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Peds-Endo & Metabolic

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olanjones's version from 2017-02-22 23:29

DM I

Question Answer
Classic signs (3 P's)polyuria, polydipsia, polyphagia
Additional signs/symptoms DKAdry, flushed skin, fruity breath odor
Interventions-generalinsulin, dietary management, exercise
Goal HbgAIC7
Hyperglycemic >240 causes what manis?weakness, fatigue, h/a, nausea; observe for dry/flush skin and "Fruity" breath
Interventions-DKAmonitor blood glucose, rapid acting insulin, fluids to flush ketones
DKA timelinedehydration, elyte imbalance, acidosis, coma, death
Key to prevention of DKADiabetic control
Hypoglycemia <70 asessment findingssweaty, shaky, tachy, behavior changes (confusion, irritability, poor coordination)
Why should you give fast acting sugars/CHO and wait for the blood glucose to rise before giving more complex sugars?Complex sugars disrupt the absorption of the fast-acting sugars/CHO (let the fast ones work first to ↑ blood sugar!)
Examples of fast acting CHO/sugarsglucose tabs, cake icing
Seizure precautionsglucagon IM or SubQ for unconscious child
Honeymoon periodpancreas might put out last bit of insulin in a last-ditch effort; important to explain to parents that their child still has DM type I
Somogi effect ("rebound" hyperglycemia)blood glucose drops at night due to maintenance insulin, body reacts with glucogenesis, producing rebound hyperglycemia. S/S HA, Night sweats, Nightmares. To dx: Check glucose btwn 0200-0400
Dawn phenomenoncounter-reg hormones work to increase glucose levels in AM, those with DM may not have enough insulin present causing morning hyperglycemia
Lispro / Humalog Insulin
Rapid-acting
Lispro / Humalog Insulin
onset 5m, peask 30min
Lispro / Humalog Insulin
administered before meal & covers the meal you are about to eat, or your current blood sugar
NPH / Lente Insulinintermediate-acting
NPH / Lente Insulinonset 2hrs, peaks 4hrs
NPH / Lente Insulincovers meal/s or snack
Lantus long acting; basal coverage
Lantus no peak; not related to meals
Lantus Do not mix with other insulins
Recommendation for site rotation with insulin administrationrotate in 1 site, don't inject in muscle they are about to exercise in b/c it messes with absorption
Insulin absorption is best when administered where?SubQ fat in abdomen
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DM II

Question Answer
Clientsobese, overweight children who are physically inactive. Insulin resistance plus some insufficiency
Assessment findingsacanthosis nigricans (skin worn b/t folds); HTN; hyperlipidemia; sleep apnea
InterventionsInterventions: 
Exercise, weight loss, and medication;
Insulin of choiceMetformin (glucophage)
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Endocrine

Question Answer
Cushingsoverproduction of steroids; excessive circulating free cortisol (hyperfunction of adrenal gland)
Cushings assessment findingsCentripetal fat distribution, moon face, muscle wasting, think skin/Subcutaneous tissue, hyperglycemia, susceptibility to infection/poor wound heal, hypertension, hyperkalemia, osteoporosis, hypercalciuria
Cushings Interventions (depend on the cause)gradual w/d of exogenous steroids; surgical removal of tumor
Why does Cushings ↑ risk for infection?hyperglycemia causes: poor wound healing; also have ↑ BP, facial hair growth, mood disorders, osteoporosis & possible fx, acne, decreased growth
Hypothyroidismcan be congenital or juvenile
Hypothyroidism assessment findings (think ↓)Impaired growth and development, Intellectual disability w/congenital form, myxedematous skin changes (dry skin, puffiness around eyes, sparse hair), constipation, sleepiness, hypotonia, hypothermia, slow pulse, easy weight gain, mental sluggishness
Name of thyroid hormone replacement for hypothyroid txsynthroid or levothroid
Why is it important to have child start tx for hypothyroidism asap?will reduce neurologic impairment in infant
Why is supplemental Vit D needed for hypothyroidism tx?to prevent rickets resulting from rapid bone growth
Labs to monitor (hypothyroid&replacement tx)T3, T4, TSH
Precocious Pubertymanis of sexual development before age 9 in boys and age 7 in caucasian girls (before 6 in african american girls)
How should you treat/talk to a child with precocious puberty?to their chronologic age, dress them for their chronologic age as well; child will not display sexual interest, but will be fertile
50% of precocious puberty sx stop w/o tx. Otherwise, monthly injections of what hormone will be implemented?Luteinizing hormone- releasing hormone to regulate pituitary secretion or a subdermal implant of GnRH
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Genitourinary

