Endocrine Dysfunction

What are the manifestations of hypoglycemia?

shaky feelings; dizziness; difficulty concentrating, speaking, focusing, and coordinating; sweating; and pallor.

What symptoms are considered a cardinal sign of diabetes mellitus?

Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia.

Long-acting insulin

Lantus takes 6 to 14 hours to start working. It has no peak or a very small peak 10 to 16 hours after injection. The insulin stays in the blood between 20 and 24 hours.

What are the manifestations of hyperglycemia?

Lethargy, thirst, and nausea and vomiting

Rapid-acting insulin

NovoLog: reaches the blood within 15 minutes after injection. The insulin peaks 30 to 90 minutes later and may last as long as 5 hours

Intermediate-acting insulins

Novolin N reach the blood 2 to 6 hours after injection. The insulins peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours.

Short-acting

Rregular insulin (Novolin R) reaches the blood within 30 minutes after injection. The insulin peaks 2 to 4 hours later and stays in the blood for 4 to 8 hours

Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin b. Weight gain c. Fluid overload d.Poor wound healing

d. Poor wound healing Poor wound healing is often an early sign of type 1 diabetes mellitus. Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus.

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should provide the parents with what information to address the child's safety needs?

Exercise lowers blood glucose levels, which can be compensated for by extra snacks. Exercise is encouraged unless indicated by other health conditions. Extra insulin is contraindicated because exercise decreases blood glucose levels.

Kussmaul respirations

Hyperventilation that is characteristic of metabolic acidosis; occurs as a result of the respiratory system attempting to eliminate excess carbon dioxide by increased depth and rate of respirations.

The nurse is implementing care for a school-age child admitted to the pediatric intensive care experiencing symptomology associated with diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first? a. Begin 0.9% saline solution intravenously as prescribed. b. Administer regular insulin intravenously as prescribed. c. Place child on a cardiac monitor. d. Place child on a pulse oximetry monitor.

a. Begin 0.9% saline solution intravenously as prescribed. All patients with DKA experience dehydration (10% of total body weight in severe ketoacidosis) because of the osmotic diuresis, accompanied by depletion of electrolytes (sodium, potassium, chloride, phosphate, and magnesium). The initial hydrating solution is 0.9% saline solution. Insulin therapy should be started after the initial rehydration bolus because serum glucose levels fall rapidly after volume expansion. The child should be placed on the cardiac and pulse oximetry monitors after the rehydrating solution has been initiated.

The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. What should be included in the teaching plan for daily injections? a. The parents do not need to learn the procedure. b. He is old enough to give most of his own injections. c. Self-injections will be possible when he is closer to adolescence. d. He can learn about self-injections when he is able to reach all injection sites.

b. He is old enough to give most of his own injections. School-age children are able to give their own injections. Parents should participate in learning and giving the insulin injections. He is already old enough to administer his own insulin. The child is able to use thighs, abdomen, part of the hip, and arm. Assistance can be obtained if other sites are used.

What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? a. Give the child half his regular morning dose of insulin. b. Substitute simple carbohydrates or calorie-containing liquids for solid foods. c. Give the child plenty of unsweetened, clear liquids to prevent dehydration. d. Take the child directly to the emergency department.

b. Substitute simple carbohydrates or calorie-containing liquids for solid foods. A sick-day diet of simple carbohydrates or calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia. The child should receive his regular dose of insulin even if he does not have an appetite. If the child is not eating as usual, he needs calories to prevent hypoglycemia. During periods of minor illness, the child with type 1 diabetes mellitus can be managed safely at home.

What is the characteristic of the immune-mediated type 1 diabetes mellitus? a. Ketoacidosis is infrequent b. Onset is gradual c. Age at onset is usually younger than 18 years d. Oral agents are often effective for treatment

c. Age at onset is usually younger than 18 years

To help the adolescent deal with diabetes, the nurse must consider which characteristic of adolescence? a. Desire to be unique b. Preoccupation with the future c. Need to be perfect and similar to peers d. Need to make peers aware of the seriousness of hypoglycemic reactions

c. Need to be perfect and similar to peers

The nurse is discussing various sites used for insulin injections with a child and her family. Which site usually has the fastest rate of absorption? a. Arm b. Leg c. Buttock d. Abdomen

d. Abdomen The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of absorption and the longest duration.

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by: a. saturated and unsaturated fat. b. fruit juice. c. several glasses of water. d. complex carbohydrate and protein.

d. complex carbohydrate and protein. Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Saturated and unsaturated fat, fruit juice, and several glasses of water do not provide the child with complex carbohydrate and protein necessary to stabilize the blood sugar.