The Child with a Metabolic Condition Chapter 31

What is the most reliable test to diagnose diabetes mellitus?

Fasting blood glucose

What are signs and symptoms of hyperglycemia?

Fruity breath, abdominal pain, and deep, rapid respiration.

Children with diabetes mellitus have problems associated with their stage of growth and development. What is one problem a toddler might have?

hydration

Children with diabetes mellitus have problems associated with their stage of growth and development. What is one problem an infant might have?

hydration

What disease is type 1 diabetes considered to be?

Autoimmune

How is the pattern of inheritance of inborn errors of metabolism is most often seen?

Autosomal recessive

What information would the nurse include when speaking to expectant parents about Tay-Sachs disease?

Carriers can be identified by a screen test. Tay-Sachs disease involves a deficiency of hexosaminidase, an enzyme necessary for the metabolism of fats. The cause is well known. Lipid deposits accumulate on nerve cells, causing both physical and mental deterioration, even if diagnosed early.

What are the 3 goals of nutritional management for the child with type 1 diabetes mellitus?

1. Ensure normal growth and development. 2. Distribute food intake so that it aids metabolic control. 3. Individualize the diet according to the child's ethnic background, age, sex, weight, activity, and food preferences.

What are the 3 reasons why a child is more prone to insulin shock than an adult?

1. The condition is more unstable in young people. 2. They are growing. 3. Their activities are more irregular.

What are 2 foot precautions in the foot care of child with diabetes?

1. Wash and dry well each day, nails are trimmed straight across. 2. Socks are changed daily and feet are washed and dried daily.

What is the immediate treatment for a child suspected of having an insulin reaction?

Administer sugar in some form, such as orange juice, hard candy, raisins, or a commercial product.

What is a characteristic common type 1 diabetes mellitus?

Always requires insulin therapy. Type 1 DM was formerly known as insulin-dependent diabetes mellitus. When beta cells are destroyed, the person is insulin dependent for the rest of his/her life. When type 1 is initially diagnosed and the child is stabilized by insulin dosage, the condition may appear to improve. Blood glucose fluctuations will continue to be a problem without regular insulin. Type 1 diabetes is not more common in preschool children nor in obese individuals.

When is screening for hypothyroidism done for all infants?

At birth.

What is the physiology diabetes mellitus?

Diabetes mellitus is a chronic metabolic condition in which the body is unable to use carbohydrates properly because of a deficiency of insulin, an internal secretion of the beta cells of the pancreas. This leads to an impairment of glucose transport.

Type 2 diabetes mellitus is increased in pubescent children. What are the 2 possible causes of the increase?

During puberty, rapid growth, increased emotional stress, and insulin antagonism of sex hormones may be implicated as contributing to development of diabetes.

What is essential to prevent permanent sequelae associated with congenital hypothyroidism?

Early recognition and diagnosis so treatment can be initialed administration of the synthetic hormone sodium levothyroxine.

What are the 3 goals of treatment in typos 1 diabetes mellitus?

Ensure normal growth and development. Enable the child to cope with a chronic illness, have a happy, active life, and be integrated into the family. Prevent family complications.

Is children with type 1 diabetes mellitus require special foods?

False

Is the symptoms of diabetes mellitus appear more slowly in children?

False

Is water intake should be limited for the child with diabetes insipidus?

False

What is recommended for the treatment of severe hypoglycemia?

Glucagon

What is glycosuria?

Glycosuria means glucose in the urine.

What test measures glycemic levels over a period of months?

Glycosylated hemoglobin test (HbA1C)

Children with diabetes mellitus have problems associated with their stage of growth and development. What is one problem a school age child?

Grief over diagnosis, get attention, avoid responsibility.

What are some signs and symptoms of hypoglycemia?

Headache, diaphoresis, and tremors.

What is hormones?

Hormones are chemical substances produced by glands.

What is hyperglycemia?

Hyperglycemia is higher than normal glucose in the blood.

What is the pathophysiology of diabetes insidious?

Hypofunciton of the posterior pituitary that results in decreased secretion of vasopressin or antidiuretic hormone. This results in uncontrolled diuretic.

What is hypoglycemia?

Hypoglycemia means lower than normal glucose in the blood.

In general, a child can be taught to perform self injection after what age?

In general, most 7-year-old children have the motor and cognitive abilities to administer their own insulin. Ages 3 and 5 are far too young, and waiting until adolescence is poor timing in most cases because it requires unnecessary dependence on the parent or caretaker a challenging issue in adolescence. In addition, adolescents struggle with less-than-perfect body images, and if self injection is yet another new thing, it can have a negative emotional impact that it will not have if the teen has been used to it and it has become second nature.

The nurse determines a parent understands teaching about hypoglycemia when he identifies which as a cause of hypoglycemia in children?

Insulin shock, also known as hypoglycemia, occurs when the blood glucose level becomes abnormally low. This condition is caused by too much insulin, not too little. Factors that may account for this imbalance include poorly planned exercise, reduced diet rather than excess food, and errors made because of improper knowledge of insulin and the insulin syringe. It is not specifically linked to GI illnesses.

Children with diabetes mellitus have problems associated with their stage of growth and development. What is one problem a preschool child?

Irregular activity and eating patterns.

The nurse recognizes a child with type 1 diabetes mellitus is having an insulin reaction when which signs occurs?

Irritable, pale, and weak. The symptoms of an insulin reaction appear suddenly in the otherwise well person. The child becomes irritable, not passive; may behave poorly; is pale; and may complain of feeling hungry, not anorexic and weak. Sweating occurs, but flushed or red skin is not apparent. Symptoms related to disorders of the nervous system arise because glucose is vital to the proper functioning of nerves. The child may become mentally confused and giddy, and muscular coordination is affected.

