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Summary Pediatrics Final Exam Study Guide easy effective study (maternal newborn)
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lOMoAR cPSD| 24130754Pediatrics Final Exam Study
Guide
Maternal Newborn (Gurnick Academy)
, lOMoAR cPSD| 24130754
Pediatrics Final Exam Study Guide
Exam Topics:
Ch.28 Endocrine
Ch.23 Cardiovascular
Ch.24 Hematology
Ch.29 Musculoskeletal Ch.30
Neuromuscular
Endocrine
- Endocrine system controls and regulates metabolic processes
- Endocrine glands are distributed throughout the body
• Three components
◦ The cell that sends a chemical message using a hormone
◦ The target cells or organs that receive the message
◦ The environment through which the chemical is transported
• Hormones – chemical substance that exerts a physiologic controlling effect on other cells, the chemical
messengers, most are released by endocrine glands into the blood stream (Table 28-1 summarizes all disorders)
The Pituitary Gland
Disorders of Pituitary Function
• Responsible for regulating other glands
• Controlled by hormones secreted from the hypothalmus
• Two lobes, each with unique functions
◦ Anterior lobe
◦ Posterior lobe
• Anterior pituitary gland is the “master gland”
◦ Controlled by secretory or inhibitory hormones of the hypothalamus
◦ Loss of all anterior pituitary hormones is called Panhypopituitarism, rare, patients should wear medical
alert bracelet at all times
ANTERIOR PITUITARY
Growth Hormone (GH) Deficiency
• Inhibits somatic growth in all cells of the body
• Often caused by tumor in the pituitary or hypothalamus
• Must look at familial patterns of growth, not all children with short stature have GH deficiency
• Definitive diagnosis is based on the absence of or subnormal reserves of pituitary GH o GH stimulation study
Blood samples every 30 minutes for 3 hours
May become hypoglycemic (glucagon is often used too stimulate)
Therapeutic Management of GH Deficiency
- Biosynthetic growth hormone (injections) o GH replacement is successful in 80% of affected children
o Response varies based on age, length of treatment, frequency of doses, dosage, weight, and GH receptor
amount
- Remove tumor
- Other hormone replacements as needed o Thyroid extract
o Cortisone
o Testosterone or estrogens and progesterone
, lOMoAR cPSD| 24130754
Nursing Considerations for GH Deficiency
• Principal consideration is identifying children with growth problems
• Family support needs o Family must learn daily injections, prep and storage of med, rotation of injection sites
• Child’s body image
o Attain their eventual adult height at a slower rate than their peers
o Many may treat them younger than they are
• Preparing the child for daily injections o Given at bedtime
• Treatment is expensive
Precocious Puberty
Defined as sexual development before age 9 years in boys; before age 7 years in Caucasian girls; or before 6 years in
African American girls
• Occurs more frequently in girls
• Three types
1. Central precocious puberty (CPP) (80%)
◦ Resulting from activation by GnRH in the hypothalmus
2. Peripheral precocious puberty (PPP)
3. Incomplete precocious puberty (IPP)
Therapeutic Management of Precocious Puberty
• Treatment of specific cause if known (i.e. tumor)
• Central variety is treated with leuprolide acetate (Lupron Depot) o Slows prepubertal growth to normal rates
o Treatment is discontinued at the age at which normal pubertal changes would resume
• Psychological support for the child and family o Education on injections o Reassure parents of the benign
nature o Chronological age should guide activities, dress, responsibilities
Thyroid Regulation
Hypothalamus TRH Anterior Pituitary TSH Thyroid T3/T4
- May have a disturbance in the secretion of thyroid-stimulating hormone (TSH) from the pituitary,
thyrotropinreleasing factor(TRF) from the Hypothalamus or T3 and T4 from the thyroid itself
Thyroid Function
Thyroid secretes thyroid hormones (T3 and T4)
What does T3 and T4 do?
◦ Burns calories
◦ Regulates how fast new cells replace old cells (growth)
◦ Regulates how fast you digest food
◦ Stimulates sympathetic nervous system (alertness, responses, reflexes)
◦ Regulates body temp
◦ Regulates heart rate and blood pressure
◦ Regulates TSH
Goiter
- Hypertrophy of the thyroid gland
- Can make the thyroid produce too much or too little T3 or T4
- Congenital o Usually results from maternal ingestion of antithyroid drugs during pregnancy o Thyroid
enlargement at birth may compromise the newborn’s airway
, lOMoAR cPSD| 24130754
Have supplemental oxygen and tracheostomy set at bedside
Hyperextend neck to facilitate breathing
- Acquired
o Result of tumor, inflammatory disease, dietary deficiency of iodine (but rarely in children), or increased
secretion of pituitary TSH
Juvenile Hypothyroidism
One of the most common endocrine problems of childhood
Congenital
◦ Congenital hypoplastic thyroid gland
◦ Newborn testing is routine
Acquired
◦ Partial or complete thyroidectomy for cancer
◦ Hashimoto’s
◦ Following irradiation for cancer
◦ Tumor (hypothalamus, pituitary, or thyroid)
Rarely occurs from dietary iodine insufficiency in the United States
Lymphocytic Thyroiditis
• Also known as Hashimoto disease or chronic autoimmune thyroiditis
◦ Accounts for the largest percentage of cases of juvenile hypothyroidism
• Most common cause of thyroid disease in children and adolescents
◦ Occurs more frequently after age 6 years
• Typically have a goiter on the thyroid
Often see decreased T3 and T4 with elevated TSH (anterior pituitary continues to secret lots of TSH trying to
stimulate the thyroid)
Clinical Manifestations of Juvenile Hypothyroidism
Decelerated growth
Myxedematous skin changes
◦ Dry skin
◦ Sparse hair
◦ Periorbital edema
Constipation
Sleepiness
Mental decline
Easy weight gain
Cold intolerance
Nursing Interventions
• Monitor for myxedema coma – life threatening condition in which the body starts shutting down
o Hypothermia
o Respiratory failure o Bradycardia
o Hypoglycemia
• Monitor vital signs (HR, BP, RR,
Patients are very sensitive to opioids (be careful with pain Blood glucose)
management)
Medication
Levothyroxine (Synthroid)
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