- Email: [email protected]
Demystifying Maturity Onset Diabetes of the Young (MODY)
Abstracts of the 2016 Pediatric Endocrinology Nursing Society Conference improvement, including holding the specimens on ice until the conclusion of the test, rapid “pull rate” while obtaining specimens, and forceful transfer of specimens to tubes. Once the focus for improvement was defined, education of the staff on proper specimen collection and handling techniques was done. Every specimen was scrutinized for hemolysis. We partnered with the experts in our lab to evaluate our performance. Feedback was received each week for six weeks. At the end of this time, it was determined that our new process dramatically reduced hemolysis. Although it is not possible to completely avoid hemolysis, we now see hemolysis on only rare occasions. Clinical Implications: The quality of specimens can be improved with education of staff in the practice of specimen collection and handling. Minimizing hemolysis can lead to more accurate and valid results, better use of health care dollars with fewer redraws and retesting for rejected specimens, better service for our patients by minimizing the need to redraw specimens, and providing valid specimens for accurate and reliable diagnosis of endocrine conditions. http://dx.doi.org/10.1016/j.pedn.2016.03.007
Teaching Guidelines for the Nurse Caring for the Pediatric Thyroid Cancer Patient Receiving Radioactive Iodine Treatment (I-131) Sandra Tomlinson BSN, RN, LaKenya Linton BSN, RN, Andrew J. Bauer M.D., F.A.A.N., Sogol Mostoufi-Moab MD, MSCE Children's Hospital of Philadelphia, Philadelphia, PA
Background: Initial treatment for differentiated thyroid cancer involves surgical total thyroidectomy. Subsequent treatment with I-131 (radioactive iodine – RAI) has improved the survival rate of patients with differentiated thyroid cancer. The thyroid gland readily absorbs iodine in the body. When the thyroid is restricted of iodine with a low iodine diet, along with withdrawal of thyroid hormone or administration of thyrotropin alfa (Thyrogen), the remaining thyroid cells are stimulated which allows for improved absorption of I-131. Radiation from treatment with I-131 destroys residual thyroid cancer cells, whether local or distant, that were not removed with surgical thyroidectomy. Purpose: Families of pediatric patients undergoing I-131 treatment require education to promote adequate patient preparation and successful treatment. Post treatment guidelines are also necessary to reduce side effects and risk of exposure of radioactive iodine to care providers and family members. Equipping pediatric endocrinology nurses with specific guidelines for patients with differentiated thyroid cancer that requires radioactive iodine treatment should ensure improved treatment outcomes, while providing support to the family of the pediatric patient. Description of Topic: Education and support for the family of the pediatric patient undergoing I-131 treatment for differentiated thyroid cancer is important for optimal safety and care. Therefore, guidelines were created to assist families through this complicated process. Pediatric endocrinology nurses instruct the patient and family about their treatment plan using these specific guidelines. Teaching includes the pre-treatment plan, low iodine diet, medication, laboratory studies, and post treatment precautions and care. Clinical Implications: Patient and family education and support by pediatric endocrinology nurses will allow for improved patient preparation for I-131 treatment and post treatment care. Adequate patient preparation allows for an improved patient treatment outcome by increasing iodine uptake in remaining thyroid cells. Appropriate planning is also directed at
365
decreasing potential side-effects, including exposure of radioiodine to care providers and family members. http://dx.doi.org/10.1016/j.pedn.2016.03.008
The Growth Center: The Role of the Endocrine Nurse Carla Kohrs BSN, RNII, CPN Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
