Ricci CH 48 (Pediatric diabetes)
A nurse who is caring for a 7-year-old is providing client education to the child and caregiver. Which response by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 diabetes mellitus? "We will just have our child exercise and take medicine to cure this." "I will just feed my child healthy foods and sign her up for more sports." "Her body fights against the insulin." "Her body doesn't have any insulin."
"Her body doesn't have any insulin." Type 1 diabetes mellitus (DM) is a disorder in which the child's body has a deficiency of insulin; children with type 1 DM cannot produce insulin. Type 2 DM is controlled through diet, medicine, and exercise. Type 2 DM can be prevented through diet and exercise, but type 1 DM cannot. Resistance to insulin is not the primary factor in type 1 DM.
The nurse is teaching a group of caregivers of children diagnosed with diabetes. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur? "If my child eats as much as their older brother eats they could have an insulin reaction." "My child measures their own medication but sometimes doesn't administer the correct amount." "My child monitors their glucose levels to keep them from going too high." "On the weekends we encourage our child to participate in lots of sports activities and stay busy so they don't have an insulin reaction."
"My child measures their own medication but sometimes doesn't administer the correct amount." Insulin reaction (insulin shock, hypoglycemia) is caused by insulin overload, resulting in too-rapid metabolism of the body's glucose. This may be attributable to a change in the body's requirement, carelessness in diet (such as failure to eat proper amounts of food), an error in insulin measurement, or excessive exercise.
A 9-year-old was just diagnosed with type 1 diabetes. The parents state, "We hope our child won't have to take insulin injections." How should the nurse respond? "The pancreas doesn't produce insulin in Type 1 diabetes, so it is likely that insulin injections will be necessary." "It is very early in the diagnosis process. Let's wait to see if insulin will be necessary." "Sometimes oral hypoglycemic agents are all that is necessary. Hopefully that will be the case with your child." "You will have to trust whatever the doctor decides to order."
"The pancreas doesn't produce insulin in Type 1 diabetes, so it is likely that insulin injections will be necessary." Since the diagnosis has been made for type 1 DM, insulin will be necessary. Insulin is used for DM to replace the body's natural insulin, which is necessary for proper glucose use.
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? 0815 0845 0900 0930
0815 The onset of rapid acting insulins like lispro (Humalog) is within 15 minutes. The onset of short-acting insulin is 30 to 60 minutes. The onset of intermediate-acting insulin is 1-3 hours, and long-acting insulin's onset is 1-2 hours.
The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which action would be the most appropriate for the school nurse to take? Request that someone call 911. Administer subcutaneous glucagon. Anticipate that the child will need intravenous glucose. Dissolve a piece of candy in the child's mouth.
Administer subcutaneous glucagon. If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child.
A nurse is reviewing with an 8-year-old how to self-administer insulin. Which of the following is the proper injection technique for insulin injections? Place the needle with the bevel facing down before the injection. Spread the skin before the injection. Aspirate the syringe for blood return before the injection. Elevate the subcutaneous tissue before the injection.
Elevate the subcutaneous tissue before the injection. Insulin injections are always given subcutaneously. Elevating the skin tissue prevents injection into muscles when subcutaneous injections are given. The needle bevel should face upward. The skin is spread in intramuscular, not subcutaneous, injections. It is no longer recommended to aspirate blood for subcutaneous injections.
A child has been prescribed desmopressin acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse? Desmopressin acetate works on your pancreas to stimulate insulin production. Desmopressin acetate is a synthetic form of insulin used to lower your blood sugar. Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. Desmopressin acetate works to help your kidneys work more efficiently.
Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. Desmopressin acetate is a synthetic antidiuretic hormone that promotes reabsorption of water by action on renal tubules; it is used to control diabetes insipidus by decreasing the amount of urine produced.