What is Kussmaul's respiration?

Kussmaul's respiration is a type of respiration seen in diabetic ketoacidosis.

What are the 4 early signs of inborn errors of metabolism in a newborn?

Lethargy, poor feeding, failure to thrive, vomiting, and an enlarged liver may be early signs of an inborn error of metabolism in the newborn.

What is the best immediate food choice for the nurse to give a child having an insulin reaction?

Low blood sugar occurs with insulin reaction. Orange juice is a high-carbohydrate food that can quickly raise the blood sugar. It should be followed by a starch and protein snack. Diet soda is counterproductive, lacking all carbohydrates, and unsalted crackers or apple slices are not absorbed rapidly enough; nor are they high enough in carbohydrates.

What information would the nurse include in teaching about thyroid hormone replacement for children with hypothyroidism?

Medication is continued for the duration of the child's life. Thyroid hormone replacement may take 1-3 weeks for the medication to reach the full therapeutic effect, not 3 months. Medication is not to be discontinued because hormone replacement for hypothyroidism is lifelong. It does not cause excessive hair growth, and lethargy and constipation are not signs of overdosage

What information would the nurse give to parents about medication for the treatment of hypothyroidism?

Medication is lifelong and cannot be discontinued. It should be taken at the same time each day, preferable in the morning. It may take a few weeks to reach the full therapeutic effect. Should not interchange brands. Parents should be taught signs of overdose.

What would the nurse teach parents about administering DDAVP nasal spray to a child with diabetes insipidus?

Monitor for signs of overdoseage, which includes signs of water intoxication such as edema, lethargy, nausea, CNS signs. The child should wear a medical identification bracelet. Parents must advise school personnel about the childs need to have access to bathrooms and water fountains.

When mixing insulin, does the nurse draws up the longest acting insulin into the syringe first?

No

The honeymoon period after diagnosis of type 1 diabetes in the child may result in what?

Parental denial of child's need for lifetime insulin. As metabolic control improves with insulin therapy, the dosage needs may temporarily decrease and the child's condition improves. This leads parents to deny that their child has a permanent disorder that will require lifelong therapy.

What are the initial signs of diabetes insipidus?

Polydipsia and polyuria

What is an initial sign of diabetes insipidus?

Polydipsia and polyuria are initial signs of diabetes insipidus; polyphagia and hyperglycemia are not initial signs. Perspiration is deficient (not excessive), and the skin is dry.

What is polydipsia?

Polydipsia means excessive thirst.

What are the 3 P's of type 1 diabetes mellitus?

Polydipsia, Polyphagia, Polyuria

What is polyphagia?

Polyphagia means excessive thirst.

The nurse determines a parents of a child with diabetes insipidus requires additional teaching when she says a sign of water intoxication is?

Polyuria is the only symptom here not associated with water intoxication. Parents should be taught to monitor for signs of overdose, which include symptoms of water intoxication include edema, lethargy, nausea, central nervous system signs.

Children with diabetes mellitus have problems associated with their stage of growth and development. What is one problem a adolescent?

Resent condition, insulin adjustments related to growth and presence of sex hormone effects, emotional conflicts in body image and dependence/independence.

What is regular insulin considered?

Short acting.

The nurse would teach a child with type 1 diabetes mellitus to check urine for acetone when he is what?

Sick. Accurate glucose blood monitoring does not test for acetone, which the patient may need to determine, particularly during illness and when the blood glucose level is high. It is not needed every time the child exercises, eats, or has a growth spurt.

What are the manifestations of hypothyroidism?

Sluggishness or sleepiness, enlarged tongue, dry skin, cold hands and feet, hypotonia, chronic constipation, and dry brittle hair.

The nurse should recognize what sign of diabetic ketoacidosis?

Some signs of diabetic ketoacidosis include Kussmaul's respirations are deep, rapid breathing, as well as fatigue and drowsiness progressing to coma which means not hyperactivity; red lips, flushed face. Increased heart rate, or tachycardia, is a symptom of hypoglycemia, not ketoacidosis

What is Somogyi phenomenon?

Somogyi phenomenon is rebound hyperglycemia occurring when blood glucose levels are lowered to a point at which the body's counterregulatory hormones are released. Hypoglycemia during the night and high glucose levels in the morning are suggestive of the phenomenon.

Genetic testing and prenatal counseling have markedly decreased the occurrence of what disease?

Tay-Sachs disease

When a child with diabetes plans to travel, what should be done prior to and during the trip?

The child should be seen by a physician prior to the trip. The child should carry a card identifying as a diabetic. Additional supplies of insulin, sugar, glucagon, and food should be kept with the child. It foreign travel is planned, parents need to be familiar with food in the new area.

Describe insulin injection site rotation.

The site of injection is rotated to prevent poor absorption and injury to tissues. One pattern is to use one area for 1 week. For each injection, a different site within the area is used. The injection should be about 1 inch apart. Sites in areas of temporarily increased circulation should be avoided.

Does exercise lowers blood glucose levels?

True

Human insulin manufactured by biosynthesis is the treatment of choice for type 1 diabetes mellitus.

True

If left untreated, congenital hypothyroidism can result in intellectual disability.

True

Is child with type 1 diabetes mellitus able to participate in almost all sports activities?

True

Which type of diabetes mellitus is resistance to insulin?

Type 2 diabetes

What should the nurse teaching parents about type 2 diabetes mellitus explain that it is associated with insulin?

Type 2 diabetes is thought to be caused by insulin resistance and decreased insulin secretion. It is precipitated by obesity, low physical activity, and a lipid-rich diet resulting in insulin resistance. It is not caused by insulin overproduction, sensitivity, or deficiency.

What is the standard form of insulin?

U-100

What is the most common concentration of insulin?

U100 insulin