NUR 414 Exam Updated 2023 Marking Scheme

NUR 414 Exam Updated 2023 Marking Scheme What does the endocrine system control? - ANSWER- the endocrine system controls and regulates metabolism, energy production, growth, fluid and electrolyte balance, response to stress, and sexual reproduction What does the endocrine control in kiddos? - ANSWER- The development of reproductive organs What is negative feedback? - ANSWER- A response to a change in the body that counteracts or opposes the initial change. What is the pituitary gland? - ANSWER- The master gland, it is attached to the hypothalamus by a stalk called the infundibulum. It has two major portions: the anterior lobe (adenohypophysis) and the posterior lobe (neurohypophysis). What does the anterior pituitary secrete? - ANSWER- Growth hormone, thyroid-stimulating hormone or thyrotropin (ACTH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL) What does the posterior pituitary secrete? - ANSWER- ADH and oxytocin During the history and assessment of children what information is important to gather in order to catch a endocrine/pituitary malfunction? - ANSWER- Review of systems Genetics Family History Prenatal care Growth proportioate appearance Genitalia Facial, axillary, body hair Skin Thyroid Dysmorphic features Muscle Tone Overall appearance What can cause pituitary hypofunction - ANSWER- idiopathic developmental defects trauma autoimmune What complications are associated with pituitary hypofunction - ANSWER- Gonadotropin deficiency: absence or regression of secondary sexual characteristics GH defiency: stunted growth TSH deficiency: hypothyroidism Corticotropin deficiency: adrenal hypofunction What constitutes short stature? - ANSWER- variation of normal, genetic (short parents), likely normal growth trends, and proportionate features/growth What constitutes growth hormone deficiency? - ANSWER- Normal growth in the first year then slowed growth and curve below the 3rd percentile, emotional problems not uncommon, delayed bone age, delayed puberty Growth Hormone Deficiency: Treatment Nursing Care - ANSWER- Treatment: - hormone replacement therapy: Recombinant GH- weekly SQ injections - treatment of any underlying lesion (if deficiency caused by pituitary tumor) Nursing care: - monitor growth velocity - teach how to give SQ injections - give medication at night What can cause pituitary hyperfunction and what are some compliations of this? - ANSWER- Causes: tumor or lesion Complications: excess GH- overgrowth of long and transverse bones - acromegaly What is acromegaly? - ANSWER- abnormal growth of the hands, feet, and face, caused by overproduction of growth hormone by the pituitary gland. precocious puberty - ANSWER- premature onset of puberty with the appearance of secondary sex characteristics in young children - evaluated by endocrinology specialist diagnosed? MRI of the brain Treatment: - monitor growth carefully if no organic cause - monthly injections of LH-releasing horome analog or long acting injection that can last up to 3 month (prevents the secretion of LSH until they reach normal age) Hypopituitarism - ANSWER- growth hormone deficiency - Diminished or deficient secretion of pituitary hormones with delayed bone age and weight to height ratio disparities *delay in sexual maturity* Diagnosis: endocrine tests, skeletal surveys, GH *blood tested between 6-8 am* Treatment: growth hormone replacement Nursing: Identify- headache (tumor) Support for regime hyperpituitarism - ANSWER- Gigantism: excess GH *before* closure of epiphyseal shafts, individuals can grow to 8 feet tall Acromegaly: excess GH *after* epiphyseal closure- transverse growth head and facial features spread out, increased facial hair, deep creases in face, hyperglycemia or diabetes mellitus Diagnosis: History, GH levels, x-rays make sure growth plates are closed, endocrine tests Treatment: lesion= repair with surgery, irradiation Nursing: identification, history of headaches, precocity How can we care for patients with precocious puberty? - ANSWER- Support and guidance! Really difficult to have a 6-8 yr old who started her period; no one else in her class has this, it can be scary, uncomfortable diabetes insipidus - ANSWER- Under sectretion of ADH from posteriour pituitary- resulting in uncontrolled diuresis! - kidneys cannot conserve water when filtrating - polyuria, polydipsia, bed wetting - diagnosed through UA; urine is very dilute, withhold fluids and if they continue to void - treatment includes vasopressin tannate, strict I&Os, treat cause and medic alert - first signs *bed wetting* - try not to embarass them, remind them to set alarms to get up and make it to the bathroom at night or to change the sheets SIADH - ANSWER- Excess ADH and hypothalmic dysfunctions- kidneys are reabsorbing fluids and putting the fluids into central circulation - s/s fluid retention, hypotonicity, urine osmolality is elevated, NA is low(*water retention decreases sodium levels*), anorexia, irritation, personality changes due to increased pressure, seizures, and abd pain treatment: fluid restriction, diuretics, declomyazin to help with hyponatremia