Chapter 18 | Endocrine Disorders 433
● Irrigate all feeding tubes with normal saline as opposed to water to prevent the pulling of sodium from the body. ● A diet high in sodium and protein should be encouraged. ● Neurological assessment is crucial for patients with SIADH, because decreased sodium levels can cause an altered level of consciousness that may lead to seizures. ● Seizure precautions at the bedside should be used and docu- mented on the patient’s chart. Caregiver Education ● Emergency patient/family education should consist of teaching how to recognize the signs and symptoms of sodium depletion, such as weight gain, altered level of consciousness, confusion, complaints of headache, and irritability. The parents should be taught to take the child to the emergency department or call for emergency assistance. ● Education regarding importance of fluid balance is essential. The child and parents/family should be taught to carefully as- sess intake and output, including fluid restrictions, obtaining diaper weights, and urinals or “toilet hats” to monitor output. Careful precautions must be taken to teach patients and fam- ily about hidden water in food sources such as Popsicles and watermelon. Encouraging a diet high in sodium and protein is also indicated. ● Encourage the patient to wear a medical alert bracelet.
CRITICAL COMPONENT Low Sodium and Risk for Seizure
Low sodium levels less than 125 mEq/L may cause seizure activity in children with SIADH. Keeping sodium levels as near to normal as possible is the primary goal of treatment. The pediatric nurse must be very thorough in keeping accurate track of the child's intake, output, and daily weights (Benzo & Hayes, 2019).
PRECOCIOUS PUBERTY
Precocious puberty is defined as early pubertal development in girls younger than 8 years and boys younger than 9 years. It can be caused by premature release and secretion of gonadotropin hormones from the pituitary. There are three classes of preco- cious puberty (Table 18-1): ● Complete or true precocious puberty ● Incomplete precocious puberty ● Puberty caused by other conditions, such as injury to the CNS Tanner staging is an assessment guide that should be used for every child’s physical examination, and it is especially important for children and adolescents during pubertal age.
TABLE 181 Classification of Sexual Precocity
TRUE PRECOCIOUS PUBERTY, COMPLETE Caused by premature activation of gonadotrophic hormones from the hypothalamic–pituitary feedback system Examples: Familial or constitutional central precocious puberty CNS tumors such as craniopharyngiomas, hamartoma, and hypothalamic astrocytoma Idiopathic precocious puberty
PRECOCIOUS PUBERTY CAUSED BY OTHER CONDITIONS May be caused by condition that directly affects the CNS Examples: Encephalitis Static encephalopathy Brain abscess Hydrocephalus Head trauma Arachnoid cyst Myelomeningocele Vascular lesions Cranial irradiation
INCOMPLETE PRECOCIOUS PUBERTY
Caused by ovarian or adrenal secretion of, or ingestion of, estrogen; in this case, the serum gonadotropins will be suppressed and serum estradiol levels will be elevated Examples: Boys Gonadotropin-releasing tumors Increased androgen secretion from the adrenal gland or testis, such as in congenital adrenal hyperplasia Leydig cell adenoma Familial testotoxicosis (sex-limited autosomal dominant disorder) Girls Ovarian cyst Estrogen-secreting ovarian or adrenal tumor Peutz-Jeghers syndrome Both sexes McCune-Albright syndrome Hypothyroidism Iatrogenic or exogenous exposure to estrogens in foods, drugs, or cosmetics
From Misra and Radovick (2018).
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