Background: Cincinnati Hospital Medical Center (CCHMC) has developed a clinic specifically looking into genetic causes for Short Stature. The Growth Center, a multidisciplinary clinic involving endocrine, genetics and research studies began in January, 2015. Nursing has been a determinant factor in the clinic’s first year success. Purpose: The purpose of this poster is to introduce the audience to how nursing is vital in the coordination and flow of a multidisciplinary clinic. Description of Topic: Multidisciplinary clinics require extensive coordination and nurses have an important role in the collaboration of services. The Growth Center sees patients referred by other endocrinologists for severe growth disorders. The nurse initiates communication with the family to explain the specialty clinic and set up an appointment. Patients come from all parts of the world and require collaboration between the nurse and other departments to assist with transportation, lodging, and financial concerns. Prior to the appointment, the nurse meets with the growth center team to develop the plan for the clinic visit. Clinical and research plans are determined. During the patient’s clinic visit, the nurse performs the intake as well as assists with auxologic measurements of the patient and all immediate family members. The patient is seen by an endocrinologist, a geneticist, and research coordinators. The nurse coordinates the flow of the visit assuring patients are seen by the entire team. Patient education is provided by the nurse as needed. Post visit conference with the growth team occurs to discuss the plan of care and follow up. The nurse then speaks with the family, relaying results, continuing patient education and discussing follow up plans. Clinical Implications: Multidisciplinary specialty clinics such as the Growth Center require coordination by the nurse to promote optimal outcomes. Using multidisciplinary collaboration to diagnose, treat and perform research, patient outcomes are improved. Nurses are vital in this process providing input in the plan, communication with multiple services, as well as continued communication and education with the family. http://dx.doi.org/10.1016/j.pedn.2016.03.009
Demystifying Maturity Onset Diabetes of the Young (MODY) Kristine M. Welsh MSN, RN, CPNP Endocrinology, Nemours/A.I. duPont Hospital for Children, Wilmington, DE
Background: MODY is a group of monogenic disorders that account for approximately 2-5% of all diabetes cases. MODY is often misdiagnosed as Type 1 (T1DM) or Type 2 (T2DM) diabetes. Some forms of MODY are sulfonylurea sensitive. Microvascular and macrovascular complications are found in varying degrees based on MODY type. Therefore, correct diagnosis may impact treatment, surveillance for complications, and the need for family screening and genetic counseling.
366
Abstracts of the 2016 Pediatric Endocrinology Nursing Society Conference
Purpose: Provide current information on types of MODY, screening guidelines, and treatment options. Description of Topic: Monogenic diabetes is a rare group of disorders characterized by pancreatic beta cell dysfunction and hyperglycemia caused by genetic defects in single genes. Many features of MODY are similar to other forms of diabetes, leading to frequent misdiagnosis as T1DM or T2DM. The most common MODY gene mutations are those in hepatocyte nuclear factor 4 alpha (HNF4A, MODY 1), glucokinase (GCK, MODY 2), and hepatocyte nuclear factor 1 alpha (HNF1A, MODY 3). Suspicion for MODY should be raised when an individual diagnosed with T1DM or T2DM has features that are not typical for these polygenic disorders. Such features include negative pancreatic autoantibodies, evidence of endogenous insulin production beyond the honeymoon period in T1DM, diagnosis of T2DM in a young, non-obese person without signs of insulin resistance, as well as family history of diabetes in two or more generations in an autosomal dominant pattern. Molecular genetic testing for MODY should be performed in phenotypic patients. Targeted next generation sequencing allows for sensitive, quicker, and more cost-effective analysis of many genes concurrently when compared to traditional Sanger sequencing. Clinical Implications: It is estimated that 95% of MODY cases in the US are misdiagnosed. This staggering statistic represents an incredible opportunity to improve patient care with more accurate diagnosis that can translate to more precise and less invasive treatment, cost efficiency, as well as improved patient satisfaction and quality of life. http://dx.doi.org/10.1016/j.pedn.2016.03.010
Decrease Risk of Obesity and Diabetes: Upstream Healthy Eating Morgan Meyer BSN, Casey Almeido BSN, Jasmine Cobb BSN, Tara Ewell BSN, Taylor Hamilton BSN, Ar'Tavia Harris BSN, Cheryl Leisy BSN, Katie O'Donnell BSN, Natalie Rutter BSN, Jessica Urquhart BSN, Carol J. Howe PhD, RN, CDE Texas Christian University, Fort Worth, Texas
