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Endocrine System in Pediatrics: A Comprehensive Study Guide, Exams of Nursing

This study guide offers a detailed overview of pediatric endocrinology, covering various conditions such as growth hormone deficiency, precocious puberty, congenital and acquired hypothyroidism, and hyperthyroidism (graves' disease). it provides in-depth information on etiology, clinical manifestations, diagnostic studies, therapeutic management, and nursing considerations for each condition. the guide also includes questions and answers to reinforce learning and assess understanding of key concepts. This resource is invaluable for students in nursing and related healthcare fields.

Typology: Exams

2024/2025

Available from 04/18/2025

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NSG 502 Exam 5 Study Guide With
Correct Solutions
The Endocrine system is _____ developed at birth than any other body system - ANSWER
less
Hormonal control is poorly regulated until ___________ months of age - ANSWER 12-18
manifestations of underdeveloped endocrine system in newborns/infants - ANSWER -
poor hormone regulation
imbalances in:
- concentration of fluids
- electrolytes
- amino acids
- glucose
- trace substances
how are endocrine abnormalities detected in pediatrics? - ANSWER - Accurate
anthropometric measurement and growth plots
- Often manifest as failure-to-thrive and/or developmental delay
growth hormone deficiency - ANSWER Inadequate production or secretion of GH
causing poor growth & short stature
growth hormone deficiency incidence - ANSWER 1/3480 children in the US
growth hormone deficiency etiology - ANSWER - Hypopituitarism
- Brain tumor (pituitary gland)
- Cranial irradiation
growth hormone deficiency clinical manifestations - ANSWER - Height less than 5th
percentile
- Growth rate less than 2 SD from mean for age
- Immature face
- Delayed puberty
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NSG 502 Exam 5 Study Guide With

Correct Solutions

The Endocrine system is _____ developed at birth than any other body system - ANSWER less Hormonal control is poorly regulated until ___________ months of age - ANSWER 12- manifestations of underdeveloped endocrine system in newborns/infants - ANSWER - poor hormone regulation imbalances in:

  • concentration of fluids
  • electrolytes
  • amino acids
  • glucose
  • trace substances how are endocrine abnormalities detected in pediatrics? - ANSWER - Accurate anthropometric measurement and growth plots
  • Often manifest as failure-to-thrive and/or developmental delay growth hormone deficiency - ANSWER Inadequate production or secretion of GH causing poor growth & short stature growth hormone deficiency incidence - ANSWER 1/3480 children in the US growth hormone deficiency etiology - ANSWER - Hypopituitarism
  • Brain tumor (pituitary gland)
  • Cranial irradiation growth hormone deficiency clinical manifestations - ANSWER - Height less than 5th percentile
  • Growth rate less than 2 SD from mean for age
  • Immature face
  • Delayed puberty
  • Hypoglycemia
  • Diminished muscle mass
  • Deficiencies in other hormones growth hormone deficiency diagnostic studies - ANSWER - Serial growth measurements using consistent equipment
  • Bone age evaluation
  • Complete metabolic laboratory analysis
  • 2 positive GH levels that indicate deficiency growth hormone deficiency therapeutic management - ANSWER - Biosynthetic replacement GH
  • SQ injection (usually specialty pen)
  • Best administered at bedtime percocious puberty - ANSWER - Puberty before the age of 8 years in females & 9 years in males HOWEVER...
  • Workup justified in Caucasian girls under 7 and African-American girls under 6 percocious puberty incidence/etiology - ANSWER - More frequently in females
  • Most are idiopathic etiology
  • CNS lesions or trauma
  • Adrenal, ovarian, testicular tumors
  • Congenital adrenal hyperplasia (CAH)
  • Partial effects seen with some medications percocious puberty clinical manifestations - ANSWER - Demonstration of secondary sexual characteristics before the ages of 7 or 8 depending on gender (also consider race)
  • Rapid bone growth
  • Early growth plate fusion
  • Short stature
  • Psychological effects percocious puberty therapeutic management - ANSWER Administration of GnRH
  • Detailed medication education
  • Dose titrated to maintain TSH in normal range & T4 in the upper half of the normal range infant hypothyroidism nursing considerations - ANSWER - Close follow-up to adjust for growth
  • Developmental screening
  • Parental education/support Acquired Hypothyroidism (children, commonly adolescents; also adults) pathophysiology - ANSWER - Circulating autoantibodies bind at pituitary TSH receptor sites resulting in decreased thyroid hormone production
  • Hashimoto's thyroiditis a common cause Acquired Hypothyroidism considerations - ANSWER - In contrast to congenital hypothyroidism, acquired hypothyroidism after 2 to 3 years of age is often reversible
  • Hypothyroid more common in women than men Acquired Hypothyroidism manifestations - ANSWER - Goiter
  • Dry, thick skin
  • Coarse, dull hair
  • Fatigue
  • Cold intolerance
  • Constipation
  • Weight gain
  • Edema of face, eyes, & hands
  • Delayed or irregular menses; infertility
  • Confusion, lethargy, depression (older adults) hypothyroidism diagnostic studies - ANSWER Primary hypothyroidism
  • Elevated TSH & low T

