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Endocrine Disorders in the Pediatric Client

Endocrine Disorders in the Pediatric Client. MARLENE MEADOR , RN, MSN, CNE. Understanding the endocrine system in children. Puberty brings many changes ↑GH released ↑ production of LH and FSH in girls Development of sexual characteristics Feedback mechanism in place.

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Endocrine Disorders in the Pediatric Client

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  1. Endocrine Disorders in the Pediatric Client MARLENE MEADOR, RN, MSN, CNE

  2. Understanding the endocrine system in children • Puberty brings many changes • ↑GH released • ↑ production of LH and FSH in girls • Development of sexual characteristics • Feedback mechanism in place

  3. Collecting data during an endocrine assessment Percentiles on weight and height Distinguishing facial features, abd. fat Onset of puberty Routine NB screening Blood glucose levels Detection of chromosomal disorders

  4. Pancreatic dysfunctions Etiology Preclinical stage Manifestations Diagnosis

  5. Therapy for diabetes in children • Diagnosis: • Under 18? • Type I diabetes • Clinical therapy combines: • insulin • nutrition • exercise regimen • psychosocial support

  6. Insulin therapy

  7. Insulin review Rapid (Lispro/Humalog) Short acting (regular) Intermediate acting (NPH, Lente) Long acting (Lantus/Ultralente)

  8. Basal-bolus therapy • ADA recommendations for children • Basal insulin administered 1-2x day; bolus of rapid acting with each meal and snack • Method of this therapy: • Lower glucose levels • Stabilize glucose levels • Eliminate ketones • Insulin dose adjusted to BS readings 4x day

  9. Basal bolus, cont. BS monitored 4-8x day; 1x a week at midnight and 3AM Therapy can be achieved with 3+ insulin injections a day or by pump There must be consistent carb counts Routine exercise

  10. Factors which may affect insulin dosage in children Stress Infection Illness Growth spurts (such as puberty) Meal coverage for finicky toddlers Adolescents concerned about weight gain not wanting to eat AM snack

  11. External insulin infusion pump in children • Advantages • Delivers continuous infusion • Maintain better control •  # of injection sites • hypo/hyper episodes • More flexible lifestyle • Eat with more flexibility • Improves growth in child • Disadvantages • Requires motivation • Requires willingness to be connected to device • Change sites every 2-4 days • More time/energy to monitor BS • Syringe, cath changes every 2-3 days • Infection may occur at site • Wt gain common when BS is controlled

  12. Insulin therapy, cont. Monitored every 3 months by hemoglobin A1c Represents amt of glucose attached to hemoglb over period of time Roughly 120 days Good predictor of levels over 6-8 wks

  13. Nursing Management at the time of diagnosis • Child is admitted to hospital • Nsg assessments directed toward: • Hydration • LOC • Hourly monitoring of BS • Dietary and caloric intake • Ability of family to manage

  14. “Sick Day guidelines” Days that child is ill Attention to glycemic control BS levels more often than routine DO NOT SKIP INSULIN! Factors key to preventing DKA

  15. Home Teaching Incorporate into the family lifestyle “Honeymoon phase” Community resources Recognizing the cognitive levels at time of teaching

  16. Diabetic Ketoacidosis • Review of patho • Causes • Criteria for diagnosis of DKA • BS levels> 300 • Serum ketones • ↓ bicarbonates • Acidosis (pH <7.3)

  17. Treatment for DKA Fluids (boluses) Wean off IV insulin when clinical stable Oral feedings introduced when alert Prevention of future episodes

  18. Type II diabetes in children There is insulin resistance Fatty tissue produces hormone Hormone desensitized to insulin Can result in hyperinsulinism Signs and symptoms

  19. Acanthosisnigricans

  20. Inborn errors of metabolism • Phenylketonuria • Galactosemia • Defects in Fatty Acid Oxidation • Maple syrup urine disease

  21. Autosomal recessive Liver deficiency Treatment/education Counseling for future pregnancies Phenylketonuria (PKU)

  22. Galactosemia Carbohydrate metabolic dysfuntion Autosomal recessive Liver enzyme deficiency Implications/symptoms Treatment/management

  23. Defects in fatty acid oxidation • Defects result in fatty acid oxidation • Most common of inborn errors • Most common presentation • Diagnosis/treatment

  24. Maple syrup urine disease • (MSUD) • Disorder of amino acid metabolism • Diagnosis made by UA • Treatment/management

  25. Nursing measures for metabolic disorders • Genetic counseling • Dietary teaching.compliance • Mixing special preparations • Mainly supportive

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