endocrine disorders.pdf endocrine disorders

endocrine diaorders

3. Definition
Congenital hypothyroidism(CHT) or
Cretinism is a condition resulting from an
absent or under developedthyroidgland
(dysgenesis) or inborn error of thyroid
synthesis.

4. Causes
1.Fetal thyroid gland dysgenesis
2.Inborn errors of thyroid synthesis
3.Maternal iodine deficiency during pregnancy
4.Antithyroid treatment for thyroid cancer
during pregnancy
5.Use of medicines that disrupt thyroid
hormone production— such as
sulfonamides, or lithium during pregnancy

5. Clinical Features
1.Yellowing of the skin and whites of the eyes
(jaundice)
2.Floppiness, low muscle tone
3.Hoarse voice
4.Unusually large tongue
5.Swelling near the navel (umbilical hernia)
6.Cool, dry skin
7.Swelling of the skin (myxedema)
8.Swelling in the neck from an enlarged
thyroid gland (goiter)

6. Diagnostic Evaluation
1.Earlydetectionbyneonatalscreening
2.Detailedhistory&Physicalexamination
3.HighTSHlevel
4.LowT3andT4
5.X-raystudies
6.ThyroidUSG

7. Treatment
Ifthediagnosisisconfirmedthrough
furtherthyroidtests,newbornsmustbe
treatedasquicklyaspossible,usuallywith
synthetic thyroid hormone
(Levothyroxine),whichshouldbegiven
asacrushedpillmixedwithasmall
amountofbreastmilkorformula.

9. Definition
Type1diabetes,onceknownasjuvenile
diabetesorinsulin-dependentdiabetes,is
achronicconditioninwhichthepancreas
produceslittleornoinsulin.
Type1diabeteshappenswhenimmune
systemdestroysbetacellsinpancreas.

10. Etiology
1.95%paediatriccasesbelongtothe
idiopathiccategory
2.Hereditaryinbornerrorofmetabolism
3.Geneticfactor
4.Autoimmunebasis
5.Certaintriggeringfactorslikemumps,
rubellaoranyothersevereinfection.

11. Types of DM
1. Type 1 diabetes: It is due to the body’s
malfunction to produce insulin in the
body, and requires the person to inject
insulin. This form was previously referred
to as “Insulin-Dependent Diabetes
Mellitus” (IDDM) or “Juvenile
Diabetes”.

12. Cont..
2. Type 2 diabetes: It is due to insulin
resistance, a condition in which cells fail
to use insulin properly. This form was
previously referred to as non insulin-
dependent diabetes mellitus
(NIDDM) or “adult-onset diabetes”.

13. Clinical features
1.Polydipsia
2.Polyphagia
3.Polyuria
4.Dry mouth
5.Unexplained weight loss
8.Fatigue (weak, tired feeling)
9.Blurredvision
10.Laboured breathing
11.Frequent infections of theskin, urinary tract,
orvagina

14. Pathogenesis

15. Pathophysiology
Genetic factors, infection or environmental factors
Activation of T-cells
Release of cytokines
Inflammation of beta cells in pancrease
Progressive destruction of beta cells over long time
Insulin deficiency or no insulin production
Type-I diabetes mellitus

16. Diagnostic tests
1.Urine test
2.FBS
3.RBS
4.GTT

18. Nutritional Modification
1.Simplesugars should be avoided.
2.Complex carbohydrates should be
included in the diet.
3.Low glycaemic index and fibres are
recommended.
4.Timing of meals are adjusted with insulin
intake.

19. Physical Activity
1.Exercise enhances the action of insulin
in reducing the blood glucose level.
2.Recommended activities- walking,
jogging, swimming etc.
3.Avoid heavy and excessive exercise.
4.Encourage child to participate in sports
activities.

20. Glucose Monitoring
1.Selfmonitoring of blood glucose by
parents is recommended before meals
and before bedtime.
2.Results should be recorded in a diary.
3.Glycosylated haemoglobin (HbA1c) also
monitored at regular intervals

21. Insulin Types
1.Rapid-acting insulin.This type of
insulin starts working within 15 minutes.
Insulin lispro (Humalog, Admelog), aspart
(NovoLog, Fiasp)
2.Short-acting insulin.Human insulin
(Humulin R, Novolin R) starts working
around 30 minutes after injection.

22. Cont..
3.Intermediate-acting insulin.NPHinsulin
(Humulin N, Novolin N) starts working
within about one to three hours and lasts 12
to 24 hours.
4.Long- and ultra-long-acting
insulin.Therapies such as insulin glargine
(Basaglar, Lantus) and insulin detemir
(Levemir) and degludec (Tresiba) may
provide coverage for as long as 14 to 40
hours.

23. Insulin Delivery Devices

24. Insulin delivery devices
Insulin pen with fine needle.This device
looks like an ink pen, except the cartridge
is filled with insulin.

25. Insulin delivery devices
An insulin pump.This is a small device
worn on the outside of body that
programmed to deliver specific amounts
of insulin throughout the day and when
patient eat.

26. Nursing Interventions
1.Monitor blood glucose level pre meal and
before bed time
2.Administer insulin as prescribed
3.Follow the insulin regimen as ordered
4.Store insulin in a cool dry place, do not heat
or freeze
5.Rotate insulin site daily.
6.Maintaining Nutrition
7.Balance the meal and snacks with insulin
injection
8.Provide low fat, low glycemic index and high
fibre food

27. Cont..
9.Identify favouritefoods of child and
incorporate in the meal
10.Provide three meals and two or 3 snacks
11.Monitor daily weight
12.Preventing Injury
13.Teach family to recognize the signs and
symptoms of hypoglycemia and
hyperglycemia
14.Treat hypoglycemia promptly with 15g of
easily digested carbohydrate
15.Teach strategies to prevent hypoglycemia
such as avoiding missed or delayed meal,
excess insulin or excessive exercise.

28. SURGICAL INTERVENTIONS

29. Health Education
1.Teachthe parents to administer insulin as per
directions.
2.Take return demonstration of insulin injection
3.Advice regarding menu planning as per insulin
need
4.Reinforce the need for regular followup
5.Encourage to express their concerns for their
child
6.Provide explanations for the treatment
7.Allow the child and family to meet other children
with diabetes
8.Involve parents in the child care