Chapter 49: The child with an endocrine disorder
Case 1: Jalissa Twyman, 8 years old, was admitted to the pediatric intensive care unit with a closed head trauma after being involved in a bicycle/motor vehicle accident. Jalissa is unconscious. The nurses caring for Jalissa document a weight loss of 1.82 kg over a 24-hour period, decreased skin turgor, and dry mucous membranes. Urine output for the same 24-hour period is 3.5 L/m2
I. What further assessments should the nurse perform on Jelissa?
The nurse should check if the child has a raised, swollen area from a bruise or a bump, any cuts in the scalp, sensitivity to light and noise, lightheadedness, confusion, and assess the functionality of the nerves, arterial blood pressure, intracranial pressure, heart rate and rhythm, central nervous pressure, and core temperature (Perry et al., 2017).
III. Increased respiratory rate
IV. Urine concentration
VI. What laboratory tests should the nurse expect to be ordered for Jelissa?
A complete blood cell count especially if the child is suspected to have bleeding, CT scan, and MRI scan. Also, there is need to carry out a coagulation profile of the patient.
VIII. CT scan, MRI, or ultrasound of the skull and kidneys
IX. Serum osmolarity
X. Serum sodium
XI. Fluid deprivation test
XII. What nursing interventions should be done for Jelissa?
The nurse should ensure that the neck is positioned at a midline position to prevent jugular vein compression, ensure adequate sedation, ensure that there is no increased pressure on the intra-abdominal pressure, and also establish early enteral feeding because the child has lost weight in 24 hours and needs energy.
Case 2: Aellai Gianopoulos , 13 years old, is brought to the clinic by her mother, who states that Aellai is losing her hair. Vital signs are as follows: T 98.4°F, HR 85, R 15, BP 121/78. Height is 64 in., and weight is 81.5 kg.
Aellai has an olive complexion marred by acne, large brown eyes, and long black hair that is very thin on the top of her head. Her breasts are small and she has an abundance of hair on her arms and legs. She reached puberty approximately 6 months ago
She has classic s/s of a specific endocrine disorder.. a big clue is that this is a girl.
a. What other information should the nurse gather in the health history?
The nurse should note down if there are any history of endocrine disorder cases in the family, the age of the onset of the patient’s symptoms, the rate at which the symptoms are progressing, history of menstruation, any other medical history and any medications that the patient could be taking, or has taken before regarding the symptoms (Clare, 2019).
b. What laboratory tests would the nurse expect to be ordered for Aellai?
A twenty four hour urine collection test,
bone density test, For what she is 13yo?
ACTH stimulation test, CRH stimulation test, Incorrect
fine-needle aspiration Biopsy, of what?
oral glucose tolerance test, dexamethasone suppression test, Incorrect
five day glucose sensor test, and TSH blood test.
c. What should the nurse include in the teaching plan for Aellai and her family?
The nurse should develop a teaching plan for Aellai and her family to enable them to understand what is happening to Aellai and the care that she needs. The plan should include the following; it is important to first of all know that children are different and they grow at a different rate. However, their Aellai has endocrine disorder whereby the hormones responsible for the growth and development of her bone, reproductive organs, and secondary sex characteristics, and the hormones responsible for hair growth and skin pigmentation (Clare, 2019). Therefore, Aellai should visit an endocrinologist regularly for correction and monitoring.
Clare, C. (2019). Endocrine Disorders. Learning to Care E-Book: The Nurse Associate, 455.
Perry, S. E., Hockenberry, M. J., Alden, K. R., Lowdermilk, D. L., Cashion, M. C., & Wilson, D. (2017). Maternal Child Nursing Care-E-Book. Mosby.