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. Abrupt onset of symptoms Marked weight loss Polyuria Polydipsia Polyphagia
Polyuria Polydipsia Polyphagia 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 is caring for an 11-year-old child who has type 2 diabetes mellitus. The child has been vomiting for 48 hours and the breath has a fruity odor. The nurse notes that respirations are deep and rapid with a temperature of 102°F (38.9°C). Which intervention would be most appropriate? Give the child 8 ounces of clear liquid. Test the child's urine to detect the presence of ketones. Prepare for IV insertion. Give the child 25 g of carbohydrates.
Prepare for IV insertion. The child needs nursing interventions rapidly to change his or her diabetic status. This child should be given an IV with fluids and electrolytes to improve and restore tissue perfusion. Fruity breath and deep and rapid respirations are signs of ketoacidosis (hyperglycemia), which occurs before oral rehydration. The urine may show ketones, but checking the urine is not the priority in this risky situation.
A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer? Regular insulin Lispro NPH Detemir
Regular insulin Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.
A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which method should she recommend to the child for regular doses? Subcutaneously in the outer thigh Intravenously in the chest Intramuscularly in the abdomen Intradermally in the outer arm
Subcutaneously in the outer thigh Insulin is always injected SC except in emergencies, when half the required dose may be given IV. SC tissue injection sites used most frequently in children include those of the upper outer arms and the outer aspects of the thighs. The abdominal SC tissue injection sites commonly used in adults can be adequate sites but most children dislike this site as abdominal skin is tender.
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 Diabetes insipidus Type 1 diabetes mellitus Hypothyroidism
Type 1 diabetes mellitus Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphagia, enuresis, and weight loss.
A nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction? Vital signs Oral intake Oral mucosa Urine output
Urine output An infant with the diagnosis of diabetes insipidus has decreased secretion of antidiuretic hormone (ADH). The infant is at risk for dehydration so monitoring urinary output is the most important intervention. The child's oral intake has been ordered. Monitoring a child who is under fluid restriction includes assessing the oral mucosa; however, urine output is the most important assessment for this patient. Vital signs are part of a basic assessment.
A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus? proteinuria a fasting blood glucose less than 126 mg/dl a fasting blood glucose greater than 126 mg/dl glucose in the urine
a fasting blood glucose greater than 126 mg/dl A fasting blood glucose greater than 126 mg/dl is diagnostic for diabetes mellitus.
The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes? recent weight loss blood pressure of 142/92 mm Hg slow healing wounds loose stools
recent weight loss Weight loss is unique to type 1 diabetes, whereas weight gain is associated with type 2. Hypertension is consistent with type 2 diabetes. Both type 1 and type 2 diabetes cause delayed wound healing. The increase in blood glucose in diabetes causes damage to the inner lining of the arteries that cause the arteries to develop plaque and harden. These damages to the blood vessels result in a decrease in the ability of oxygen-rich blood to be transported effectively to the tissues to promote wound healing. Loose stools or repeated loose stools (diarrhea) is a common side effect of the oral medication metformin, which is prescribed for clients with type 2 diabetes. Insulin, the treatment for type 1 diabetes, has constipation as one of the side effects.
A nurse is to see a child. Assessment reveals the chief complaints of urinating "a lot" and being "really thirsty." The nurse interprets these symptoms as being associated with which condition? syndrome of inappropriate antidiuretic hormone secretion hypopituitarism diabetes insipidus precocious puberty
diabetes insipidus The most common symptoms of central diabetes insipidus are polyuria (excessive urination) and polydipsia (excessive thirst). Children with diabetes insipidus typically excrete 4 to 15 L/day of urine despite the fluid intake. The onset of these symptoms is usually sudden and abrupt. Ask about repeated trips to the bathroom, nocturia, and enuresis. Other symptoms may include dehydration, fever, weight loss, increased irritability, vomiting, constipation, and, potentially, hypovolemic shock.