Question Answer
Normal urine output infants5ml/kg/hour (min 1ml/kg/hour); infants don't concentrate urine until about age 2 (hence diapers)
How much does a 4 year old bladder hold?250 mls
How much does a 10 year old bladder void?10-25ml/hour (adults are 35/hour)
Best measure of renal function in a normal childcreatinine clearance; should be 0.2-2.0 ml/dl
UTI'scystitis, urethritis, pyelonephritis
What is the culprit for UTI's 80% of the time?E.coli
Etiology UTI'svesicoureteral reflux (urine goes backwards); bubble baths; poor hygiene; incomplete bladder emptying
Conditions that contribute to residual urine in bladderspina bifida or any musculoskeletal diseases
UTI assessment findings of urinehematuria, cloudy, foul smelling, ↑'s urinary pH
UTI symptoms from children, some of them have a hard time expressing itlow-grade fever, lethargy, irritability, poor feeding, enuresis, sometimes touching themselves
Interventions UTIantibiotics; force fluids 100ml/kg/day; toileting hygiene **FEMALES WIPE FRONT TO BACK
Enuresis after 5 years old, two typesPrimary-never achieved control or Secondary- new onset
How should parents handle a bed-wetting situationNever scold child, don't say it was an "accident," have them help make the bed, don't make a big deal about it.
Meds used for enuresis (only for sleep-overs, daily meds not recommended)imipramine or DDAVP ← (synthetic ADH, so you can hold your pee)
What can parents do to help prevent accidents?Take child to bathroom before bed, then before parent goes to sleep, wake up the child to use the bathroom again.
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Kidneys

Question Answer
acute glomerulonephritis follows what type of infection?autoimmune complex disorder which comes 1-2 weeks after a Group A beta hemolytic strep
acute glomerulonephritis effect on kidneysAntibody-antigen complex attacks kidney; kidney looses selective permeability; loose proteins and RBCs
Assessment to look for acute glomerulonephritishematuria, cola-colored (smoky) urine,decreased volume, increased ESR (sed), increased ASO titer, increased BP, edema, lethargy, anemia
Interventions acute glomerulonephritisantibiotics and anti-hypertensives, 
May need dialysis, 
Replace fluid & electrolytes but restricted fluid, Handle gently to avoid bruising
hypospadiasUrethral meatus opens on ventral surface (underside)
Complications of hypospadiasrecurrent UTI's; infertility
Interventions hypospadiasavoid circumcision. Surgery age 1-4, be sure to keep area clean to prevent infection until surgery
Nephrotic syndrome **KEY COMPONENT FINDINGSMASSIVE protein loss, edema, frothy urine
Nephrotic synd. assessmentProteinuria, hypoproteinemia (hypoalbuminemia), hypovolemia

Nephrotic syndrome urineDark, foamy, and frothy, high specific gravity, decrease production Microscopic hematuria

System assessment findings nephrotic syndromeDecreased serum potassium
Fatigue/lethargy, anorexia, abdominal pain
Interventions nephrotic syndromeSkin care, Nutrition, Strict I&O, 
Daily weight; 
Immune suppression
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CPT1A Deficiency

Question Answer
CPT1A deficiency (arctic variant)body lacks this enzyme which switches our body from using sugar to using stored fat
CPT1A and fastingif body cannot utilize glucose storages, can get low blood sugar fast
Is it a disease?No, a child born with the deficiency is healthy and in time, the risk of having any problems will decrease, as long as treated appropriately.
Until risks decrease, what should parents know about this?It can cause children to get very sick if they do not get breast milk, formula or other glucose filled fluids regularly.
What is the regulation now for newborns in alaska?they have to be tested for this deficiency; esp. AK natives
How long before a child (with even just mild deficiency of CPT1A) gets very sick if they don't eat?6-8 hours; important to feed children, esp. bc when they are born they are always sleeping.
How to explain disorder to parents?Normally, our bodies can burn fat for energy if we skip meals or don't have foods; these children do not have an ability to do this.
Symptoms if fever, can't keep fluids down, vomitting, diarrhea, etc. they need to see provider asap
Does it cause brain damage or learning problems?Doesn't have direct effect on brain, esp. if tx is implemented. If not and seizures occur, then that could do some damage.
What should you do with kids with this deficiency who gets sick (fever or cold) way out in the village?Get them some fluids with glucose (breast milk, formula, pedialyte). If they can't get fluids down they need to get somewhere where they can get an IV whether it's the village cliinic or hospital
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