NURS 401: Ch. 48 (Ricci): Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder

The nurse is preparing to administer the child's ordered lispro (Humalog) insulin at 0800. When will the child's blood glucose level begin to decline? 0930 0845 0900 0815

0815 Explanation: The onset of rapid acting insulins like lispro (Humalog) is within 15 minutes. Short-acting insulin's onset is 30 to 60 minutes. Intermediate-acting insulin's onset is 1-3 hours, and long-acting insulin's onset is 1-2 hours.

A 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result? 7.5 % 7.0% 8.5% 6.5%

8.5% Explanation: The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.

A child is prescribed glargine (Lantus) insulin. What information would the nurse include when teaching the child and parents about this insulin? Give the dose first thing in the morning. Discard any opened vials after a week. Store the insulin in the refrigerator until just before giving it. Do not mix this insulin with other insulins.

Do not mix this insulin with other insulins. Explanation: Glargine (Lantus) is not to be mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.

The nurse is teaching a child with type 1 diabetes mellitus to administer insulin. The child is receiving a combination of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when the child: administers the insulin into a doll at a 30-degree angle. wipes off the needle with an alcohol swab. draws up the short-acting insulin into the syringe first. administers the insulin intramuscularly into rotating sites.

Draws up the short-acting insulin into the syringe first. Explanation: Drawing up the short-acting insulin first prevents mixing a long-acting form into the vial of short-acting insulin. This maintains the short-acting insulin for an emergency. Insulin is given subcutaneously not intramuscularly. A SQ injection is administered at a 90-degree angle if the person can grasp 2 in (5 cm) of skin. If only 1 in (2.5 cm) of skin can be grasped, then the injection should be given at a 45 degree angle. The needle is sterile. It should not be wiped with an alcohol swab. Only the top of the insulin vial should be wiped with an alcohol swab.

A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver? Metformin Glipizide Glyburide Nateglinide

Metformin Explanation: Metformin, a biguanide, reduces glucose production from the liver. Glipizide stimulates insulin secretion by increasing the response of β cells to glucose. Glyburide stimulates insulin secretion by increasing the response of β cells to glucose. Nateglinide stimulates insulin secretion by increasing the response of β cells to glucose.

A 7-year-old child who has type 1 diabetes mellitus is at school reporting a headache and dizziness. The school nurse notices sweat on the child's face. What should the nurse do first? Give rapid-acting insulin Offer the child 8 ounces of juice or soda Give glucagon IM Offer the child 8 ounces of water

Offer the child 8 ounces of juice or soda Explanation: These are symptoms of hypoglycemia. Glucagon is given only for severe hypoglycemia. Juice or soda is the best choice to get the child an immediate source of carbohydrates. Insulin or water would be given for hyperglycemia.

Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply. Polyphagia Abrupt onset of symptoms Polyuria Marked weight loss Polydipsia

Polyuria Polydipsia Polyphagia Explanation: Type 2 diabetes mellitus is characterized by a gradual onset and is most often associated with obesity and not marked weight loss. Type 1 diabetes is most often abrupt and associated with marked weight loss. Polyuria, polydipsia, and polyphagia are frequent assessment findings in both types of diabetes mellitus.

The nurse working with the child diagnosed with type 2 diabetes mellitus recognizes that mostoften the disorder can be managed by: Taking oral hypoglycemic agents Decreasing amounts of daily insulin Increasing protein in the diet, especially in the evening Conserving energy with rest periods during the day

Taking oral hypoglycemic agents Explanation: If the child presents with diabetic ketoacidosis, initial treatment is insulin administration, but then oral hypoglycemic agents such as metformin are often effective for controlling blood glucose levels. Lifestyle changes such as weight loss and increased exercise are important aspects of treatment for the child.

A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? Syndrome of inappropriate diuretic hormone Type 1 diabetes mellitus Hypothyroidism Diabetes insipidus

Type 1 diabetes mellitus Explanation: Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphasia, enuresis, and weight loss.

An elementary school child takes metformin (Glucophage) three times each day. Which of the following disorders would the school nurse expect the child to have? Inflammatory bowel disorder Gastrointestinal reflux Type 2 DM Type 1 DM

Type 2 DM Explanation: Metformin is the common treatment to manage type 2 DM. Insulin, not oral medication, is the treatment of choice for type 1 DM. Metoclopramide is the treatment for GI reflux. Methylprednisolone is used to treat inflammatory bowel disease.

A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus? proteinuria glucose in the urine a fasting blood glucose greater than 126 mg/dL a fasting blood glucose leass than 126 mg/dL

a fasting blood glucose greater than 126 mg/dL Explanation: A fasting blood glucose greater than 126 mg/dL is diagnostic for diabetes mellitus.

What should be included in the teaching plan for a child with type 1 diabetes mellitus who is going home on insulin therapy? Children show an increased need for insulin during the first months after glucose control is established. Once glucose control is established, there will never be a need for an increase in the amount of insulin administered. All children should be on at least two types of insulin to establish glucose control. It is absolutely normal for the growing child to require an increase in insulin; this does not mean his/her condition is getting worse.

It is absolutely normal for the growing child to require an increase in insulin; this does not mean his/her condition is getting worse. Explanation: Children show a decreased need for insulin shortly after glucose control has been established, which is referred to by some as the "honeymoon phase" and should be described to parents so that they do not get any false hope that the child does not need insulin. As children grow, they will require increased doses of insulin to maintain glucose control, and not all children need to receive two types of insulin. Insulin treatment should be based on each individual child.

A 7-year-old cjo;d is diagnosed as having type 1 diabetes. What is one of the first symptoms usually noticed by parents when this illness develops? swelling of soft tissue craving for sweets loss of weight severe itching

loss of weight Explanation: The classic signs of type 1 diabetes are polydipsia, polyuria, and polyphagia. With polyphagia, the child has an increased appetite and an increased hunger, and the child eats all the time but is losing weight. This occurs because the lack of energy sugar supplies cause the muscle tissues and the fat stores to shrink. The lack of insulin also reduces the ability of the body's cells to use glucose. This leads to starvation of the cells. Loss of weight is an early symptom parents see first. They tend to equate the increased appetite as normal with growing, but become concerned when the child starts losing weight even though the child is eating. Itching and swelling are not signs of diabetes. A craving for sweets is normal for a child, especially one who is growing rapidly.