Endocrine Disorders in Children
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| Absence of the hepatic enzyme phenylalanine hydroxylase needed to metabolize the essential amino acid phenylalanine to tyrosine. | show 🗑
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| show | throsine - missing in pt with PKU
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| If phenylanine is not metabolized, as seen in pt with PKU, it accumulates in the blood stream and causes damage to the developing ____ Mental retardation will occur if not corrected. | show 🗑
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| show | caucasian
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| show | Guthrie blood test
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| show | 4
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| show | FTT, vomiting, irritable, developmental delay, unpredictable erratic behaviros, MR, mousy or musty odor to urine in older infant
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| T/F restriciting dietary protein can maintain phenylalanine levels within the safe range 2-8mg/dl | show 🗑
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| show | 20-30mg of phenylalanine
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| T/F an infant with PKU should not be breast fed | show 🗑
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| show | low-protein breads and pasta, veggies, fruits and juices
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| Foods with the highest amount of phenylalanine include | show 🗑
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| Since aspartame is converted to phenylanine in the GI tract, pt with PKU should avoid ____ | show 🗑
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| show | True - even after brain is fully developed
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| ____ is the inability to synthesize adequate amounts of Thyroid hormone | show 🗑
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| show | thyroid digenesis (defective thyroid gland development)
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| Congenital hypothyroidism is due to ____ recessive trait | show 🗑
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| show | poor feding, lethargy, prolonged neonatal jaundice, resp difficulty and bradycardias, constipation, hoarse cry, and large fontanels
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| manifestations of congenital hypothyroidism after 6 weeks of age: | show 🗑
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| show | T4 blood levels - usually taken within first 24-48 hrs
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| T/F diagnosis of congenital hypothyroidism and PKU are mandatory in all 50 states | show 🗑
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| show | prevent progressive deterioration of the nervous system and MR
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| show | thyroid hormone - Synthetic Levothyroxine Sodium (Synthroid or Levothyroid)
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| Prognosis of congenital hypothyroidism if hormone replacement is started shortly after birth | show 🗑
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| Signs of overdosage of Synthroid or Levothyroid to treat congenital hypothyroidism include | show 🗑
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| show | fatigue, sleepiness, decreased appetite and constipation
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| Cause of growth hormone deficiency include disfunction of the ____ gland | show 🗑
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| show | panhypopituitarism - result of trauma, hypoplasia, tumor, irradiation and all hormones of the pituitary need to be replaced
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| show | short stature
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| show | two
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| show | organic - like family history, child's nutrition and past illnesses, and growth patterns
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| A diagnostic evaluation for short stature includes ____ surveys including epiphyseal maturation and bone age | show 🗑
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| What percentage of growth hormone is produced during sleep | show 🗑
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| show | no growth hormone is present or that the amount of growth hormone is not enough
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| show | 80%
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| ____ closure is definite criterion to stop therapy | show 🗑
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| show | 25-50mcg/kg
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| How much is a child expected to grow after receiving the synthetic growth hormone | show 🗑
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| ____ puberty is sexual development has been before the age of 9 in boys and 8 in girls | show 🗑
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| show | hault the progress of sexual development
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| Drug used to block the body's production of the sex hormone to treat precocious puberty | show 🗑
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| show | at a chronological appropriate time allowing pubertal changes to resume
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| T/F a child with precocious puberty should dress appropriate for their development | show 🗑
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| show | sexual, even though the child is fertile
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| show | contraception - unless sexually active
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| Congenital Adrenal Hyperplasia causes increases of what three hormones from the adrenal gland | show 🗑
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| Adrenals normally synthesize ____ from cholesterol to secrete the hormones | show 🗑
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| With congenital adrenal hyperplasia there is a lack of steriods (cortisol) and the pituitary senses this and attempts to force the adrenals to produce cortisol - but there is no cortisol being made by the fetal adrenal gland so what happens | show 🗑
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| show | ambiguous genitalia from congenital adrenal hyperplasia
