HESI RN Case Study Diabetes Type 1
The nurse must briefly explain to the parents what is occurring in Anya's body. What is the best explanation by the nurse?
"The body is not able to make enough insulin and your child will need to take injections." Type 1 diabetes mellitus is an auto-immune disease caused by the destruction of insulin-producing pancreatic β cells. The client is unable to make insulin and will require insulin injections for the rest of their life.
The client's dehydration and ketoacidosis are corrected and the client is discharged. When planning for the client's discharge, which priority topics should the nurse include when providing family teaching?
-Adjust insulin dosages in the presence of illness. The parents must know how to adjust the dosage of insulin according to the blood glucose level, carbohydrate intake, illness, and activity level of the child. -Detect signs of hypoglycemia. Parents must know the signs of hypoglycemia in order to prevent an insulin overdose. -Encourage healthy eating Treatment consists of glucose monitoring, insulin therapy, observing for common problems, and encouraging healthy eating and physical activity. Concentrated sweets are discouraged. Avoid high-sugar, high-carbohydrate foods to prevent hyperglycemia, and to maintain consistent blood sugar levels.
Which of the following topics are important for the nurse to include in teaching provided to the client and parents?
-Teach the client and parents to do carbohydrate counting and make appropriate food choices. It is important for the client to receive the proper ratio of carbohydrates to insulin, and to know how to choose a fast-acting carb when blood glucose is low and a low-carbohydrate snack when blood sugar is high. The child should be cautioned to avoid high-fat and high-sugar/high-carbohydrate items, and she and her family must insist upon healthy eating. -Teach the client and parents how to recognize the signs and symptoms of hypoglycemia and hyperglycemia. It is important for the client to notify her parents of any symptoms, and it is equally important for the parents to recognize the signs and symptoms of hypoglycemia and hyperglycemia. -Teach the client to do independent blood glucose testing with supervision. It is important that the client learns to test blood glucose independently, but supervision is still required. Self-management is the ultimate goal for children with diabetes. -Teach the client and parents how to test urine for ketones. It is important for the client and parents to know when to test for ketones to prevent diabetic ketoacidosis.
Which insulin regimen would Anya use at bedtime?
1 dose of intermediate insulin
What is the most appropriate answer from the nurse?
The abdomen is the most appropriate site
When planning for Anya's discharge, which priority topics should the nurse include in the teaching plan?
The adjustment of insulin dosages in the presence of illness Detection signs of hypoglycemia
According to Erikson, to meet the psychosocial needs of a 5-year-old child in relation to a diagnosis of diabetes, which of the following should the nurse implement?
Allow the client to check blood glucose levels independently whenever possible. This meets the psychosocial needs of a 5 to 8-year-old. According to Erikson, this stage of development is initiative vs. guilt. This stage focuses on children's abilities, helping them make realistic and appropriate choices, to allow independence.
What nursing action provides the most complete health profile for this family?
Complete a genome and ecomap of the family
To elicit this information, what is the most appropriate action by the nurse?
Discuss with the family about their current lifestyle
Considering the potential problem of hypoglycemia, what nursing intervention has the highest priority?
Emphasize the importance of frequent blood glucose monitoring. The frequent monitoring of blood glucose helps to establish an appropriate dosage of insulin and can prevent episodes of hypoglycemia.
In the presence of this potential problem, what advice is best for the nurse to give Anya's parents?
Give the child apple juice
The client is very drowsy so the mother performs a blood glucose check. The result is 42. The test is repeated by the nurse, who gets the same result. Which of the following actions are appropriate?
Give the client 4 oz of apple juice. Apple juice will raise blood sugar quickly. If the client is unable to drink the apple juice, glucagon will be used. Give the client 0.5 mg of glucagon This is an appropriate action for a child with very low blood glucose.
What test does the nurse understand to be the most accurate in establishing if Anya's diabetes is well controlled?
Glycosylated Hemoglobin
Which immunizations would the nurse anticipate administering to Anya?
IVP, MMR, Varicella, & DtaP (appropriate for 4-6 years of age)
Anya's initial plan of treatment includes 3 main elements. What elements are implemented by the interdisciplinary team?
Insulin therapy, supervision, and nutrition
What approach to care is most indicated for Anya and her parents?
Management of care is a collaboration between members of an interdisciplinary team
What assessment findings would indicate to the nurse that the client's goal is being met?
Measure Anya's weight and height on a regularly scheduled basis
Which assessment findings are consistent with this diagnosis? (DKA)
Nausea, fruity breath, & ketonuria
Which diagnostic assessment tool will provide the nurse with the most information related to Anya's level of consciousness?
Pediatric coma scale
When providing care for Anya, which intervention has the highest priority?
Placing an intravenous line
Headaches & Dizziness Based on these complaints, what nursing diagnosis has the highest priority?
Risk for hypoglycemia related to the illness
When establishing the nursing plan of care, what is the most significant potential problem related to this new diagnosis?
Risk for hypoglycemia related to the illness.
What element is essential to considering when teaching to Anya
Stage of development
When evaluating the effectiveness of parental education, what result demonstrates an understanding of the care of a child with diabetes?
The parents can describe the importance of insulin and demonstrate the correct technique for injections. A demonstration by the parents of their knowledge of insulin and their ability to perform injections is an indicator of an understanding of the care of a child with diabetes.
At the first follow-up visit, the client's parents state that they have administered the injections, but they confess that they are uncomfortable giving the injections for fear of harming their child. What nursing intervention has the highest priority at this time?
Validating their concerns and understanding their level of knowledge and comfort will provide a baseline to begin intervention. Learning to give insulin injections is a source of anxiety for both parents and children. It is helpful for the learner to know that this important aspect of care will become as routine as brushing the teeth.
Which assessment findings are of concern to the nurse?
Vision results 20/50 Ketones +2 in the urine Serum Glucose of 210mg/dL