Background: More than one third of children and adolescents are overweight or obese and the prevalence of type 2 diabetes is increasing in the pediatric population. Minority children are at higher risk than nonHispanic white children for obesity and developing diabetes. My Plate and USDA guidelines advocate for healthy eating, including an increase in consumption in vegetables and fruits. Children, however, often resist or dislike eating vegetables. Purpose: The purpose of this project was to promote healthy eating habits to decrease the risk of obesity and diabetes in the students and staff at an elementary school in North Texas. Description of Topic: Using the Healthy People 2020 framework “MAPIT”, ten senior public health nursing students with their faculty mobilized partners at the school, completed a community assessment (Windshield and School Sector Survey), planned and implemented a USDA ‘Try Day’, and tracked outcomes. The program included exposing 1st to 8th grade students to different vegetable options during their lunch periods, a healthy eating and diabetes awareness presentation for the teachers, and email updates to parents. Objectives, lessons plans, and evaluation goals were created. Children progressively increased their willingness to try vegetables from first through sixth grade. From sixth to eight grade, the willingness to try vegetables noticeably dropped. Children rejected high textured foods such as hummus. A class competition added incentive for the students to try the vegetables. Clinical Implications: Pediatric Endocrine nurses may have more opportunities to contribute to preventative efforts as more emphasis is put
on public health nursing. Future partnerships with school nurses to plan and implement upstream approaches may decrease the risk of obesity and diabetes development in children. In these efforts, pediatric endocrine nurses should know there are a tremendous amount of resources, including the USDA guidelines, which provide several project ideas. This project represents one of many healthy eating interventions. http://dx.doi.org/10.1016/j.pedn.2016.03.011
Nurse-Monitored Calcium Protocol Halts Hypocalcemia in Total and Completion Thyroidectomy Patients Jennifer Abernathy BSN, Ioanna Athanassaki MD Texas Children’s Hospital, Houston, TX
Background: Hypocalcemia (serum calcium b8 mg/dl) is the most common complication after total and completion thyroidectomy. While the condition may be transient, hypocalcemia can prolong hospitalization or cause hospital readmission. Hypocalcemia in the acute care setting may necessitate intravenous calcium which requires careful monitoring due to potential tissue necrosis should extravasation occur. Additionally, if intravenous calcium is administered rapidly, cardiotoxicity can result. Preventing post-operative hypocalcemia is one important indicator of a successful surgical outcome. Purpose: The purpose of this nurse-monitored calcium protocol is to reduce the risk of hypocalcemia in the post-operative period, thus avoiding the need for intravenous calcium while in the hospital and preventing readmission for symptomatic hypocalcemia. Description of Topic: At the Thyroid Tumor Program at Texas Children’s Hospital in Houston, Texas, a protocol was designed and implemented in which pediatric patients undergoing a total or completion thyroidectomy would receive calcium and calcitriol before and after surgery. Patients are instructed by the endocrine nurse to begin calcium carbonate 30 mg/kg/day and calcitriol 0.5 mcg daily for one week prior to surgery. The nurse also calls the day before surgery to remind the patient to take calcium and calcitriol the morning of surgery. Based on the calcium protocol outlining safe levels for pediatric patients and the corresponding treatment, the patient is discharged home the first day postoperatively with daily dosing instructions for calcium carbonate and calcitriol in the first week. The endocrine nurse monitors the patient’s weekly labs and calls the family to wean the calcium and calcitriol based on the established protocol. This process continues for approximately four to six weeks. The weekly communication increases compliance to the medication regimen and lab draws. Clinical Implications: The pediatric endocrine nurse acts as an advocate for the patient’s family to ensure that the patient avoids postsurgical hypocalcemia and potential complications. When the nurse plays an active role in implementing the perioperative calcium protocol and monitoring calcium levels, compliance increases and the risk of potential complications decreases. http://dx.doi.org/10.1016/j.pedn.2016.03.012