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| show | females present with ambiguous genitalia at birth, both male and female present with a salt-losing adrenal crisis in the first weeks - shock, dehydration, and elevated K+ levels
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| Non-classic salt wasting of congenital adrenal hyperplasia signs include | show 🗑
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| show | girls do not have ambiguous genitalia, less severly affected infants with variable manifestations
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| show | stress
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| show | 17-ketosteroid
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| Tx for congenital adrenal hyperplasia | show 🗑
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| show | supression of ACTH by the pituitary, androgen production is decreased, and virilization is halted
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| lifelong replacement of hydrocortisone (cortisol) is neeed with increased doses during periods of ___, ____, ____, and ____ | show 🗑
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| Medications for Salt-Losers with congenital adrenal hyperplasia | show 🗑
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| show | masculization
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| show | dwarfed adults
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| show | sterile
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| surgical tx in girls for congenital adrenal hyperplasia should be done before ____ months of age | show 🗑
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| Most common endocrine disease in children peaks in incidence between 10-15 years but can occure anytime usually b4 age 20 | show 🗑
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| show | caucasians with absolute insulin deficiency
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| factors behind type 1 diabetes is ____ predisposition and ____ factors such as viral illness, toxins, & cows milk which trigger an autoimmune response | show 🗑
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| Incidence of type 2 diabetes has increased in recent years due to | show 🗑
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| type 2 diabetes is more prevelent in ____ ancestery | show 🗑
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| show | 3P's (polyuria, polydipsia, polyphasia) weight loss, ketonuria, hyperglycemia, fatigue, and irritability
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| clinical manifestations of type 2 diabetes | show 🗑
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| 90% of children with type 2 diabetes have ____ nigricans which is a velvety hyperpigmented area in skin folds | show 🗑
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| show | Metformin
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| Tx plan for children with type 2 diabetes should be addressed at | show 🗑
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| show | 126mg/dl - the perfered method of diagnosis
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| ____ - administration of glucose to determine how quickly it is cleared from the blood is one of the diagnosis used for type 1 diabetes | show 🗑
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| Goals for management of diabetes in children | show 🗑
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| Infant desired blood glucose levels | show 🗑
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| Toddler and Preschool blood glucose levels b4 meals and bedtime and A1c | show 🗑
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| School age desired blood glucose (age 6-12) B4 meals, Bed time and A1c | show 🗑
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| Adolescent and young adults desired blood glucose B4 meals, Bedtime and A1c | show 🗑
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| The younger a pt is with diabetes the higher the rates of desired blood glucose levels due to thier ____ | show 🗑
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| Shortly after insulin therapy, the pancrease kicks in one last time and releases exogenous insulin for a period of time is called | show 🗑
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| show | Beta cells destruction
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| Rapid acting insulin - onset peak and duration | show 🗑
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| Short acting insulin - onset, peak and duration | show 🗑
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| Intermediate-acting insulin - onset, peak, duration | show 🗑
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| Long-acting insulin - onset, peak and duration | show 🗑
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| Which insulin do you not mix with ohter insulins | show 🗑
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| show | subQ - BID minimum
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| Tight control of diabetes involves ____ dose injections. | show 🗑
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| T/F the insulin pump improves the A1c levels | show 🗑
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| Advantages of the insulin pump | show 🗑
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| The insulin pump allows for ____ baseline infusion with intermittent boluses as determined by user | show 🗑
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| Boluses given via insulin pump are determined by ____, ____, and ____ | show 🗑
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| show | At least 5-6X a day
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| show | subcutaneous
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| show | every 48 hours
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| show | One hour per day
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| ____ is the main food that raises blood sugar no matter its source and must be counted to determine how much insulin is needed | show 🗑
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| ____ helps establish total grams of carbohydrates to eat at meal's and snacks | show 🗑
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| One serving of starch, fruit, or milk is equal to ____ grams of carbohydrates | show 🗑
