# A nurse is caring for a 10-year-old child who has been diagnosed with growth hormone deficiency and is receiving growth hormone therapy. Which nursing intervention is most important to include in the child's care plan? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542032 > language: ko > subject: Child Health ## 문제 A nurse is caring for a 10-year-old child who has been diagnosed with growth hormone deficiency and is receiving growth hormone therapy. Which nursing intervention is most important to include in the child's care plan? ## 보기 1. Monitor the child's height and weight monthly and maintain accurate growth charts **✔ 정답** 2. Administer growth hormone injections only during daytime hours 3. Restrict the child's physical activity to prevent injury 4. Encourage a high-calorie, high-fat diet to promote weight gain **정답: 1** ## 해설 Monitoring height and weight monthly is essential to evaluate treatment effectiveness and adjust dosages in growth hormone therapy. Other options are not priority interventions. ## 심화 해설 Understanding Growth Hormone Deficiency and Therapy Growth hormone (GH) is essential for linear bone growth, protein synthesis, and metabolic regulation. In a child with growth hormone deficiency, the pituitary gland fails to secrete adequate amounts of GH, resulting in short stature, delayed skeletal maturation, and a reduced growth velocity. The primary therapeutic goal of recombinant growth hormone therapy is to restore normal growth patterns and maximize final adult height. Why Monitoring Growth is the Priority The systematic review by Martín Pérez and Martín Pérez [1] emphasizes that the effectiveness of hormonal treatments in children with growth disorders is fundamentally assessed through changes in linear growth, skeletal maturation, and metabolic regulation. To determine whether the prescribed dose of growth hormone is achieving the desired therapeutic effect—or if it requires adjustment—the nurse must obtain objective, serial anthropometric data. Monitoring the child’s height and weight monthly and plotting these values on a standardized growth chart provides the clinical team with a dynamic view of the child's growth velocity. A positive change in the growth velocity percentile is the single most reliable indicator of treatment efficacy. Without this data, it is impossible to differentiate between a non-responder, a child requiring a dose titration, or a child developing complications such as insulin resistance, which can be an adverse effect of therapy. Analyzing the Incorrect Options - **Administering injections only during daytime hours** contradicts the physiological secretion pattern of growth hormone, which is predominantly released in a pulsatile manner during deep sleep. To mimic this endogenous rhythm and maximize therapeutic benefit, GH injections are typically administered at bedtime. Restricting administration to daytime hours would blunt this synergy and is not supported by clinical evidence. - **Restricting physical activity to prevent injury** is not indicated. Weight-bearing physical activity is actually encouraged because mechanical loading on the bones stimulates osteoblast activity and works synergistically with growth hormone to promote bone mineralization and linear growth. Unnecessary restriction would hinder musculoskeletal development and overall health. - **Encouraging a high-calorie, high-fat diet** is not a targeted intervention for growth hormone deficiency. While adequate nutrition is a prerequisite for growth, the goal is a balanced diet that supports lean body mass development, not excessive caloric intake that could lead to obesity and increased insulin resistance. Growth hormone therapy itself improves lean body mass and reduces adiposity; a high-fat diet would counteract this metabolic benefit. The core of safe and effective nursing care during growth hormone therapy lies in the systematic evaluation of the treatment's impact. Accurate growth charting is the foundational intervention that guides all subsequent clinical decisions regarding dosing and duration of therapy [1].References (research sources) - [1]Effectiveness and Safety of Hormonal Treatments in Children with Growth Disorders: A Systematic Review of Clinical Evidence.Meta-analysis/systematic reviewMartín Pérez IM, Martín Pérez SE. (2026) · DOI: 10.3390/clinpract16050096 ## 임상 시나리오 Clinical Practice Guide Pediatric Growth Hormone Therapy Monitoring Key Monitoring Parameters - Measure standing height using a calibrated stadiometer at the same time of day, preferably morning, to minimize diurnal variation in spinal compression. - Obtain weight using the same calibrated scale each visit, with the child in light clothing and without shoes. - Calculate growth velocity (cm/year) by comparing current height to measurements from 6-12 months prior; a minimum of 6 months of data is needed for reliable interpretation. - Plot all measurements on a condition-specific or standardized CDC/WHO growth chart, noting both absolute values and percentile trends. Injection Administration Best Practices - Administer recombinant growth hormone subcutaneously in the evening to mimic the body's natural nocturnal pulsatile secretion pattern. - Rotate injection sites (upper arms, thighs, buttocks, abdomen) systematically to prevent lipoatrophy or lipohypertrophy. - Ensure the family demonstrates proper reconstitution technique if using a multi-dose vial and needle/syringe system, or proper pen device loading. - Store medication according to manufacturer guidelines; most preparations require refrigeration (36-46 degrees Fahrenheit) and must not be frozen. Nutritional and Activity Guidance - Promote a balanced, age-appropriate diet rich in protein, calcium, and vitamin D to support bone mineralization and lean muscle development during catch-up growth. - Avoid prescribing high-calorie, high-fat diets that may cause disproportionate weight gain and increase the risk of insulin resistance, a known adverse effect of growth hormone therapy. - Encourage regular weight-bearing physical activity and play to stimulate bone remodeling and muscle strength; only high-impact collision sports require individualized risk assessment. Adverse Effect Surveillance - Monitor for signs of insulin resistance, including acanthosis nigricans, polydipsia, or polyuria; periodic fasting glucose or HbA1c may be indicated. - Assess for slipped capital femoral epiphysis (SCFE) by asking about new-onset hip or knee pain and observing gait for limping. - Evaluate for pseudotumor cerebri symptoms such as headache, vomiting, or visual changes, which require urgent ophthalmologic evaluation. - Check for injection site reactions, including redness, swelling, or nodules, and reinforce proper technique if issues arise. Family Education and Psychosocial Support - Teach families that growth response is gradual; a typical increase is 2-4 cm/year above pre-treatment velocity, and therapy often continues for several years until epiphyseal closure. - Address the child's emotional well-being by screening for bullying, low self-esteem, or social withdrawal related to short stature, and provide referrals to child life specialists or support groups. - Emphasize the critical importance of adherence; missed doses directly reduce annual growth achieved, and families should problem-solve barriers such as injection anxiety or scheduling conflicts. - Coordinate with the school nurse to ensure a plan is in place if doses must be administered during school hours or for field trips. ## 핵심 개념 - **Growth Hormone Deficiency** — A pituitary disorder where inadequate growth hormone secretion results in short stature, delayed bone age, and reduced growth velocity in children. - **Growth Velocity** — The rate of linear growth over time, typically expressed in cm/year, which is the primary indicator used to assess the effectiveness of growth hormone therapy. - **Recombinant Growth Hormone** — A biosynthetic form of human growth hormone used therapeutically to replace deficient endogenous hormone and stimulate linear growth. - **Anthropometric Data** — Objective measurements of the human body, such as height, weight, and head circumference, used to track growth and nutritional status. - **Standardized Growth Chart** — A percentile-based tool developed by organizations like the CDC or WHO used to plot a child's measurements and compare them to a reference population of the same age and sex. ## 같은 주제 문제 - [A nurse is assessing a 6-year-old child who is being evaluated for possible growth hormone…](https://mymerci.kr/pages/nclex_q.php?qn_id=542029) - [A nurse is assessing a 6-year-old child suspected of having growth hormone deficiency. 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