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Endocrine Disorders Endocrine Disorders in the Pediatric Clientin the Pediatric Client
MARLENE MEADOR, RN, MSN, CNEMARLENE MEADOR, RN, MSN, CNE
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Understanding the Understanding the endocrine system in endocrine system in childrenchildren
Puberty brings many changesPuberty brings many changes ↑↑GH releasedGH released ↑ ↑ production of LH and FSH in girlsproduction of LH and FSH in girls
Development of sexual characteristicsDevelopment of sexual characteristics Feedback mechanism in placeFeedback mechanism in place
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Collecting data during an Collecting data during an endocrine assessmentendocrine assessment
Percentiles on weight and heightPercentiles on weight and height Distinguishing facial features, abd. fatDistinguishing facial features, abd. fat Onset of pubertyOnset of puberty Routine NB screeningRoutine NB screening Blood glucose levelsBlood glucose levels Detection of chromosomal disordersDetection of chromosomal disorders
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Pancreatic dysfunctionsPancreatic dysfunctions EtiologyEtiology Preclinical stagePreclinical stage ManifestationsManifestations DiagnosisDiagnosis
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Therapy for diabetes in Therapy for diabetes in childrenchildren
Diagnosis:Diagnosis: Under 18?Under 18? Type I diabetesType I diabetes
Clinical therapy combines:Clinical therapy combines: insulininsulin nutritionnutrition exercise regimenexercise regimen psychosocial supportpsychosocial support
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Insulin reviewInsulin review Rapid (Lispro/Humalog)Rapid (Lispro/Humalog) Short acting (regular)Short acting (regular) Intermediate acting (NPH, Lente)Intermediate acting (NPH, Lente) Long acting (Lantus/Ultralente)Long acting (Lantus/Ultralente)
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Basal-bolus therapyBasal-bolus therapy ADA recommendations for childrenADA recommendations for children Basal insulin administered 1-2x day; bolus of Basal insulin administered 1-2x day; bolus of
rapid acting with each meal and snackrapid acting with each meal and snack Method of this therapy:Method of this therapy:
Lower glucose levelsLower glucose levels Stabilize glucose levelsStabilize glucose levels Eliminate ketonesEliminate ketones Insulin dose adjusted to BS readings 4x dayInsulin dose adjusted to BS readings 4x day
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Basal bolus, cont.Basal bolus, cont. BS monitored 4-8x day; 1x a week at BS monitored 4-8x day; 1x a week at
midnight and 3AMmidnight and 3AM Therapy can be achieved with 3+ insulin Therapy can be achieved with 3+ insulin
injections a day or by pumpinjections a day or by pump There must be consistent carb countsThere must be consistent carb counts Routine exerciseRoutine exercise
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Factors which may affect Factors which may affect insulin dosage in childreninsulin dosage in children
StressStress InfectionInfection IllnessIllness Growth spurts (such as puberty)Growth spurts (such as puberty) Meal coverage for finicky toddlersMeal coverage for finicky toddlers Adolescents concerned about weight Adolescents concerned about weight
gain not wanting to eat AM snackgain not wanting to eat AM snack
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External insulin infusion External insulin infusion pump in childrenpump in children
AdvantagesAdvantages Delivers continuous infusionDelivers continuous infusion Maintain better controlMaintain better control # of injection sites# of injection sites hypo/hyper episodeshypo/hyper episodes More flexible lifestyleMore flexible lifestyle Eat with more flexibilityEat with more flexibility Improves growth in childImproves growth in child
DisadvantagesDisadvantages Requires motivationRequires motivation Requires willingness to be Requires willingness to be
connected to deviceconnected to device Change sites every 2-4 daysChange sites every 2-4 days More time/energy to monitor More time/energy to monitor
BSBS Syringe, cath changes every Syringe, cath changes every
2-3 days2-3 days Infection may occur at siteInfection may occur at site Wt gain common when BS is Wt gain common when BS is
controlled controlled
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Insulin therapy, cont.Insulin therapy, cont. Monitored every 3 months by hemoglobin Monitored every 3 months by hemoglobin
A1cA1c Represents amt of glucose attached to Represents amt of glucose attached to
hemoglb over period of timehemoglb over period of time Roughly 120 daysRoughly 120 days Good predictor of levels over 6-8 wksGood predictor of levels over 6-8 wks
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Nursing Management at Nursing Management at the time of diagnosisthe time of diagnosis
Child is admitted to hospitalChild is admitted to hospital Nsg assessments directed toward:Nsg assessments directed toward:
HydrationHydration LOCLOC Hourly monitoring of BSHourly monitoring of BS Dietary and caloric intakeDietary and caloric intake Ability of family to manageAbility of family to manage
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““Sick Day guidelines”Sick Day guidelines” Days that child is illDays that child is ill Attention to glycemic controlAttention to glycemic control BS levels more often than routineBS levels more often than routine DO NOT SKIP INSULIN!DO NOT SKIP INSULIN! Factors key to preventing DKAFactors key to preventing DKA
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Home TeachingHome Teaching Incorporate into the family lifestyleIncorporate into the family lifestyle ““Honeymoon phase”Honeymoon phase” Community resourcesCommunity resources Recognizing the cognitiveRecognizing the cognitive levels at time of teachinglevels at time of teaching
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Diabetic KetoacidosisDiabetic Ketoacidosis Review of pathoReview of patho CausesCauses Criteria for diagnosis of DKACriteria for diagnosis of DKA
BS levels> 300BS levels> 300 Serum ketonesSerum ketones ↓ ↓ bicarbonatesbicarbonates Acidosis (pH <7.3)Acidosis (pH <7.3)
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Treatment for DKATreatment for DKA Fluids (boluses)Fluids (boluses) Wean off IV insulin when clinical stableWean off IV insulin when clinical stable Oral feedings introduced when alertOral feedings introduced when alert Prevention of future episodesPrevention of future episodes
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Type II diabetes in Type II diabetes in childrenchildren
There is insulin resistanceThere is insulin resistance Fatty tissue produces hormoneFatty tissue produces hormone Hormone desensitized to insulinHormone desensitized to insulin Can result in hyperinsulinismCan result in hyperinsulinism Signs and symptomsSigns and symptoms
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Acanthosis nigricansAcanthosis nigricans
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Inborn errors of metabolism
Phenylketonuria Galactosemia Defects in Fatty Acid Oxidation Maple syrup urine disease
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Phenylketonuria (PKU) Autosomal recessive Liver deficiency Treatment/education Counseling for future pregnancies
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GalactosemiaGalactosemia Carbohydrate metabolic dysfuntionCarbohydrate metabolic dysfuntion Autosomal recessiveAutosomal recessive Liver enzyme deficiency Liver enzyme deficiency Implications/symptomsImplications/symptoms Treatment/managementTreatment/management
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Defects in fatty acid oxidation
Defects result in fatty acid oxidation Most common of inborn errors Most common presentation Diagnosis/treatment
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Maple syrup urine disease
(MSUD) Disorder of amino acid metabolism Diagnosis made by UA Treatment/management
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Nursing measures for metabolic disorders
Genetic counseling Dietary teaching.compliance Mixing special preparations Mainly supportive