430 Unit 4 | Common Illnesses or Disorders in Childhood and Home Care
● Parents won’t allow the child to be involved in activities, because they believe the child is not capable or “too small” to be involved. ● Siblings or other children treat the child as if he or she is younger than his or her age. For example, the child’s peers carry the child with a growth disorder around or treat him or her like a baby. ● Educate the patient and parents regarding the disease process of GHD, including the causes, diagnostic testing methods, and medical treatments available. ● Educate the family regarding the medications administered for the treatment of GHD and the potential side effects of the medication. ● GH replacement therapy is a medical regimen administered in the home setting. Follow-up with the endocrinologist every 3 to 4 months is crucial for assessing response to therapy. Caregiver Education ● Provide detailed instructions regarding the administration of GH replacement therapy. ● Provide the parents with educational and online resources and support groups. ● The Human Growth Foundation (http://www.hgfound.org) ● The Magic Foundation (http://www.magicfoundation.org) ● Stress the importance of medication compliance and clinic follow-up appointments with the endocrinologist every 3 to 4 months to ensure the patient is responding to therapy. ● Educate the parent regarding the side effects of somatropin (growth hormone) treatment and when to contact the physi- cian with concerns.
DIABETES INSIPIDUS
Diabetes insipidus (DI) is insufficient production of ADH, which is stored in the posterior pituitary gland and acts on kidneys to restore water and control the amount of urine excreted. There are two forms of DI: central (or neurogenic) DI and nephrogenic DI. Central DI is caused by insufficient ADH production. Nephro- genic DI occurs when kidneys fail to respond to appropriate levels of ADH. Both have abrupt onset and similar manifesta- tions (Marks, 2021).
Assessment Assessment for DI includes the following measures.
Clinical Presentation ● Central (neurogenic) DI: ● Polyuria, polydipsia, enuresis ● Getting up to drink water throughout the night ● Irritability in infants that can only be relieved by giving water instead of formula or breast milk ● Fever ● Constipation, fever, dehydration, and hypernatremia ● Nephrogenic DI: ● Polyuria, polydipsia
● Hypernatremia in the neonatal period ● Dilute urine, vomiting, dehydration ● Fever ● Possible changes in mental status
CRITICAL COMPONENT Dehydration
SAFE AND EFFECTIVE NURSING CARE: Understanding Medication
Dehydration is a critical effect of DI in children. Severe dehydration can occur very quickly in infants and smaller children, so fluids must be increased as soon as possible during exacerbation. The nurse must be able to recognize signs and symptoms of dehydration, such as dry mucous membranes, sunken fontanel in infants, tachycardia, minimal or no tears when crying, and decreased skin turgor. Severe dehydration can lead to hypovolemic shock. The administration of IV fluids is essential to treat severe dehydration, especially when the child is unable to tolerate liquid intake (Grant, 2018; Somers, 2021). Diagnostic Testing ● Measure 24-hour urine collection for daily output total. ● Serum sodium is elevated (greater than 146 mEq/L) (Gubbi et al, 2019). ● Serum osmolality >300 mOsm/kg in the presence of urine osmolality <300 mOsm/kg (Castellanos, 2021). ● Water deprivation testing ● The patient is under direct supervision by the nurse while the nurse carefully monitors vital signs and weight.
Growth Hormone Replacement Therapy GH replacement therapy consists of the child receiving daily sub- cutaneous injections of manufactured GH called somatropin. As with many medications, several manufacturers have developed GH with different trade names, including Genotropin, Nutropin, Humatrope, Tev-Tropin, and Norditropin. These derivatives of GH lack one amino acid but are otherwise identical to human GH. Somatropin is dosed differently depending on the manufacturer, but recommended doses start at 0.16 to 0.24 mg/kg/week di- vided into daily doses. As with insulin, GH is available in vials that must be reconstituted, pen devices that contain cartridges, and needleless injection devices. Some side effects include headache and achiness in the joints and muscles, particularly the knees, ankles, and wrists. If side effects occur, the physician may decrease the starting dose and then increase the dose slowly until side effects resolve. It is recommended to start children on GH therapy as early as possible to achieve maximum growth benefit (Rogol & Richmond, 2021; Vallerand & Sanoski, 2021).
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