Endocrine - Outline

1. Endocrine Disorders

Pituitary Function Disorder

• The pituitary is the “master gland” with two parts:

  • Anterior: GH deficiency, Cushing’s, acromegaly, precocious puberty.

  • Posterior: SIADH, Diabetes Insipidus.

Hypopituitarism (GH Deficiency)

• Problem with GH production; mainly hypothalamus dysfunction.

• Symptoms: Short stature (proportional), delayed bone age/teeth, crowded/misaligned teeth.

• Treatment: GH injections (usually at night); other hormones (PRN: thyroid, cortisol, testosterone, estrogen).

• Nursing: Family support, education, body image support, injections are expensive.

Hyperpituitarism (GH Excess) – Gigantism

• Too much GH before growth plate closure → tall stature (8+ ft), muscle growth, delayed fontanelle closure.

• Treatment: Tumor removal, radiation, hormone replacement.

• Nursing: Monitor emotional well-being, early treatment, body image, cardiac risks.

Precocious Puberty

• Early sexual development (< age 8 in girls, < age 9 in boys).

• Causes: Early activation of gonads/adrenal glands/pituitary axis.

• Treatment: Lupron (slows puberty, discontinued at normal age).

• Nursing: Treat child’s actual age (emotional, physical), support and educate family.

2. Thyroid & Adrenal Disorders

Juvenile Hypothyroidism

• Most common cause: congenital (underdeveloped thyroid).

• Symptoms: Growth delay, constipation, cold intolerance, coarse skin, sparse hair, brain delay.

• Treatment: Thyroid hormone replacement (daily on empty stomach); may take weeks/months to normalize.

• Nursing: Emphasize medication compliance for brain growth.

Pheochromocytoma

• Tumor of adrenal medulla → releases excess catecholamines (epinephrine, norepinephrine).

• Symptoms: Hypertension, headache, sweating, palpitations.

• Do not palpate abdomen!

• Diagnosis: CT/MRI, 24-hour urine (metanephrines).

• Treatment: Surgery, steroid therapy post-adrenalectomy.

• Nursing: Monitor BP, reduce stress.

3. Diabetes Mellitus (DM)

Type 1 Diabetes (DM1)

• Autoimmune destruction of beta cells → no insulin.

• Symptoms: Polyuria, polydipsia, polyphagia, bedwetting, fatigue, weight loss, slow healing.

• Treatment: Insulin therapy (injections or pump).

• Nursing: Monitor for illness/stress → ↑ insulin needs. Educate on exercise, 3 meals + 2 snacks, body image issues (teens), avoid sorbitol.

Insulin Therapy

• Types: rapid, regular, intermediate (NPH), long-acting.

• Regular insulin: 30 mins before meals.

• Pumps: require strict compliance.

Type 2 Diabetes (DM2)

• Insulin resistance; common in overweight kids.

• Treatment: Diet changes, oral hypoglycemics.

Monitoring Glucose

• A1C: Avg glucose over 2–3 months (goal < 7%).

• Target BGL: 70–120 (normal), 80–180 (DM goal).

• Ketones: Test if sick or glucose >240.

4. Hypoglycemia & Hyperglycemia

Mild Hypoglycemia (<60 mg/dL)

• Symptoms: Hunger, shakiness, sweating, nervousness.

• Treatment: Juice + starch (e.g., crackers), recheck sugar.

Severe Hypoglycemia

• Symptoms: Seizures, unconsciousness, coma.

• Treatment: Glucagon IM or 50% glucose IV.

• Risk: Permanent brain damage.

Hyperglycemia

• Symptoms: Polydipsia, polyuria, polyphagia, fatigue.

• Treatment: Increase insulin, fluids, activity.

5. Diabetic Ketoacidosis (DKA)

• Life-threatening insulin deficiency → fat breakdown → acidosis.

• Symptoms: Vomiting, acetone breath, Kussmaul respirations, dehydration, LOC changes.

• Labs: pH < 7.35, BGL > 300, HCO3 < 15, ketonuria.

• Treatment: Fluids, IV insulin, electrolyte replacement.

6. Dehydration (GI Dysfunction)

Degrees

• Mild (5-6%): Dry mouth, slight ↓ output.

• Moderate (7-9%): Sunken eyes, poor cap refill, ↑ pulse.

• Severe (≥10%): No tears, lethargy, hypotension → needs IV fluids.

Therapy

• Mild/Moderate: Oral rehydration (Pedialyte).

• Severe: IV fluids (bolus 20 ml/kg).

ursing Care

• Strict I&Os, assess weight, skin turgor, cap refill, mucous membranes.

7. Diarrhea

• Types:

  • Acute (viral/bacterial)

  • Chronic (malabsorption)

  • Intractable diarrhea of infancy

• Dx: Stool tests, CBC, electrolytes.

• Management: Oral rehydration, breast milk, avoid sugary drinks (e.g., soda).

• Prevention: Hygiene, clean food/water.

8. Vomiting & Constipation

• Vomiting: Caused by infection, obstruction.

  • Treat with oral fluids, Zofran if needed.

• Constipation: Common in kids; treat with fiber, fluids, stool softeners.

• Encopresis: Involuntary soiling.

9. Hirschsprung Disease

• Missing ganglion cells → no bowel movement.

• Symptoms: Constipation, vomiting, abdominal distention.

• Treatment: Surgery, possibly ostomy.

• Nursing: Monitor post-op bowel function, teach ostomy care.

10. GERD & GI Abnormalities

GERD

• Delayed gastric emptying → reflux.

• Symptoms: Spitting up, poor weight gain.

• Treatment: Sit up, small feeds, thicken feeds, surgery (Nissen if severe).

Biliary Atresia

• Blocked bile ducts → liver damage.

• Signs: Jaundice, pale stools, dark urine.

• Treatment: Kasai procedure, may need liver transplant.

11. Cleft Lip/Palate

• Lip/palate fails to close.

• Tx: Surgery at 12–18 months.

• Nursing: Protect sutures, upright feeding, no suctioning, support family.

12. Hernias, GI Obstructions

Omphalocele/Gastroschisis

• Abdominal wall defects.

• Care: Cover with sterile saline dressings, surgery needed.

Hypertrophic Pyloric Stenosis

• Muscle thickening → vomiting (projectile), FTT.

• Signs: Olive-shaped mass, visible waves.

• Tx: Pyloromyotomy.

Intussusception

• Telescoping bowel → obstruction.

• Signs: Sausage-shaped mass, red jelly stools.

• Tx: Air/contrast enema or surgery.

13. Genitourinary Disorders (GU)

UTIs

• Cause: E. coli.

• Symptoms: Fever, dysuria, foul-smelling urine.

• Dx: Urine culture (clean catch).

• Treatment: ABX (sulfa), push fluids, hygiene education.

Pyelonephritis

• Kidney infection; needs IV ABX.

• Dx: Renal US, VCUG.

Glomerulonephritis

• Follows strep infection.

• Symptoms: Hematuria, edema, HTN, ↓ UOP.

• Tx: ABX, antihypertensives, low salt/protein diet.

Nephrotic Syndrome

• Leaky kidneys → massive proteinuria, edema.

• Tx: Steroids, diuretics, albumin.

Hemolytic Uremic Syndrome

• E. coli toxin → renal failure.

• Tx: Dialysis.

14. General GU Nursing Tips

• Aseptic technique during caths.

• Encourage fluids, prevent constipation.

• Good hygiene (front to back).

• Avoid irritants: caffeine, spicy foods, citrus.