NUR2010 - Exam 3- Cardiac,
Endocrine, Hematologic, & Cancer
Study Guide
Patho of HYPOpituitarismAnswer - 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 HypopituitarismAnswer dwarfism, developmental delay, various
visual and neurological symptoms, seizure disorder, congenital malformations, delayed
sexual maturation (amenorrhea, micropenis, undescended testicles), hypoglycemia,
diabetes
Diagnostics for hypopituitarismAnswer 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 hypopituitarismAnswer 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 hypothyroidismAnswer - 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 pubertyAnswer 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 pubertyAnswer Sexual development before 9 in boys (typically 11-14)
or before 8 in girls (usually 10-12)
Treatment/management of precocious pubertyAnswer 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 hypothyroidismAnswer 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 PedsAnswer 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 hypothyroidismAnswer 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 hyperplasiaAnswer 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 hyperplasiaAnswer - 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 hyperplasiaAnswer - 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 hyperplasiaAnswer 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 hyperplasiaAnswer - 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 phenylketonuriaAnswer Deficiency of liver enzyme making the patient unable
Endocrine, Hematologic, & Cancer
Study Guide
Patho of HYPOpituitarismAnswer - 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 HypopituitarismAnswer dwarfism, developmental delay, various
visual and neurological symptoms, seizure disorder, congenital malformations, delayed
sexual maturation (amenorrhea, micropenis, undescended testicles), hypoglycemia,
diabetes
Diagnostics for hypopituitarismAnswer 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 hypopituitarismAnswer 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 hypothyroidismAnswer - 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 pubertyAnswer 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 pubertyAnswer Sexual development before 9 in boys (typically 11-14)
or before 8 in girls (usually 10-12)
Treatment/management of precocious pubertyAnswer 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 hypothyroidismAnswer 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 PedsAnswer 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 hypothyroidismAnswer 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 hyperplasiaAnswer 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 hyperplasiaAnswer - 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 hyperplasiaAnswer - 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 hyperplasiaAnswer 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 hyperplasiaAnswer - 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 phenylketonuriaAnswer Deficiency of liver enzyme making the patient unable
