Chapter 18 | Endocrine Disorders 435
● Follow up with newborn screening results before or at first newborn visit within 1 week of birth. ● Carefully assess height and weight on the growth chart to determine growth delay. ● Obtain history of infant’s activity level, feeding ability, frequency of feedings, and bowel habits during follow-up visits. ● Provide patient/family education regarding thyroid replace- ment therapy and medication administration. Caregiver Education ● Teach parents how to administer thyroid medications by hav- ing them crush and mix the medication with a small amount of water, breast milk, formula (milk-based), or baby food. ● Instruct parents to give thyroid medications at the same time each morning and not skip or double doses. ● Instruct parents to administer medication via needleless syringe and not put it in a bottle. ● Instruct parents that formula should be milk-based and not soy-based. Soy-based formulas can break down the effects of the medication (Bosch i Ara et al, 2021). If the child cannot tolerate milk-based formulas, the provider will need to adjust the medication dose accordingly. ● Reinforce importance of medication compliance and lifelong need for thyroid medications. ● Instruct parents on the potential side effects of thyroid replacement medications and instruct them to notify their physician immediately if side effects are experienced. Acquired Hypothyroidism ● Onset in childhood or teen years ● Cause may be related to an autoimmune condition known as Hashimoto’s thyroiditis ● Medications such as lithium may interfere with thyroid synthesis Assessment Assessment for acquired hypothyroidism includes the following measures. Clinical Presentation ● Decreased appetite, thinning of the hair or hair loss, dry and cool skin, depressed tendon reflexes, bradycardia, con- stipation, extreme fatigue, sensitivity to cold temperatures, abnormal menstrual cycles ● Manifestations unique to children include changes or decel- eration in growth velocity, weight increase, delayed bone age, delayed dentition, muscle weakness, and delayed or precocious puberty ● School-age children may show a decline in school performance ● Goiter may be present Diagnostic Testing ● In children with suspected acquired hypothyroidism, labo- ratory results of T4, TSH, and antithyroid antibodies are evaluated.
SAFE AND EFFECTIVE NURSING CARE: Understanding Medication
Congenital Hypothyroidism Congenital hypothyroidism occurs at birth. State newborn screening programs identify infants born with congenital hypo- thyroidism and report the results immediately to the family and the infant’s health-care provider. It is important that a newborn with congenital hypothyroidism get the appropriate treatment as soon as possible to avoid delays in cognitive development. Assessment Assessment for hypothyroidism must include the following elements. Clinical Presentation ● Most infants are born asymptomatic. ● Ten percent of affected infants have symptoms that develop within weeks to months of birth. ● Symptoms may include hypotonia, lethargy, open posterior fontanel, open cranial sutures, umbilical hernia, prolonged jaundice, pallor, enlarged tongue, hoarse cry, constipation, dry skin, respiratory difficulties, poor weight gain, general- ized edema, goiter, abdominal distention, and increased birth weight (Uday, Davis, & Gleeson, 2020). Diagnostic Testing ● Thyroid laboratory tests are part of the state mandatory new- born screening. ● In children with suspected acquired hypothyroidism, T4, TSH, and antithyroid antibodies are taken. ● Thyroid scan or ultrasound may be indicated to confirm the presence and position of the thyroid gland. ● Assessment of the infant’s or child’s growth velocity may also indicate hypothyroidism, especially if there are extreme differ- ences between height and weight percentiles. Nursing Interventions ● Immediate initiation of thyroid replacement hormone is essen- tial to prevent cognitive damage in newborns and infants. Lupron Leuprolide acetate (Lupron Depot Pediatric) is the most com- mon medication for treating true central precocious puberty in children. Because this medication is also used to treat adults for other causes, it is critical to ensure the child receives the pediat- ric formulation. Beginning doses start at 3.75 mg and increase based on weight to a maximum dose of 15 mg. This medica- tion can be given intramuscularly (IM) or subcutaneously (SQ). It must be given as directed or the child may experience increased hormone levels that cause signs of puberty to pro- gress (Vallerand & Sanoski, 2021).
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