Nursing Research Development and Psychometric Testing of the Neonatal Growth Measurement Survey Jan M. Foote DNP, ARNP, CPNP (Co-PI)a,b, Kirsten Hanrahan DNP, ARNP, CPNP (Co-PI)c, Pamela Mulder PhD, RNa, Anne Bye BSN, RNa, Amelia Fleming BSN, RNa, Maria Hein MSWa, Yelena Perkhounkova PhDa, Nicole L. Bohr MSN, RNa, Ann Marie McCarthy PhD, RN, PNPa a University of Iowa College of Nursing, Iowa City, IA b Blank Children's Hospital, Des Moines, IA c University of Iowa Hospitals and Clinics, Iowa City, IA
Teaching Guidelines for the Nurse Caring for the Pediatric Thyroid Cancer Patient Receiving Radioactive Iodine Treatment (I-131) Sandra Tomlinson BSN, RN, LaKenya Linton BSN, RN, Andrew J. Bauer M.D., F.A.A.N., Sogol Mostoufi-Moab MD, MSCE Children's Hospital of Philadelphia, Philadelphia, PA
Background: Initial treatment for differentiated thyroid cancer involves surgical total thyroidectomy. Subsequent treatment with I-131 (radioactive iodine – RAI) has improved the survival rate of patients with differentiated thyroid cancer. The thyroid gland readily absorbs iodine in the body. When the thyroid is restricted of iodine with a low iodine diet, along with withdrawal of thyroid hormone or administration of thyrotropin alfa (Thyrogen), the remaining thyroid cells are stimulated which allows for improved absorption of I-131. Radiation from treatment with I-131 destroys residual thyroid cancer cells, whether local or distant, that were not removed with surgical thyroidectomy. Purpose: Families of pediatric patients undergoing I-131 treatment require education to promote adequate patient preparation and successful treatment. Post treatment guidelines are also necessary to reduce side effects and risk of exposure of radioactive iodine to care providers and family members. Equipping pediatric endocrinology nurses with specific guidelines for patients with differentiated thyroid cancer that requires radioactive iodine treatment should ensure improved treatment outcomes, while providing support to the family of the pediatric patient. Description of Topic: Education and support for the family of the pediatric patient undergoing I-131 treatment for differentiated thyroid cancer is important for optimal safety and care. Therefore, guidelines were created to assist families through this complicated process. Pediatric endocrinology nurses instruct the patient and family about their treatment plan using these specific guidelines. Teaching includes the pre-treatment plan, low iodine diet, medication, laboratory studies, and post treatment precautions and care. Clinical Implications: Patient and family education and support by pediatric endocrinology nurses will allow for improved patient preparation for I-131 treatment and post treatment care. Adequate patient preparation allows for an improved patient treatment outcome by increasing iodine uptake in remaining thyroid cells. Appropriate planning is also directed at
365
decreasing potential side-effects, including exposure of radioiodine to care providers and family members. http://dx.doi.org/10.1016/j.pedn.2016.03.008
The Growth Center: The Role of the Endocrine Nurse Carla Kohrs BSN, RNII, CPN Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
Background: Cincinnati Hospital Medical Center (CCHMC) has developed a clinic specifically looking into genetic causes for Short Stature. The Growth Center, a multidisciplinary clinic involving endocrine, genetics and research studies began in January, 2015. Nursing has been a determinant factor in the clinic’s first year success. Purpose: The purpose of this poster is to introduce the audience to how nursing is vital in the coordination and flow of a multidisciplinary clinic. Description of Topic: Multidisciplinary clinics require extensive coordination and nurses have an important role in the collaboration of services. The Growth Center sees patients referred by other endocrinologists for severe growth disorders. The nurse initiates communication with the family to explain the specialty clinic and set up an appointment. Patients come from all parts of the world and require collaboration between the nurse and other departments to assist with transportation, lodging, and financial concerns. Prior to the appointment, the nurse meets with the growth center team to develop the plan for the clinic