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Dwarfism by Katie Neal - Coggle Diagram
Dwarfism
by Katie Neal
Assessment
Diagnosis
Use parental heights to identify target range
Calculate growth rate
Calculate bone age of left hand and wrist
Head MRI or CT scan
To look for abnormalities
Track weight and height on standardized growth charts
Blood tests
Pituitary stimulation tests
Triggers pituitary gland to produce GH and evaluates amount produced
Assess for adverse effects to treatment
Assess cautions, contraindications, interactions of medication
Interacts with glucocorticoids
Contraindications
Children with closed growth plates
Tumours
Acute illnesses
Recommended to discontinue use during pregnancy
Monitor
Hormone levels
thyroid hormones
GH
Vital signs
I & O
Weight
Etiology
Deficit of growth hormone
Idiopathic
Majority of diagnoses have no identifiable cause
Congenital
Autosomal recessive
Autosomal dominant
X-linked recessive
Acquired
Injury
Infection
Tumor growth
Surgery or radiation
Early identification is important
Treatment must be done before puberty, otherwise replacement therapy will have no effect on final bone length
More common in boys
Manifestations
Short stature but proportional height and weight
Delayed puberty
Reduced muscle mass and increased body fat
Nursing Care
GH replacement therapy
Eg: Somatropin
Common adverse effects
Headache
Hyperglycemia
Hypothyroidism
Hypercalciuria
Rash
Urticaria
Development of antibodies to growth hormone
Develop therapeutic relationship with family
Address risk for distrubed body image
Client Education
Risk and consequences of juvenilisation
Children may look younger than they are
May be treated as though they are younger
May impair social and emotional development
Address client and family anxieties
Eg: Anxiety regarding social stigma around short stature
Medication
Administration
Disposable pen with preloaded cartridge
Store in refrigerator before use
Push needle down onto syringe and twist until it no longer turns
Hold with needle pointing upwards, turn plunger clockwise to mix powdered GH with diluent
Do not shake it
Administer subcutaneous injection
Multi-dose prefilled pen
Prime before first use
Use a new needle for each injection