Thyroiditis

  • Circulating antibodies
  • Elevated TSH & normal T4 that decreases over time

Secondary or tertiary hypothyroidism (pituitary=TSH & hypothalamus=TRH)

  • TSH not elevated & low T
  • TRH stimulation test required for diagnosis

hypothyroidism therapeutic management - ANSWER Thyroid hormone replacement -Levothyroxine -May require frequent lab tests and dose adjustments

Monitor growth & development

hypothyroidism nursing considerations - ANSWER - Constipation

  • Activity intolerance
  • Cardiac output

hyperthyroidism/graves disease incidence - ANSWER - 1/

  • Females 5Xs more likely to be affected
  • Pediatric peak age for acquiring: 11 to 15 years old
  • Highest frequency: 20 to 40 years old

hyperthyroidism/graves disease etiology - ANSWER - Circulating antibodies thyroid-stimulating immunoglobulins (TSIs) bind to pituitary TSH receptor sites resulting in excessive T3 & T4 production

hyperthyroidism/graves disease neonate manifestations - ANSWER - Irritability

  • Tachycardia
  • HTN
  • Increased thyroid uptake of radioactive iodine

antithyroid drug therapy - ANSWER - Propylthiouracil (PTU) or Methimazole

  • MOA: Blocking thyroid hormone production by the thyroid gland
  • PTU administered three times daily & lowers thyroid hormones in several weeks
  • beta blockers for side effects
  • Success rate of 20 to 40%

antithyroid drug therapy side effects - ANSWER - Arthralgia

  • skin rash
  • pruritus
  • gastric intolerance
  • leukopenia
  • hepatotoxicity
  • hypothyroidism

antithyroid drug therapy nursing considerations - ANSWER Activity restriction despite high energy -Children may be limited to school work only -Large muscle group exercise

Emotional lability -Stress and interpersonal interactions

Nutrition -High metabolic needs -Small, frequent, high-calorie, high-protein meals

Side effects of antithyroid drugs -Agranulocytosis (severe leukopenia)

  • Fever and sore throat

radioactive iodine - ANSWER - treats hyperthyroidism by destroying the thyroid gland

  • Given as an oral solution
  • Thyroid tissue destroyed in 6 to 8 weeks

radioactive iodine nursing considerations - ANSWER - treat Dryness and irritation mouth and throat with Salt and soda gargle

  • Teach precautions to minimize radiation exposure to others

thyroidectomy - ANSWER - surgical removal of the thyroid gland to treat hyperthyroidism

  • Iodine administered 10 to 14 days before surgery to decrease vascularity
  • may be partial or total

thyroidectomy nursing considerations - ANSWER - Address fear of "having neck cut" and scarring

  • Usually a period of relative hypothyroidism post-op
  • Will have decreased caloric needs
  • Balanced iodide levels
  • Total thyroidectomy requires lifelong thyroid replacement
  • Risk of parathyroid damage--hypocalcemia Signs/symptoms? -Post-op: positioning (avoid neck flexion), bleeding, risk of airway obstruction, monitor calcium levels
  1. The nurse reviews the laboratory results of a patient with primary hypothyroidism.

T2D age of onset - ANSWER - More common in adults but can occur at any age.

  • Incidence is increasing in children.

T2D type of onset - ANSWER Insidious, may go undiagnosed for years.

T2D primary defect - ANSWER - Insulin resistance

  • decreased insulin production over time

Endogenous insulin production in patients with T2D - ANSWER - Initially increased in response to insulin resistance.