After teaching a group of students about endocrine disorders, the instructor determines that the teaching was successful when the students identify insulin deficiency, increased levels of counterregulatory hormones, and dehydration as the primary cause of which condition? diabetic ketoacidosis ketone bodies ketonuria glucosuria
diabetic ketoacidosis Insulin deficiency, in association with increased levels of counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis, a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. The liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glucosuria is glucose that is spilled into the urine.
Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of: diabetic ketoacidosis. ketone bodies. ketonuria. glucosuria.
diabetic ketoacidosis. Insulin deficiency, in association with increased levels of counter-regulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis (DKA), a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glucosuria is glucose that is spilled into the urine.
The nurse is educating the parents of a client newly diagnosed with type 1 diabetes. Which statement by the parents indicates additional teaching is needed? "When our child is sick, we may need to check glucose levels more frequently." "Our child should eat three meals and midafternoon and bedtime snacks each day." "We and our child need to learn to identify carbohydrate, protein, and fat foods." "Our child should not participate in sports or physical activity."
"Our child should not participate in sports or physical activity." The nurse would provide additional education if the parents state the child should not participate in sports or physical activity. The child with diabetes can, and should, be physically active to maintain proper health and facilitate efficient insulin usage by the body. Glucose levels should be checked more frequently during times of sickness, as well as assessing the urine for ketones. Consistency of intake can help prevent complications and maintain near-normal blood glucose levels. The parents and child should know how to identify foods to adequately monitor the child's nutritional intake. A dietitian with expertise in diabetes education should be consulted for referral as needed.
A 16-year-old adolescent is at the office for a checkup. The parent states, "My child keeps forgetting to take insulin. What can we do to make sure my child takes it?" Which is the best response by the nurse? "You can set a medication time that allows your child to have a normal routine that does not interrupt school or sleep." "You can offer your child prizes for taking the medication." "You can make sure that you are the only one who understands and is able to administer the medication." "You can remind your child that the medication is in the cabinet, and that the child should take it when needed."
"You can set a medication time that allows your child to have a normal routine that does not interrupt school or sleep." Guidelines for successful long-term medication administration include making a dosing schedule/calendar that promotes a normal lifestyle. Avoid bribing kids; this is too hard to maintain. Involve the child in the purpose and administration of medication as early as possible to ensure interest, independence, and cooperation.
When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which finding in the child's fasting glucose levels? 60 mg/dl 100 mg/dl 140 mg/dl 220 mg/dl
220 mg/dl A fasting blood sugar result of 200 mg/dL or more almost certainly is diagnostic for diabetes when other signs, such as polyuria and weight loss despite polyphagia, are present.
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? 8.5% 6.5% 7.5 % 7.0%
8.5% 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 pediatric client has just been diagnosed with diabetes. What would the nurse do first? Educate the client on stress management. Regulate nutrition. Check blood glucose levels. Administer insulin.
Check blood glucose levels. The nurse must check the insulin level before it can be administered. Once a need is established, then insulin administration becomes the priority intervention. Stress management, glucose checks, and nutritional consultation can all be implemented once therapy with insulin begins.
After hospital discharge, the parent of a child newly diagnosed with type 1 diabetes mellitus telephones the nurse because the child is acting confused and very sleepy. Which emergency measure would the nurse suggest the parent carry out before bringing the child to see the health care provider? Give the child one unit of regular insulin. Give the child a glass of orange juice. Give the child nothing by mouth so that a blood sugar can be drawn at the health care provider's office. Give the child a glass of orange juice with one unit regular insulin in it.
Give the child a glass of orange juice. The child is experiencing symptoms of hypoglycemia. Administering a form of glucose would help relieve them. This can be glucose tablets or a rapidly absorbable carbohydrate such as orange juice. This should be followed by a snack of complex carbohydrates and protein within 30 to 60 minutes. Insulin cannot be absorbed when taken orally and administering insulin would make the hypoglycemia worse. Withholding treatment waiting to get to the health care provider's office may cause the hypoglycemia to worsen and be a risk to the child's life. Children with diabetes and their parents need to be taught to recognize and treat the symptoms of hypoglycemia.
