NUR2010 - FINAL EXAM (ALL
COMPS) STUDY GUIDE
Patho of HYPOpituitarism - Answer - growth hormone deficiency due to LOW amounts of
growth hormones (patients will be small & frail)
- can be caused by congenital defect, trauma that damages pituitary gland, pituitary
tumor, or issue with hypothalamus
Signs & Symptoms of Hypopituitarism - Answer dwarfism, developmental delay, various
visual and neurological symptoms, seizure disorder, congenital malformations, delayed
sexual maturation (amenorrhea, micropenis, undescended testicles), hypoglycemia,
diabetes
Diagnostics for hypopituitarism - Answer Not something that is automatically screened
for, but will be obvious when height & weight is plotted & there is no progression
- hormone stimulation test: administer insulin, argining, glucagon and check the release
of growth hormones
- Bone density tests
- Xrays/CT scans
Treatment of hypopituitarism - Answer Biosynthetic growth hormone injection
Somatropin (Humatrope) - VERY EXPENSIVE and child will only take until they reach
optimal height (what height this is will depend on parents/pediatrician discussion)
Other hormone replacements (levothyroxine, estrogen, testosterone, progesterone,
synthroid, cortisone)
Nursing teaching for hypothyroidism - Answer - Patient not growing taller, but growing
wider - body image issues
- Teaching about growth hormone injections - 2cm from umbilicus or thighs, rotate sites,
teach infection control, teach child how to clean and eventually adminster these
injections on their own (so they can be involved in their own healthcare)
patho of precocious puberty - Answer Disorder of gonads, adrenal glands, or
hypothalamic-pituitary-gonadal axis - cause is usually unknown
2 types - central (most common, kids can reproduce & have somatic growth) &
peripheral (overproduction of gonads, increased sex organ sensitivity)
S&S of precocious puberty - Answer Sexual development before 9 in boys (typically
,11-14) or before 8 in girls (usually 10-12)
Treatment/management of precocious puberty - Answer Can treat the cause if the cause
is known
- Surgery, chemo, radiation to remove any tumors
- GnRH analog for central precocious puberty
- Girls: luteinizing hormone releasing hormone (Lupron): HOT FLASHES is a normal side
effect
- Depoprovera shot or Cycrin tables to reduce secretion of gonadrotrophins & stop
menstruation
- Stop medications when child reaches normal pubertal age
- Parents will need to have "birds and bees" conversation early with these children -
teach them about body image, periods, etc.
Patho of hypothyroidism - Answer Juvenile hypothyroid can be congenital (genetic
mutation, most common preventable cause of intellectual disability, covered in newborn
screening test) or acquired (such as from a thyroidectomy or radiation for Hodgkins)
S&S of hypothyroidism in Peds - Answer Thyroid enlargement the compromises
newborn airway, decelerated growth, periorbital edema, delayed mental
responsivenessm constipation
All other symptoms like adults - low and slow body
Babies hard to wake up, round belly from decreased peristalsis, sparse hair and dry
skin
Treatment of hypothyroidism - Answer Levothyroxine (Synthroid)
- measure & record growth at regular intervals
- Obtain thyroid tests more frequently until adolescence (every 3-4 mths, then every 6-12
as adolescents)
- Provide additional rest periods and extra measures for thermoregulation
patho of congenital adrenal hyperplasia - Answer Prolonged oversecretion of
adrenocorticopic hormone causes enlargement or hyperplasia of adrenal glands &
EXCESS ANDROGEN PRODUCTION - makes male characteristics appear too early or
inappropriately
S&S of congenital adrenal hyperplasia - Answer - Males will usually have no genital
abnormalities
- females will have ambiguous genitalia - enlarged clitoris that appears to look like a
,small phallus, fused labia that can produce a sac-like structure, internal anatomy will be
normal for females
- Can also cause hypogycemia & adult testicular tumors
- ACUTE adrenal hyperplasia crisis - like an Addisonian crisis - patient will have severe
dehydration and salt loss, require IV steroids
Diagnostics for congenital adrenal hyperplasia - Answer - Metabolic screening that
reveals 21-OH enzyme deficiency
- Random hormone level test
- Radiographs/xrays to look for advanced bone age, premature closure of epiphyseal
plates or long bones, chromosomal typing
Treatment/management of congenital adrenal hyperplasia - Answer Confirm diagnosis
and assign a sex to the baby according to their genotype (use an ultrasound to visualize
a uterus for confirmation)
Cortisone (dexamethasone, hydrocortisone) to suppress high secretion of ACTH
Reconstructive surgery
Monitor for acute adrenal crisis
Nursing considerations for congenital adrenal hyperplasia - Answer - Teach parents the
signs of acute adrenal crisis: signs of dehydration like sunken fontanels, dry
membranes)
- Help family understand disease
- Teach hormone supplementation
- Genetic counseling b/c increased chances of having another child born this way
- LEGALLY, parents can decide to choose one gender or another, decision may be
difficult depending on their preference & ethical considerations
What is a newborn metabolic screen? - Answer -tests for genetic & metabolic
abnormalities such as PKU and 60+ other conditions
-requires blood to be drawn from the foot
- Dried blood drops sent to state lab at birth and lab will follow up with any affected
individuals
Patho of phenylketonuria - Answer Deficiency of liver enzyme making the patient unable
to breakdown and process the essential amino acid phenylalanine - causes brain
damage, cardiac anomalies, intellectual disability
, Treatment/Diet considerations for PKU - Answer Too much protein can cause severe
brain damage - there is a special infant formula for babies, low-phenylalanine diet for
older children (avoid high protein and iron, these children will have a mostly vegan diet)
S&S of PKU - Answer May not have any symptoms at birth, but will be tested with
newborn screen
Once symptoms show - look for developmental delays, vomiting, irritability, eczema like
rash, mousy odor to urine, microcephaly, seizures
Exercise guidance for child w/diabetes - Answer - Add extra snack with 15-30g carbs for
every 45-60 mins of exercise
- Avoid excess exercise when insulin is peaking
Recommended HbA1c levels for children - Answer 0-6 years old <8.5%
6-12 years old <8%
13-19 years old <7.5%
Nursing education for children w/diabetes - Answer - Sick day instructions (still take
insulin even if you arent eating!)
