Child with Alterations in Endocrine Function The Child with Diabetes Brittany is a 13 yr-old high school student living

g at home with her parents and younger brother. She has had Type 1 Diabetes Mellitus since age ! which has been well controlled with morning and evening in"ections o# $%& '(ntermediate )cting* and +egular 'Short )cting* (nsulin! Diet and ,-ercise Brittany has been staying up later in the evenings to study #or her end-o#-year e-ams! and is also the pitcher #or her high school so#tball team! which is playing in the semi#inals. &er heavy schedule has contributed to changes in her eating and sleeping habits. Brittany developed a cough! nasal Congestion and a low grade #ever 3. C '1//.0 1* 3 days ago! but told her parents she #elt well enough to go to school and didn2t want to miss any o# her classes or her so#tball practice. Today Brittany #elt worse! so her mother called the %$%! who told her to bring Brittany into the o##ice. )#ter her (nitial assessment in the o##ice! the %$% sent Brittany and her mother immediately to the ,D at the nearby hospital. Brittany2s assessment revealed tachypnea! tachycardia! #ruity odor to her breath and her capillary blood sugar was elevated. (n the ,D the #ollowing blood wor3 results were noted4 o Serum 5lucose 0./ mg6d7! Sodium 13/ m,867! Chloride 9 m,867 and %otassium 3.3 m,867 o )B52s - p& .19! %aC:; <= mm&g! o %a:; 9< mm Sa:; 9 > and &C:? 1/ m,867 Case Study @uestions +elated to Case Study o Discuss your impression o# Brittany2s blood wor3. o Ahat data indicates that Brittany2s lungs are trying to compensate #or her present conditionB o Ahat #actors place Brittany at ris3 #or DC) o Ahat other data would be help#ul to determine whether she has developed other complications o# her DC) or her #lu-li3e symptomsB o Brittany has now been admitted to 3A ')dolescent Dnit* E Saint )ccelerated &ospital. %lace in order o# %riority what the sta## nurse should do at the time o# admission. o 1. 0. o <. =. o 3. o F. Can any o# the initial interventions the nurse per#orms be delegated to the %atient Care )ssistant '%C)* or TechB )#ter she has received 1 G 7 /.9> $aCl (H #luids and her blood glucose level decreases to <0/ mg6d7! the MD orders adding => de-trose to her (H solution. Should you 8uestion this orderB Ahy or Ahy notB Brittany was admitted to the %ediatric Medical unit at 1<//. &er initial blood glucose level is reported to be 1./ mg6dl. The ne-t day right a#ter the change #rom night to day shi#t! the nurse #inds Brittany in the bathroom complaining o# nausea. She is also noted by the nurse to be diaphoretic. Ahat is the #irst thing the nurse should doB Ahat should the nurse do when the blood glucose is noted to 0/B

.. Ahat other medical management interventions would you e-pect to be prescribed to #acilitate Brittany2s recoveryB Ahat are the teaching priorities #or Brittany and her parents prior to dischargeB Ahat clinical mani#estations might be noted in a child << months-o#-age and an older child or adolescentB Ahat developmental issues would be di##erent #or a << month-old vs an 11 year-oldB

DISORDERS OF THYROID FUNCTION Thyroid hormone regulates BM+ Thyroid secretes two types o# hormones o Thyroid hormone! which is made up o# Thyro-ine 'T0* Triiodothyronine 'T3* o Thyrocalcitonin May have hypo- or hyperthyroidism May have disturbance in secretion o# TS& Juvenile H !oth roidis" Congenital &ypothyroidism o Classic symptoms in newborns4 7ong 5estation I 0< wee3s 7arge &ypoactive in#ant Delayed Meconium %assage 1eeding problems J poor suc3 %rolonged physiologic "aundice &ypothermia +espiratory Distress and Cyanosis Symptoms in ,arly (n#ancy o Dsually occur a#ter F wee3s o# li#e Typical 1acial #eatures4 Depressed nasal bridge! short #orehead! pu##y eyelids and enlarged tongue Coarse hair 7ethargy and sleepiness 1lat #acial e-pression Constipation )c8uired o %artial or complete thyroidectomy #or C) or thyroto-icosis o 1ollowing radiation #or &odg3in or other malignancy +arely occurs #rom dietary insu##iciency in Dnited States

Clinical #ani$estations o$ Juvenile H !oth roidis" Decelerated growth Constipation Sleepiness My-edematous s3in changes o Dry s3in

o Sparse hair o %eriorbital edema Thera!eutic #ana%e"ent :ral thyroid hormone replacement J Synthroid is drug o# choice %rompt treatment needed #or brain growth in in#ant May administer in increasing amounts over 0 to . wee3s to reach euthyroidism Compliance with medication regimen is crucial Serum levels o# T3! T0 ! TS& levels must be measured on a routine basis to ensure optimum treatment Nursin% Considerations (denti#y children with hypothyroidism )lert #or signs and symptoms Child needs 8uiet environment! rest periods &elp #amily cope with emotional lability associated with disorder Dietary re8uirements to meet the child2s increased metabolic rate MedicationsKside e##ects Sa"!le &uestions ) hospitaliLed patient with Type 1 Diabetes reports hunger and nervousness and the nurse notes that the patient is diaphoretic. The nurse understands that the patient is most li3ely e-periencing o ). )n-iety related to the hospitaliLation o B. Signs related to an in#ection o C. ) hyperglycemic reaction o D. ) hypoglycemic reaction The nurse reviews the laboratory results o# a patient2s blood glucose level. The nurse 3nows that which o# the #ollowing is a normal levelB o ). 0/ mg6d7 o B. 1// mg6d7 o C. 1./ mg6d7 o D. <</ mg6d7 ) patient is e-periencing a hypoglycemic reaction. The nurse should administer which o# the #ollowing items to best treat the reactionB o ). Aater o B. Diet Soda o C. Mil3 o D. :ne sugar coo3ie The nurse administers < units o# +egular (nsulin at / // to a patient with Type 1 Diabetes mellitus . The nurse monitors the patient #or a hypoglycemic reaction starting at appro-imately at what timeB o ). /9// o B. 1/// o C. 1<// o D. 10// Ahich o# the #ollowing is a common clinical mani#estation o# "uvenile hypothyroidismB

)*(nsomnia B* Diarrhea C* Dry s3in D* +apid growth