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Peds Ch. 52


Hypopituitarism refers to GH deficiency and will be a dysfx where? Caused by? hypothalamus cause: dev defects, tumors, trauma, surg, hereditary disorders, anorexia nervosa, dwarfism
Diagnostic studies include? fam hx, growth patterns, hand xrays to evaluate growth potential vs ossification, endocrine tests Diffinitive dx: GH levels in blood
Tx for hypopituitarinism GH injections is tx of choice May need TH, cortisone, test or estrogen/progesterone
what is Prader-Willi Syndrome uncommon genetic disorder cause poor muscle tone, low levels of sex hormones, constant hunger, so obesity. Infants floppy(poor muscle tone). Boys undescended testicles
Late s/s that may appear wtih Prader-Willi Syndrome short stature, poor motor skills, wt gain, underdev sex organs, mild mental retardation. No cure
Nsg for hypopituitarianism help fam w/ body image, prepare child for inj and very exp, give inj at bedtime to resemble normal GH release
What is consideration of pt getting GH from cadavers that does not occur from biosynthetic GH? Creutzfeldt-Jakob Disease
What do you get with hyper pituitary fx? Giants, up to 8ft, excess long bone growth if give GH before epiphyseal shafts close
After epiphyseal closure and have excess GH, what do you get? acromegaly, overgrowth of head, lips, nose, tongue, jaw, mastoid sinuses, malocclusion of teeth, incr facial hair, thick, creased skin
Tx for hyper pituitary fx? remove tumor from sella turcica, radiation implants, hormone replacement after
What is precocious puberty? sex dev b4 9y/boys, 8y/girls. Girls w/ higher body fat at 5y more likely. Am then mex-Am, then white
two types of precocious puberty true: premature activation of hypo-pit-gonadal w/ early maturation pseudopuberty - incomplete: no early secretion of gonadotropin, overproduction of sex hormones caused by tumor
tx for precocious puberty Lupron: luteinizing hormone
What is nephrogenic DI? unresponsiveness of renal tubules to hormone, rare hereditary disorder and will not respond to DDAVP
First sign of neruogenic DI? enuresis, infants are irritable and prefer water to milk.
Does SIADH lead to edema? not necessarily bc edema is excess of water and sodium, this is retention of water. s/s: FVE (no edema), seizure from low Na tx: ADH antagonizing meds
What is most common endocrine disorder for children? s/s? tx? nsg? juvenile hypothyroidism s/s: decelerated growth, constipation, sleepiness, dry skin, sparse hair, periorbital edema tx: TH replacement, infant need immediate care for brain growth which happens by 2-3y
What are some antithyroid or iodide meds? SE of PTU? MTZ methimazole, PTU propylthiouracil SE: sore throat, fever, leukopenia, hypothyroidism
what is lymphocytic thyroiditis? Hashimoto disease or juvenile autoimmune thyroiditis. Most common cause of thyroid disease in children/teen
what are cardinal s/s of Grave's Disease? emotional liability, restlessness, poor school performance, voracious appetite w/ wt loss. Dx: elevated T3 & T4 tx: PTU, thyroidectomy, radioiodine
What is tx for thyrotoxicosis or thyroid storm? antithyroid drugs, propranolol for s/s of hyperthyroidism
what is fx of PTH? incr Ca & Phosphate release bone demineralization incr absorption of Ca and excretion os phosphate by kidneys Incr Ca absorption in GI
With Pseudohypoparathyroidism what r s/s? PTH is incr, but end organs are unresponsive to hormone s/s: short stature, round face, thick neck, stubby fingers/toes, dimpling skin over knuckles, mental retardation
s/s? tx for hypoparathyroidism s/s: muscle cramps(early), numbness, stiffness, tingling in hands/feet, +Chvostek/Trousseau's sign, laryngeal spasms tx: massive Vit. D
Early s/s of acute adrenocortical insufficiency? Shocklike state s/s? In infants? early: irritable, HA, abd pain, weak, N/V/D shock: weak, rapid pulse, decr BP, shallow resp, cold/clammy skin, cyanosis, cirulatory collapse Inf: hyperpyrexia, tachypnea, cyanosis, seizures, palpable gland
what is Waterhouse-Friderichsen Syndrome? generalized cerebrospinal meningitis with fever, nuchal rigidity, seizures, stupor, coma
tx for acute adrenocortical indufficiency Nsg? cortisol, fluids for dehydration/hypovolemia, glucose for hypoglycemia, antibiotics if inf. Nsg: monitor for hypokalemia(weak, paralysis, hyporeflexia, ileus, arrhythmias)
Addison's disease is chronic adrenocortical insufficiency and is rare in children, what are s/s? Neuro: muscle weak, mental fatigue, irritable, listless Pigment: palmar creases, dark over elbows/knees/waist GI: dehydration, anorexia, wt loss
more s/s of Addison's dis circulatory: hypotension, sm heart size, dizzy, fainting Hypoglycemic: HA, hunger, weak, tremble other: crave salt, acute abd pain, electrolyte imbalance
tx for Addison's Disease cortisol, aldosterone
s/s of Cushing's dx tests? tx? excessive hair growth, red cheeks, moon face, pendulous abd with red stiae, poor wound healing, ecchymosis dx: fasting blood glucose, serum electrolytes, 24h urine tx: surgery, GH, ADH, TH, donadotropins, steroid replacement.
Nsg for cushings If steroid cause, give early morn or every other day. if surgery, watch for shocklike state, like hypotension adn hyperpyrexia
Waht does hyperaldosteronism casue? nsg? tx? htn, K imbalances, polyuria that fails to respond to ADH tx: spironolactone nsg: s/s of hypo/hyperkalemia
what is congenital adrenogenital hyperplasia? decr enzyme activity req for cortisol production in adrenal cortex, 21-hydroxylase insufficiency so masculination of female fetus. Can't assign sex to female
tx for congenital adrenogenital hyperplasia give cortisone to suppress high ACTH, reconstructive surgery. Nsg: can be reason for ambiguous genitalia in newborns. Salt losing type, will tell parents need lifelong meds of aldosterone
What is nsg considerations for pheochromocytoma? Can mimic hyperthyroidism and DM Do not palpate mass bc release catecholamines. monitor for hyperglycemia, htn, CHF preop and shock postop
s/s hypopitutarism short stature, ht retarded more than wt, inactive,
What is ht velocity? How calculate project target ht? observe child's ht over time, 6mos of observe, father ht + mother's ht + 13/2 for boys father + mother -13/2 for girls
premature thelarche(breast dev), menarche, pubarche r s/s of incomplete precocious puberty
best test to dx DI restrict oral fluids and observe changes in urine. Watch for kids drinking from toilet bowl, flower vases, etc.
How do you make vasopressin for DI effective? resuspend in oil under warm water for 10-15m and shake vigorously b4 draw in syringe, want to see brown particles
With SIADH, what s/s are severe? disorientation, confusion, coma, seizures r/t hyponatremia
what are s/s or lymphocytic thyroiditis enlarged thyroid, hoarseness, dysphagia, possible hyperthyroidism
Created by: palmerag
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