visit. Clinical and research plans are determined. During the patient’s clinic visit, the nurse performs the intake as well as assists with auxologic measurements of the patient and all immediate family members. The patient is seen by an endocrinologist, a geneticist, and research coordinators. The nurse coordinates the flow of the visit assuring patients are seen by the entire team. Patient education is provided by the nurse as needed. Post visit conference with the growth team occurs to discuss the plan of care and follow up. The nurse then speaks with the family, relaying results, continuing patient education and discussing follow up plans. Clinical Implications: Multidisciplinary specialty clinics such as the Growth Center require coordination by the nurse to promote optimal outcomes. Using multidisciplinary collaboration to diagnose, treat and perform research, patient outcomes are improved. Nurses are vital in this process providing input in the plan, communication with multiple services, as well as continued communication and education with the family. http://dx.doi.org/10.1016/j.pedn.2016.03.009
Demystifying Maturity Onset Diabetes of the Young (MODY) Kristine M. Welsh MSN, RN, CPNP Endocrinology, Nemours/A.I. duPont Hospital for Children, Wilmington, DE
Background: MODY is a group of monogenic disorders that account for approximately 2-5% of all diabetes cases. MODY is often misdiagnosed as Type 1 (T1DM) or Type 2 (T2DM) diabetes. Some forms of MODY are sulfonylurea sensitive. Microvascular and macrovascular complications are found in varying degrees based on MODY type. Therefore, correct diagnosis may impact treatment, surveillance for complications, and the need for family screening and genetic counseling.
366
Abstracts of the 2016 Pediatric Endocrinology Nursing Society Conference
Purpose: Provide current information on types of MODY, screening guidelines, and treatment options. Description of Topic: Monogenic diabetes is a rare group of disorders characterized by pancreatic beta cell dysfunction and hyperglycemia caused by genetic defects in single genes. Many features of MODY are similar to other forms of diabetes, leading to frequent misdiagnosis as T1DM or T2DM. The most common MODY gene mutations are those in hepatocyte nuclear factor 4 alpha (HNF4A, MODY 1), glucokinase (GCK, MODY 2), and hepatocyte nuclear factor 1 alpha (HNF1A, MODY 3). Suspicion for MODY should be raised when an individual diagnosed with T1DM or T2DM has features that are not typical for these polygenic disorders. Such features include negative pancreatic autoantibodies, evidence of endogenous insulin production beyond the honeymoon period in T1DM, diagnosis of T2DM in a young, non-obese person without signs of insulin resistance, as well as family history of diabetes in two or more generations in an autosomal dominant pattern. Molecular genetic testing for MODY should be performed in phenotypic patients. Targeted next generation sequencing allows for sensitive, quicker, and more cost-effective analysis of many genes concurrently when compared to traditional Sanger sequencing. Clinical Implications: It is estimated that 95% of MODY cases in the US are misdiagnosed. This staggering statistic represents an incredible opportunity to improve patient care with more accurate diagnosis that can translate to more precise and less invasive treatment, cost efficiency, as well as improved patient satisfaction and quality of life. http://dx.doi.org/10.1016/j.pedn.2016.03.010
Decrease Risk of Obesity and Diabetes: Upstream Healthy Eating Morgan Meyer BSN, Casey Almeido BSN, Jasmine Cobb BSN, Tara Ewell BSN, Taylor Hamilton BSN, Ar'Tavia Harris BSN, Cheryl Leisy BSN, Katie O'Donnell BSN, Natalie Rutter BSN, Jessica Urquhart BSN, Carol J. Howe PhD, RN, CDE Texas Christian University, Fort Worth, Texas