  • Secretion diminishes over time

T2D nutritional status - ANSWER - Frequently obese/overweight

T2D symptoms - ANSWER - Frequently none

  • Fatigue
  • recurrent infections
  • May also experience polyuria, polydipsia, and polyphagia

how is pre-diabetes characterized? - ANSWER - Impaired fasting glucose (IFG)

  • Impaired glucose tolerance (IGT)
  • typically asymptomatic
  • long term damage to kidneys, heart, and vasculature is already occuring

what to monitor for with pre-diabetes - ANSWER - Polyuria

  • Polyphagia
  • Polydipsia

A1C ranges - ANSWER - normal below 5.7% -pre-diabetes 5.7 - 6.4%

  • diabetes > 6.5%

T2D diagnosis - ANSWER 1. Hemoglobin A1c (HbA1c) ≥ 6.5% (>140 mg/dL)

  1. Fasting glucose level >126 mg/dL
  2. Random glucose measurement ≥200 mg/dL with symptoms
  3. Two-hour oral glucose tolerance test (OGTT) level ≥200 mg/dL when a glucose load of 75g is used

diabetes collaborative care goals - ANSWER - Active participant in the management of the diabetes regimen

  • Informed decision making (empowerment approach)
  • Experience few or no episodes of acute hyperglycemic or hypoglycemic emergencies
  • Maintain blood glucose levels between 70-100 mg/dL
  • Prevent, minimize, or delay complications
  • Adjust lifestyle to accommodate diabetes regimen with minimum stress

know the different types of insulins. onset, duration, etc - ANSWER too lazy to put all this in so hopefully you remember from farm!

"basal bolus" insulin schedule - ANSWER - bolus rapid acting at meal time

  • basal long acting once daily (evening/bed time)

Correction factor: - ANSWER insulin dose needed to correct current blood sugar to normal

diabetes care nursing considerations - ANSWER - Is patient or caregiver physically able to prepare and administer accurate doses of the medication?

  • What emotions and attitudes are patient and caregiver displaying in regard to diagnosis of diabetes and insulin or oral agent treatment?
  • Clarification of diabetes medications for NPO status
  • Hold metformin day of and for 48 hours post surgery/ radiologic procedures requiring contrast medium
  • Resume metformin after serum creatinine is within normal limits

"sick day rules" for patients with diabetes - ANSWER - Call primary care provider (PCP)

  • Blood glucose every 4 hours
  • Urine for ketones when blood glucose is >240 mg/dl (for Type 1)
  • Take insulin/oral antidiabetic agents
  • Drink 8-12 oz sugar free liquids every hour awake
  • Eat regular meals (if possible)
  • Call PCP for mod/large ketones, N/V, uncontrolled blood glucose (>300 for two readings), high fever

weight management is important for which type of diabetes? - ANSWER 2

considerations for carb counting in patients with diabetes - ANSWER - important for calculating insulin dose in T1D

  • important for BG control in T2D
  • Involve dietician and certified diabetes educator
  • one serving of carbs = 15g
  • 45-60 g per meal
  • 130g per day

exercise therapy requirements for patients with diabetes - ANSWER 150 minutes/week

of a moderate-intensity aerobic physical activity and (for Type 2) resistance training 3 times/week in the absence of contraindications

how does exercise benefit patients with T2D? - ANSWER - ↑ insulin receptor sites (less insulin needed in the long term)

  • Lowers blood glucose levels
  • Contributes to weight loss

hypoglycemia prevention during exercise for patients with T2D - ANSWER - Monitor blood glucose levels before, during, and after exercise

  • Small carbohydrate snacks every 30 minutes
  • Exercise after meals
  • especially important for patients on insulin

when/how should exercise plans be started for t2d? - ANSWER - After medical clearance

  • Slowly with gradual progression
  • Should be individualized

diabetes health promotion - ANSWER - Identify & screen at risk individuals

  • Screen all adults over 45
  • Weight management/physical activity

hospitalization/surgery considerations for diabetes - ANSWER - Risk for delayed surgical recovery

  • Stress and illness impact glycemic control (per hospital protocol usually target blood glucose less than 180mg/dL)

hyperglycemia s/s - ANSWER - dry mouth

  • extreme thirst
  • Skin dry and loose; eyes soft and sunken
  • Abdominal pain, anorexia, nausea/vomiting
  • Kussmaul respirations
  • Sweet, fruity breath odor (acetone)
  • Blood glucose level ≥ 250 mg/dL
  • Blood pH lower than 7.30 (HCO3 < 16 mEq/L)
  • Moderate to high ketone levels in urine or serum

