • A low-grade fever can be a good thing!

  • Cultural considerations

Measles

  • Highly contagious viral infection. 1 person infects 18 people (high R0 factor)

  • Airborne Precautions

  • Manifestations: mild fever, 3 C’s: conjunctivitis, coryza, cough, Koplik spots & maculopapular rash

  • Supportive treatment: fluids, pain meds, supplemental oxygen if needed, & droplet precautions

  • Complications: pneumonia, encephalopathy & seizures

Mumps

  • Droplet precautions

  • Vaccinations have decreased incidence rates: best way to prevent, need booster at 4 years

  • Manifestations: Parotid swelling, fever, aches

  • Supportive management with pain meds & fluids

  • Monitor for meningitis and/or orchitis (inflammation of testicle/s) (complications associated with the infection)

Mononucleosis

  • Caused by Epstein Bar Virus

  • Symptoms: sore throat, fatigue & splenomegaly

  • Spleen can rupture- no contact sports or rough play for at least 1 month

Streptococcus: Group A Strep

  • Sore throat that comes on quickly & is especially painful when swallowing

  • Red & enlarged tonsils with white patches or streaks on them

  • Painful or swollen lymph nodes

  • Treatment

    • Abx- Amoxicillin or Penicillin

  • Teaching:

    • Throw out toothbrush after 48 hours

    • If no fever, may return to school 24 hrs after 1st abx