Congenital hypothyroidism correct answers __, also known as cretinism, may have a number of causes and can be either permanent or transient. Deficiency of
... [Show More] thyroid hormones at birth. It can be permanent, caused by defective thyroid gland development, enzymatic defect in thyroxine synthesis, or rarely pituitary dysfunction. Transient can be associated w maternal Graves disease that was treated w antithyroid drugs or expectorants given for asthma. Worldwide the most common cause of this results from iodine deficiency. Early detection and prompt initiation of tx are essential bc their delay will result in various degrees of cognitive impairment, in which IQ is lost. Newborns do not usually exhibit obvious s/s of this. Manifestations at birth include poor feeding, lethargy, prolonged jaundice >2 weeks, respiratory difficulties, cyanosis, constipation, bradycardia, hoarse cry, large fontanels, posters, birth weight over 8.8 lbs. Untreated can lead to hypotension, anemia, wide cranial sutures, bone age is delayed, severe mental retardation, dry hair, thick and dry and mottled skin, depressed nasal bridge, puffy eyelids, large tongue, hyporeflexia, hypothermia, secondary teeth do not erupt. Dx TSH and T4.
Double correct answers Nursing care and therapeutic tx of hypothyroidism: Tx involves lifelong thyroid hormone replacement therapy as soon as possible after dx to reestablish normal physical and mental development. The drug pf choice is synthetic levothyroxine (Synthroid). Regular measurement of thyroxine levels is important to ensure optimal tx. Bone age surveys are also performed to ensure optimal growth. Most important nursing objective is early identification--must be certain screening is performed especially in infants who are preterm, discharged early, or born at home. Nurses in community health need to be aware of earliest signs of disorder. Parental remarks about unusually quiet and good baby w demonstrated s/s should lead to suspicion. After dx, parents need explanation of disorder and need of lifelong tx. Child should be referred to a pediatric endocrinologist. Importance of compliance w drug regimen for child to achieve normal growth and development must be stressed. Bc drug is tasteless, it can be crushed and added to formula, water, or food. Put in a little bit of breastmilk or formula or food (about 1-2 mL) to make sure its all taken. Give same time everyday. If dose is missed, __ for next day. Teach s/s of OD (rapid pulse, dyspnea, irritability, insomnia, fever, sweating, and weight loss). Inadequate tx will show s/s of hypothyroidism. If dx was delayed past infancy, permanent cognitive impairment risk is great. Guide parents on how to care for these children. Genetic counseling is important for families when thyroid dyshormonogenesis is the cause (autosomal recessive).
Hypopituitarism
Idiopathic hypopituitarism correct answers __ is diminished or deficient secretion of pituitary hormones. Born with deficit thyroid hormones. Send metabolic screening--TSH increase T4 decrease. The consequences of the condition depend on the degree of dysfunction and can lead to gonadotropin deficiency w absence or regression of secondary sex characteristics; growth hormone deficiency, TSH deficit, and corticotropin deficit which manifests adrenal hypo function. Most common organic cause of pituitary under secretion is tumors in pituitary or hypothalamic region. Congenital hypopituitarism can be a result of birth trauma. __ is related to GH deficiency which inhibits growth in all cells of body. They are born normal at birth but grow slowly--fall of growth curve for height. Chief complaint is short stature. Remember to look for familial short stature--this would be healthy children just w ancestors w adult height in low percentile. Look at childs bone age versus their chronological age. Manifestations include [Show Less]