- Understand how to count carbs per serving: a bag of chips may have 3 servings so
make sure to multiply the carbs
- May need additional insulin before recess
- Call doctor if ketone strips show ketones
- **REMEMBER: TYPE 2 Diabetes is on the rise with children also - Kids are not always
TYPE 1 like it used to be assumed
Onset/Peak/Duration of insulins - Answer - Rapid: 15mins, 30-90mins, 3-5 hours
- Short: 30-60mins, 2-4 hours, 5-8 hours
- Intermediate/NPH: 1-3 hours, 4-10 hours, 10-16 hours
- Long: 1-2 hours, no peak, 6-24 hours
Special developmental considerations with diabetes - Answer - Infants are at risk of
hypoglycemia with inconsistent feeding times and amounts (they don't always eat when
they need to and the amount they need to!), are at risk for more adverse consequences
due to the brain still being developed
- Toddlers are picky eaters - increased risk of hypoglycemia; can be hard to distinguish
temper tantrums vs. hypoglycemia
- Preschoolers are at increased risk because of increased activity, begin to allow them
COMPS) STUDY GUIDE
Patho of HYPOpituitarism - Answer - growth hormone deficiency due to LOW amounts of
growth hormones (patients will be small & frail)
- can be caused by congenital defect, trauma that damages pituitary gland, pituitary
tumor, or issue with hypothalamus
Signs & Symptoms of Hypopituitarism - Answer dwarfism, developmental delay, various
visual and neurological symptoms, seizure disorder, congenital malformations, delayed
sexual maturation (amenorrhea, micropenis, undescended testicles), hypoglycemia,
diabetes
Diagnostics for hypopituitarism - Answer Not something that is automatically screened
for, but will be obvious when height & weight is plotted & there is no progression
- hormone stimulation test: administer insulin, argining, glucagon and check the release
of growth hormones
- Bone density tests
- Xrays/CT scans
Treatment of hypopituitarism - Answer Biosynthetic growth hormone injection
Somatropin (Humatrope) - VERY EXPENSIVE and child will only take until they reach
optimal height (what height this is will depend on parents/pediatrician discussion)
Other hormone replacements (levothyroxine, estrogen, testosterone, progesterone,
synthroid, cortisone)
Nursing teaching for hypothyroidism - Answer - Patient not growing taller, but growing
wider - body image issues
- Teaching about growth hormone injections - 2cm from umbilicus or thighs, rotate sites,
teach infection control, teach child how to clean and eventually adminster these
injections on their own (so they can be involved in their own healthcare)
patho of precocious puberty - Answer Disorder of gonads, adrenal glands, or
hypothalamic-pituitary-gonadal axis - cause is usually unknown
2 types - central (most common, kids can reproduce & have somatic growth) &
peripheral (overproduction of gonads, increased sex organ sensitivity)
S&S of precocious puberty - Answer Sexual development before 9 in boys (typically
,11-14) or before 8 in girls (usually 10-12)
Treatment/management of precocious puberty - Answer Can treat the cause if the cause
is known
- Surgery, chemo, radiation to remove any tumors
- GnRH analog for central precocious puberty
- Girls: luteinizing hormone releasing hormone (Lupron): HOT FLASHES is a normal side
effect
- Depoprovera shot or Cycrin tables to reduce secretion of gonadrotrophins & stop
menstruation
- Stop medications when child reaches normal pubertal age
- Parents will need to have "birds and bees" conversation early with these children -
teach them about body image, periods, etc.
