Care of the Child with
Endocrine Problems
Elizabeth Allen RN, MSN
Learning Objectives
• Describe thyroid and growth hormone
disorders of childhood
• Explain aspects of diabetes care unique to
pediatrics
Endocrine System
• Releases Hormones
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•
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• For Proper Growth and
Maturation
– Hormones affect cellular
– Growth (metabolic process)
activity
– Thyroid (G/D metabolizing
– Cell response: quantity
nutrients and energy)
plus timing of hormone
– Adrenal (glucocorticoids and
Responsible for Fetal
androgens)
This is FYI Only
Development
– Gonadal (androgens-males &
Regulate Central Nervous
progesterone-females)
System
• For Proper Metabolic Function
Responsible for Maturation of
– Antidiuretic hormone (ADH)
Reproductive Organs
– Parathyroid
Maintain Homeostasis
– Insulin
Endocrine System Problems
• Diabetes Mellitus
– Type 1
• Juvenile Diabetes
– Autoimmune destruction of beta cells in pancreas
– Inherited susceptibility to the disease
– Caucasians more often affected
– Type 2
– Cystic Fibrosis-related Diabetes
• Pancreas scarred, doesn’t produce enough insulin
• Develop Insulin Resistance
Endocrine System Problems
• Diabetes Mellitus
• Support
• Psychosocial support
– Peers with diabetes
– Education entire family
and patient
• Teaching
– Pathophysiology of
insulin insufficiency
– Glucose monitoring
– Insulin injection
– Diet modification
– Complication
prevention and
response
Endocrine Problems
• Diabetes Mellitus
• Initial diagnosis often in DKA (diabetic
ketoacidosis)
DKA Symptoms
Elevated Blood sugar
Polydipsia
Polyuria
Headache, fatigue, lethargy
Dark circles under eyes
Fruity odor to breath
Endocrine Problems
• Diabetes Mellitus
• Treatment of DKA/Hyperglycemia
– Slowly correct blood sugar
– Hydration!! (NS Boluses)
– Education
– Insulin Regimen
Endocrine Problems
• Diabetes Mellitus
• Carbohydrate Counting
– http://www.diabetes.org/food-and-fitness/food/what-can-ieat/understanding-carbohydrates/carbohydrate-counting.html
• Sick day rules
– http://www.diabetes.org/living-with-diabetes/parents-andkids/everyday-life/sick-days.html
Endocrine Problems
• Diabetes Mellitus
• Insulin Pump
• Psychosocial Support
– Adolescents!
• Present oriented
Endocrine Problems
• Growth Hormone Deficiency
• Hypopituitarism
• Hypothalamus
Pituitary Gland
GH
– GH – Growth, bone density, glucose uptake
• Infarction
• Tumors
• Trauma
• Genetic disorders
• Growth Hormone Level challenge/stimulation testing
– Bone age
– Growth hormone replacement? (SQ qday? For several years)
– Focus on appropriate developmental age
Endocrine Problems
• Hypothyroidism
– Congenital (1 in 3000)
– Causes mental retardation (cretinism)
• Big tongue, dull appearance, hypotonia
– Bradycardia, constipation, cool
– Newborn screening – T4 with Increased TSH
– Levothyroxine (Synthroid)
– Maybe Acquired- autoimmune process