Transcript Endocrine Disorders in the Pediatric Client

Endocrine Disorders in
the Pediatric Client
Susan Beggs, MSN, CPN
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
Collecting data during an
endocrine assessment
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Percentiles on weight and height
Distinguishing facial features, abd. fat
Onset of puberty
Routine NB screening
Blood glucose levels
Detection of chromosomal disorders
Pancreatic dysfunctions
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Etiology
Preclinical stage
Manifestations
Diagnosis
Therapy for diabetes in
children
 Diagnosis:
 Under 18?
 Type I diabetes
 Clinical therapy combines:
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insulin
nutrition
exercise regimen
psychosocial support
Insulin therapy
Insulin review
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Rapid (Lispro/Humalog)
Short acting (regular)
Intermediate acting (NPH, Lente)
Long acting (Lantus/Ultralente)
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:
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Lower glucose levels
Stabilize glucose levels
Eliminate ketones
Insulin dose adjusted to BS readings 4x day
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
Factors which may affect
insulin dosage in children
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Stress
Infection
Illness
Growth spurts (such as puberty)
Meal coverage for finicky toddlers
Adolescents concerned about weight
gain not wanting to eat AM snack
External insulin infusion
pump in children
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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
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
Nursing Management at
the time of diagnosis
 Child is admitted to hospital
 Nsg assessments directed toward:
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Hydration
LOC
Hourly monitoring of BS
Dietary and caloric intake
Ability of family to manage
“Sick Day guidelines”
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Days that child is ill
Attention to glycemic control
BS levels more often than routine
DO NOT SKIP INSULIN!
Factors key to preventing DKA
Home Teaching
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Incorporate into the family lifestyle
“Honeymoon phase”
Community resources
Recognizing the cognitive
levels at time of teaching
Diabetic Ketoacidosis
 Review of patho
 Causes
 Criteria for diagnosis of DKA
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BS levels> 300
Serum ketones
↓ bicarbonates
Acidosis (pH <7.3)
Treatment for DKA
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Fluids (boluses)
Wean off IV insulin when clinical stable
Oral feedings introduced when alert
Prevention of future episodes
Type II diabetes in
children
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There is insulin resistance
Fatty tissue produces hormone
Hormone desensitized to insulin
Can result in hyperinsulinism
Signs and symptoms
Acanthosis nigricans
Inborn errors of
metabolism
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Phenylketonuria
Galactosemia
Defects in Fatty Acid Oxidation
Maple syrup urine disease
Phenylketonuria (PKU)
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Autosomal recessive
Liver deficiency
Treatment/education
Counseling for future pregnancies
Galactosemia
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Carbohydrate metabolic dysfuntion
Autosomal recessive
Liver enzyme deficiency
Implications/symptoms
Treatment/management
Defects in fatty acid
oxidation
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Defects result in fatty acid oxidation
Most common of inborn errors
Most common presentation
Diagnosis/treatment
Maple syrup urine disease
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(MSUD)
Disorder of amino acid metabolism
Diagnosis made by UA
Treatment/management
Nursing measures for
metabolic disorders
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Genetic counseling
Dietary teaching.compliance
Mixing special preparations
Mainly supportive