Patho of hypothyroidism - Answer Juvenile hypothyroid can be congenital (genetic
mutation, most common preventable cause of intellectual disability, covered in newborn
screening test) or acquired (such as from a thyroidectomy or radiation for Hodgkins)
S&S of hypothyroidism in Peds - Answer Thyroid enlargement the compromises
newborn airway, decelerated growth, periorbital edema, delayed mental
responsivenessm constipation
All other symptoms like adults - low and slow body
Babies hard to wake up, round belly from decreased peristalsis, sparse hair and dry
skin
Treatment of hypothyroidism - Answer Levothyroxine (Synthroid)
- measure & record growth at regular intervals
- Obtain thyroid tests more frequently until adolescence (every 3-4 mths, then every 6-12
as adolescents)
- Provide additional rest periods and extra measures for thermoregulation
patho of congenital adrenal hyperplasia - Answer Prolonged oversecretion of
adrenocorticopic hormone causes enlargement or hyperplasia of adrenal glands &
EXCESS ANDROGEN PRODUCTION - makes male characteristics appear too early or
inappropriately
S&S of congenital adrenal hyperplasia - Answer - Males will usually have no genital
abnormalities
- females will have ambiguous genitalia - enlarged clitoris that appears to look like a
,small phallus, fused labia that can produce a sac-like structure, internal anatomy will be
normal for females
- Can also cause hypogycemia & adult testicular tumors
- ACUTE adrenal hyperplasia crisis - like an Addisonian crisis - patient will have severe
dehydration and salt loss, require IV steroids
Diagnostics for congenital adrenal hyperplasia - Answer - Metabolic screening that
reveals 21-OH enzyme deficiency
- Random hormone level test
- Radiographs/xrays to look for advanced bone age, premature closure of epiphyseal
plates or long bones, chromosomal typing
Treatment/management of congenital adrenal hyperplasia - Answer Confirm diagnosis
and assign a sex to the baby according to their genotype (use an ultrasound to visualize
a uterus for confirmation)
Cortisone (dexamethasone, hydrocortisone) to suppress high secretion of ACTH
Reconstructive surgery
Monitor for acute adrenal crisis
Nursing considerations for congenital adrenal hyperplasia - Answer - Teach parents the
signs of acute adrenal crisis: signs of dehydration like sunken fontanels, dry
membranes)
- Help family understand disease
- Teach hormone supplementation
- Genetic counseling b/c increased chances of having another child born this way
- LEGALLY, parents can decide to choose one gender or another, decision may be
difficult depending on their preference & ethical considerations
What is a newborn metabolic screen? - Answer -tests for genetic & metabolic
abnormalities such as PKU and 60+ other conditions
-requires blood to be drawn from the foot
- Dried blood drops sent to state lab at birth and lab will follow up with any affected
individuals
Patho of phenylketonuria - Answer Deficiency of liver enzyme making the patient unable
to breakdown and process the essential amino acid phenylalanine - causes brain
damage, cardiac anomalies, intellectual disability
, Treatment/Diet considerations for PKU - Answer Too much protein can cause severe
brain damage - there is a special infant formula for babies, low-phenylalanine diet for
older children (avoid high protein and iron, these children will have a mostly vegan diet)
S&S of PKU - Answer May not have any symptoms at birth, but will be tested with
newborn screen
Once symptoms show - look for developmental delays, vomiting, irritability, eczema like
rash, mousy odor to urine, microcephaly, seizures
Exercise guidance for child w/diabetes - Answer - Add extra snack with 15-30g carbs for
every 45-60 mins of exercise
- Avoid excess exercise when insulin is peaking
Recommended HbA1c levels for children - Answer 0-6 years old <8.5%
6-12 years old <8%
13-19 years old <7.5%
Nursing education for children w/diabetes - Answer - Sick day instructions (still take
insulin even if you arent eating!)
- Understand how to count carbs per serving: a bag of chips may have 3 servings so
make sure to multiply the carbs
- May need additional insulin before recess
- Call doctor if ketone strips show ketones
- **REMEMBER: TYPE 2 Diabetes is on the rise with children also - Kids are not always
TYPE 1 like it used to be assumed
Onset/Peak/Duration of insulins - Answer - Rapid: 15mins, 30-90mins, 3-5 hours
- Short: 30-60mins, 2-4 hours, 5-8 hours
- Intermediate/NPH: 1-3 hours, 4-10 hours, 10-16 hours
- Long: 1-2 hours, no peak, 6-24 hours
Special developmental considerations with diabetes - Answer - Infants are at risk of
hypoglycemia with inconsistent feeding times and amounts (they don't always eat when
they need to and the amount they need to!), are at risk for more adverse consequences
due to the brain still being developed
- Toddlers are picky eaters - increased risk of hypoglycemia; can be hard to distinguish
temper tantrums vs. hypoglycemia
- Preschoolers are at increased risk because of increased activity, begin to allow them