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| T/F vegetables are counted as carbs | show 🗑
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| How much fat and protein are recommended for children with type 1 diabetes | show 🗑
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| show | prohibited
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| show | 15
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| show | exercise/Physical Activity
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| show | lowers blood sugar and helps insulin ener cell
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| show | hypoglycemia
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| Do not exercise if blood glucose is greater than ____ | show 🗑
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| How long after activity can glucose drop | show 🗑
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| Alcohol increases or decreases blood glucose | show 🗑
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| show | sweating, pallor, nervous, palpitations, tremulousness, hunger, cold, clammy
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| Moderate reactions of hypoglycemia | show 🗑
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| severe reaction of hypoglycemia | show 🗑
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| show | 10-15 grams of simple carbohydrates followed by complex carbs and retest blood sugar in 15-30 minutes
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| show | Adminster glucagon, 911 to get 50% IV glucose
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| Too much stress and stressful events such as illness/surgery or emotional upsets cause hyper or hypoglycemia | show 🗑
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| show | Hyperglycemia
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| Gradual onset of hyperglycemia includes | show 🗑
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| show | warm and dry blood sugar is high, cool and clammy need more candy
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| At which stage may a child need a major readjustment of insulin dosages | show 🗑
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| Occures most frequently in adolescents due to noncompliance or changs in hromone levels | show 🗑
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| show | diabetic ketoacidosis
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| Blood sugar above 240 and pH less than 7.3 is an indication of | show 🗑
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| Manifestations of diabetic ketoacidosis | show 🗑
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| show | insulin
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| show | 8oz per hour
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| show | every 2-4 hours
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| Notify healthcare provider if type 1 diabetic ill patient has blood sugar over ____ and is vomiting | show 🗑
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| diagnosis is difficult at which growth and development stage | show 🗑
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| show | Toilet training
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| show | Mostly Toddler - preschoolers as well
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| Factors that make it difficult to treat toddlers with type 1 diabetes | show 🗑
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| During the preschool stage the child may interpret diagnosis of diaetes as ____ for real or imagined offenses | show 🗑
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| Preschool children may suffer a set back in ____ and need positive reinforcement | show 🗑
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| Preschoolers also fear injections, and have unpredictable ____ and food intake which lead to hypoglycemic episodes | show 🗑
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| show | coordination
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| show | active role in his own care with adult supervision
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| School age children have ____ issues | show 🗑
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| show | body image concerns, peer pressure, behavioral experimentation, loss of control and coping skill
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| education in diabetic management is a major responsibility of ___ | show 🗑
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| The more a family understands about diabetes the better they will be able to maintain a high degree of ____ | show 🗑
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| show | Phenylketonuria (PKU) is an inborn error of metabolism caused by a deficiency or absence of the enzyme needed to metabolize the essential amino acid phenylalanine. Phenyketones are metabolites of phenylalanine, excreted in the urine.
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| Early diagnosis of CH and PKU is essential to prevent which of the following? A. Obesity B. Diabetes C. Mental retardation D. Respiratory distress | show 🗑
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| Which of the following is characteristic of type 1 diabetes mellitus? A. Onset is usually gradual B. Ketoacidosis is infrequent C. Peak age incidence is 10-15 years D. Oral agents are available for treatment | show 🗑
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| show | Hallmarks of diabetes mellitus are polyuria, polydipsia, and polyphagia.
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| Glucocorticoids, mineralcorticoids, and sex steroids are secreted by the? A. Thyroid gland B. Adrenal cortex C. Anterior pituitary D. Parathyroid glands | show 🗑
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| show | S/S of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate & protein. Milk supplies lactose & prolonged action from the protein. The bread is a complex carbohydrate, peanut butter provides a sustained action
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| what should the nurse explain a bout exercise to a newly Dx type 1 diabetes fam? A. Exercise increases BS B. extra insulin is required during exercise C. additional snacks are needed before exercise D. excessive physical activity should be restricted. | show 🗑
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