Background: More than one third of children and adolescents are overweight or obese and the prevalence of type 2 diabetes is increasing in the pediatric population. Minority children are at higher risk than nonHispanic white children for obesity and developing diabetes. My Plate and USDA guidelines advocate for healthy eating, including an increase in consumption in vegetables and fruits. Children, however, often resist or dislike eating vegetables. Purpose: The purpose of this project was to promote healthy eating habits to decrease the risk of obesity and diabetes in the students and staff at an elementary school in North Texas. Description of Topic: Using the Healthy People 2020 framework “MAPIT”, ten senior public health nursing students with their faculty mobilized partners at the school, completed a community assessment (Windshield and School Sector Survey), planned and implemented a USDA ‘Try Day’, and tracked outcomes. The program included exposing 1st to 8th grade students to different vegetable options during their lunch periods, a healthy eating and diabetes awareness presentation for the teachers, and email updates to parents. Objectives, lessons plans, and evaluation goals were created. Children progressively increased their willingness to try vegetables from first through sixth grade. From sixth to eight grade, the willingness to try vegetables noticeably dropped. Children rejected high textured foods such as hummus. A class competition added incentive for the students to try the vegetables. Clinical Implications: Pediatric Endocrine nurses may have more opportunities to contribute to preventative efforts as more emphasis is put
on public health nursing. Future partnerships with school nurses to plan and implement upstream approaches may decrease the risk of obesity and diabetes development in children. In these efforts, pediatric endocrine nurses should know there are a tremendous amount of resources, including the USDA guidelines, which provide several project ideas. This project represents one of many healthy eating interventions. http://dx.doi.org/10.1016/j.pedn.2016.03.011
Nurse-Monitored Calcium Protocol Halts Hypocalcemia in Total and Completion Thyroidectomy Patients Jennifer Abernathy BSN, Ioanna Athanassaki MD Texas Children’s Hospital, Houston, TX
Background: Hypocalcemia (serum calcium b8 mg/dl) is the most common complication after total and completion thyroidectomy. While the condition may be transient, hypocalcemia can prolong hospitalization or cause hospital readmission. Hypocalcemia in the acute care setting may necessitate intravenous calcium which requires careful monitoring due to potential tissue necrosis should extravasation occur. Additionally, if intravenous calcium is administered rapidly, cardiotoxicity can result. Preventing post-operative hypocalcemia is one important indicator of a successful surgical outcome. Purpose: The purpose of this nurse-monitored calcium protocol is to reduce the risk of hypocalcemia in the post-operative period, thus avoiding the need for intravenous calcium while in the hospital and preventing readmission for symptomatic hypocalcemia. Description of Topic: At the Thyroid Tumor Program at Texas Children’s Hospital in Houston, Texas, a protocol was designed and implemented in which pediatric patients undergoing a total or completion thyroidectomy would receive calcium and calcitriol before and after surgery. Patients are instructed by the endocrine nurse to begin calcium carbonate 30 mg/kg/day and calcitriol 0.5 mcg daily for one week prior to surgery. The nurse also calls the day before surgery to remind the patient to take calcium and calcitriol the morning of surgery. Based on the calcium protocol outlining safe levels for pediatric patients and the corresponding treatment, the patient is discharged home the first day postoperatively with daily dosing instructions for calcium carbonate and calcitriol in the first week. The endocrine nurse monitors the patient’s weekly labs and calls the family to wean the calcium and calcitriol based on the established protocol. This process continues for approximately four to six weeks. The weekly communication increases compliance to the medication regimen and lab draws. Clinical Implications: The pediatric endocrine nurse acts as an advocate for the patient’s family to ensure that the patient avoids postsurgical hypocalcemia and potential complications. When the nurse plays an active role in implementing the perioperative calcium protocol and monitoring calcium levels, compliance increases and the risk of potential complications decreases. http://dx.doi.org/10.1016/j.pedn.2016.03.012
Nursing Research Development and Psychometric Testing of the Neonatal Growth Measurement Survey Jan M. Foote DNP, ARNP, CPNP (Co-PI)a,b, Kirsten Hanrahan DNP, ARNP, CPNP (Co-PI)c, Pamela Mulder PhD, RNa, Anne Bye BSN, RNa, Amelia Fleming BSN, RNa, Maria Hein MSWa, Yelena Perkhounkova PhDa, Nicole L. Bohr MSN, RNa, Ann Marie McCarthy PhD, RN, PNPa a University of Iowa College of Nursing, Iowa City, IA b Blank Children's Hospital, Des Moines, IA c University of Iowa Hospitals and Clinics, Iowa City, IA