DKA interprofessional care - ANSWER - Ensure patent airway and O2 PRN

  • IV access for fluids (NS) and to correct electrolyte imbalance (especially K+)
  • Protect from cerebral edema; monitor for fluid overload, renal or cardiac compromise
  • IV insulin drip and reduce glucose by 30- mg/dL per hour

Hyperosmolar Hyperglycemic Syndrome (HHS) - ANSWER - acute complication of T2D

  • extreme hyperglycemia causes profound dehydration and electrolyte imbalances
  • insulin is usually present in patients with T2D so ketoacidosis does not occur

HHS s/s - ANSWER - glucose levels > 600 mg/dL

  • Somnolence
  • Coma
  • Seizures
  • Hemiparesis
  • Aphasia

HHS interprofessional care - ANSWER - Medical emergency; high mortality rate

  • Ensure patent airway and O2 PRN
  • IV access for fluids and to correct electrolyte imbalance (especially K+)
  • More fluid replacement needed (more profoundly dehydrated)
  • Correct cause

common causes of hypoglycemia - ANSWER - Insulin/oral agent was administered and food was late/missed

  • Overestimation of insulin needs (carb count incorrect)
  • Unplanned increase in activity

mild hypoglycemia treatment - ANSWER - BG 40-

  • Treat with 10-15g of carb
  • recheck BG in 15 minutes

moderate hypoglycemia treatment - ANSWER - BG < 40

  • Treat with 15-30g of carb
  • recheck BG in 15 minutes

moderate hypoglycemia s/s - ANSWER - Deprives brain cells of fuel & impairs CNS

  • Cold, clammy skin
  • pale
  • rapid pulse
  • rapid shallow respirations
  • marked change in mood

how to give glucose to NPO/unconscious patient - ANSWER - IV D50 (20-50 mL)

  • IM glucagon
  • Capsaicin cream (Axsain, Zostrix)

nephropathy r/t diabetes - ANSWER - damage to small vessels in glomeruli

  • Leading cause of end-stage renal disease
  • Prevention - proper diabetes management
  • Annual urinalysis for microalbuminiria
  • Serum creatinine to estimate GFR & stage CKD
  • Blood pressure management
  • Prompt treatment of UTIs
  • Avoidance of nephrotoxic drug

retinopathy r/t diabetes - ANSWER - Leading cause of blindness

  • Prevention - proper diabetes management
  • Not reversible
  • Maintenance of remaining vision

infection r/t diabetes - ANSWER - Elevated glucose is a risk for infection

  • Impaired mobilization of inflammatory cells and impaired phagocytosis by neutrophils and monocytes
  • Loss of sensation may delay detection or provide a skin opening to become infected
  • Treatment must be prompt and vigorous including glucose management (<180mg/dL)

gerontological considerations for diabetes - ANSWER - Prevalence of type 2 increases with age

  • Delayed psychomotor function could interfere with treatment
  • Must consider patient's own desire for treatment and coexisting medical problems
  • Recognize limitations in physical activity, manual dexterity, and visual acuity
  • Education based on individual's needs, using slower pace if needed

pediatric considerations for diabetes - ANSWER - Recognition of hypoglycemia

  • Math skills for carb counting and insulin dosing
  • Impact on parents and family
  • Childcare
  • Disease management at school
  • Unpredictable with eating/activity (sports)
  • Developmentally appropriate education
  • Psychological effects of life-long management of chronic illness

considerations for pediatric A1C goals - ANSWER - generally younger children are okay with higher A1C and BG levels

  • approach adult standard with age
  1. The nurse is assessing a patient newly diagnosed with type 1 diabetes. Which symptom reported by the patient correlates with the diagnosis?

a. Excessive thirst b. Gradual weight gain c. Overwhelming fatigue d. Recurrent blurred vision - ANSWER a

  1. When distinguishing between persons with type 1 diabetes from type 2 diabetes, the nurse is aware that

a. persons with type 1 diabetes require insulin therapy. b. autoantibodies to pancreatic β-cells are found in type 2 diabetes. c. persons with type 1 diabetes may be managed with metformin alone.