432 Unit 4 | Common Illnesses or Disorders in Childhood and Home Care
● Focus on long-term complications of noncompliance, such as hypertension, cardiomegaly, subsequent cardiovascular disease, diabetes mellitus, osteoarthritis, sleep apnea, and early death.
HYPERPITUITARISM
Hyperpituitarism is a rare condition in which the pituitary gland secretes excess pituitary hormones. We discuss conditions related to excess GH, secreted from the pituitary gland, causing children to experience uncontrolled growth. If the patient has precocious puberty in conjunction with hyperpituitarism, the condition may be caused by a tumor on or near the hypothala- mus or pituitary gland. Once closure of epiphyseal plates occurs and hyperpituitarism continues, overgrowth of bones occurs. This is referred to as acromegaly. Before the epiphyseal plates close, it is called gigantism. Enlargement of the hands and feet and coarseness of facial features, including the forehead, nose, lips, tongue, and jaw, are common. Other symptoms may in- clude generalized muscle weakness and pain in the muscles and joints (Ilie, 2020). Diagnostic Testing ● Early identification is essential, and monitoring growth charts for excessive growth spurts or consistent growth greater than the 95th percentile is warranted. Children with an estimated midparental height that is greater than 2 SD scores above normal should be monitored. ● IGF-1 levels will be elevated with hyperpituitarism. ● Radiological testing such as a bone age x-ray will depict advancement of bone growth. ● An MRI may be necessary to evaluate the hypothalamus and pituitary gland to rule out a GH-producing or other type of tumor. Nursing Interventions ● Nursing care should focus on accurate assessment of growth trends by carefully documenting height and weight on the ap- propriate growth chart. ● Physical assessment is important to evaluate for early physical signs of excess bone growth characteristics and other features of gigantism. ● Evaluation of laboratory values of IGF-1 levels. ● If surgery is indicated, preoperative and postoperative nurs- ing interventions such as neurological assessment, vital signs, wound assessment, and dressing care and assessment for potential complications are important. ● Follow-up home care may be indicated depending on the sta- tus of the patient after surgery. The nurse should take respon- sibility to refer the patient/family to a home-care provider. Caregiver Education ● Focus on educating patients and families about the disorder, treatment options, psychosocial support, and surgical prepa- ration if indicated. ● Patient and family education regarding home medications such as somatostatin analogs, dopamine agonists, and GH receptor antagonist. ● Promote medication compliance.
SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE
Syndrome of inappropriate antidiuretic hormone (SIADH) oc- curs in the presence of excessive ADH production. The kidneys are unable to conserve appropriate amounts of water, so the body retains water, leading to water intoxication, hyponatremia, and cellular edema. SIADH is very closely associated with children who have had CNS infections or intrathoracic disease and may occur in postoperative patients as a complication. The signs and symptoms of SIADH have varying degrees of seriousness. Symp- toms may include nausea; vomiting; seizures; and personality changes such as irritability, combativeness, hallucinations, and confusion leading to stupor or coma. Other signs may include increased blood pressure, neck vein distention, crackles heard on lung examination, weight gain with no external visible edema, decreased urine output despite a high urine-specific gravity, and low sodium levels. Diagnostic Testing Serum laboratory levels are monitored, and diagnosis is con- firmed when the laboratory levels present the following results: ● Serum osmolality <275 mOsm/kg in the presence of urine osmolality >100 mOsm/kg (Castellanos, 2021) Nursing Interventions ● Fluid restriction is essential for a child with SIADH. The fluid restriction protocol may begin with restricting 75% of fluid maintenance and decreasing the fluids to half of maintenance if there is no improvement in 4 to 6 hours. ● Emergency management of severe SIADH may include administration of hypertonic sodium chloride solution, especially if hyponatremia is severe and neurological disease is present. ● If adrenal insufficiency is present, corticosteroids will be ad- ministered according to stress dosing protocols. ● Very detailed intake and output must be monitored by the nurse, including accounting for all routes of fluid administra- tion. Careful attention must be paid to children old enough to reach water fountains or toilets. ● Strict diaper weights must be obtained when caring for infants with SIADH. ● Medications should be given during the meal so that additional fluid intake is not needed when administering medications. ● Urinary sodium >40 mmol/L (Castellanos, 2021) ● Low serum sodium (greater than 125 mEq/L) ● Decreased BUN (more than 10 mg/dL) ● Decreased hematocrit
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