what is GH important for?
normal growth, development, and cellular metabolism
deficiency of GH causes what?
prevents somatic growth throughout body
other hormones that work with GH
adrenocorticotropic hormone (ACTH)
thyroid stimulating hormone (TSH)
gonadotropins: follicle-stimulating hormone (FSH), and luteinizing hormone (LH)
hypopituitarism
diminished or deficient secretion of pituitary hormones primarily GH
growth hormone deficiency risk factors
structural factors: tumors, trauma, structural defects, surgery
heredity disorders
pituitary hormone deficiencies: TSH/ACTH
most often idiopathic
growth hormone deficiency s/s
short stature but proportional ht. wt.
delayed epiphyseal plate closure
increased insulin sensitivity
delayed dentition/underdeveloped jaw
delayed sexual development
growth hormone deficiency labs
plasma insulin-like growth factor-1 (IGF-1)
IGF binding protein - 3 (IGFBP-3) levels
further eval. if values are one standard deviation below mean for age
growth hormone deficiency lab nursing actions
collect appropriate amount of blood
explain tests to family
growth hormone deficiency lab client ed.
fast the night before
growth hormone deficiency diagnostics
GH stim.
radiologic assessments
CT/MRI/skull x-rays
evaluation of growth curve
GH stim. for GHD
done for children who have a low level of IGF-1 and IGFBP-3 and short stature
GH stim. for GHD nursing actions
draw baseline blood smaple 0600-0800
administer triggering med.s
obtain blood sample Q30M for 3 hours
GH stim for GHD client ed.
fast 10-12 hours before
limit activity 10-12 hours before
Radiologic assess for GHD
assess skeletal maturity by comparing epiphyseal centers
general skeletal survey in children < 3 y. or hands/wrists in older children for growth and epiphyseal function
radiologic assess for GHD nursing actions
positioning
CT/MRI/skull x-rays for GHD
to identify tumors, or other structural defects
CT/MRI/skull xray for GHD nursing actions
monitor child during procedure
sedate prn
CT/MRI/skull xray for GHD client ed.
emotional support
eval. of growth curve GHD nursing actions
obtain and plot measurements
asses ht. velocity / ht. over time
ht/wt relationship
project target ht in context to genetic potential
GHD nursing care
ht/wt measured and marked every visit
effectiveness of GH replacement
administer other hormone replacements prn
support psychosocial concerns
maintain realistic expectations
GHD measuring ht.
<3 6 months
>3 1x year
GHD meds
somatropin
used as a human growth hormone that is a replacement for growth hormone
somatropin nursing considerations
subq injections
caution when receiving insulin
GHD team
endocrinologist, psych. counseling
GHD d/c nursing actions
no significant side effects with appropriate dosage
GH assists in muscle growth and self esteem
GHD d/c client ed.
how to administer med.
6-7 days/week
continued until bone maturation/xray shows epiphyseal plate closure 16 boys/ 14 for girls
evaluation during early adulthood may need continued therapy
GHD complications
disruption of vertical growth
delayed epiphyseal closure, retarded bone growth, delayed sexual development, premature aging later in life