The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which instruction does not focus on glucose management? Teaching that 50% of daily calories should be carbohydrates. Instructing the child to rotate injection sites. Encouraging the child to maintain the proper injection schedule. Promoting higher levels of exercise than previously maintained.
Instructing the child to rotate injection sites. Instructing the child to rotate injection sites to decrease scar formation is important, but does not focus on managing glucose levels. Teaching the child and family to eat a balanced diet, encouraging the child to maintain the proper injection schedule, and promoting a higher level of exercise all focus on regulating glucose control.
In a child with diabetes insipidus, which characteristic would mostlikely be present in the child's health history? delayed closure of the fontanels (fontanelles), coarse hair, and hypoglycemia in the morning gradual onset of personality changes, lethargy, and blurred vision vomiting early in the morning, headache, and decreased thirst abrupt onset of polyuria, nocturia, and polydipsia
abrupt onset of polyuria, nocturia, and polydipsia Diabetes insipidus is characterized by deficient secretion of antidiuretic hormone leading to diuresis. Most children with this disorder experience an abrupt onset of symptoms, including polyuria, nocturia, and polydipsia. The other choices reflect symptoms of pituitary hyperfunction.
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. draws up the short-acting insulin into the syringe first. wipes off the needle with an alcohol swab. administers the insulin intramuscularly into rotating sites.
draws up the short-acting insulin into the syringe first. 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 pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client? fluid replacement weight loss polydipsia headache
fluid replacement Children with diabetes insipidus lose tremendous amounts of fluid, so fluid replacement is the priority consideration for this client. Excessive fluid loss can lead to seizures and death. Headache and polydipsia can be relieved with fluid replacement. Children will requirement a nutritional consultation for weight loss, but it is not the main consideration.
The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes and the parents. Which comment by a parent demonstrates a need for additional teaching? "During exercise we should wait to check blood sugars until after our child completes the activity." "If our child is sick we should check blood glucose levels more often." "We should check our child's blood glucose levels before meals." "Blood glucose level, food intake, and activity need to all be considered when calculating insulin dosage."
"During exercise we should wait to check blood sugars until after our child completes the activity." Blood glucose monitoring needs to be performed more often during prolonged exercise. Frequent glucose monitoring before, during, and after exercise is important to recognize hypoglycemia or hyperglycemia. Frequent glucose monitoring if the child is sick is also important to recognize changes in glucose levels and prevent hypoglycemia or hyperglycemia. The parents are correct that they will check their child's glucose before meals; they should also check it before bedtime snacks. Blood glucose level should never be the only factor considered when calculating insulin dosing. Food intake and recent or expected activity/exercise must be factored in.
The nurse has told the 14-year-old adolescent with diabetes that the doctor would like to have a hemoglobin A1C test performed. Which comment by the client indicates that she understands what this test is for? "That is the test that I take after I have fasted for at least 8 hours." "The normal level for my hemoglobin A1C is between 60 to 100 mg/dl." "I monitor my own blood glucose every day at home. I don't see why the doctor would want this done." "This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months."
"This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months." Hemoglobin A1C (HgbA1C) provides the physician or nurse practitioner with information regarding the long-term control of glucose levels, as it provides an average of what the blood glucose levels are over a 2 to 3 month period. No fasting is required. Desired levels for children and adolescents 13 to 19 years are less than 7.5%.
Diabetes insipidus is a disorder of the posterior pituitary that results in deficient secretion of which hormone? Adrenocorticotropic hormone (ACTH) Thyroid stimulating hormone (TSH) Luteinizing hormone (LH) Antidiuretic hormone (ADH)
Antidiuretic hormone (ADH) Central diabetes insipidus (DI) is a disorder of the posterior pituitary that results from deficient secretion of ADH. ADH is responsible for the concentration of urine in the renal tubules. Without ADH there is a massive amount of water loss and an increase in serum sodium. Nephrogenic DI occurs as a genetic problem or from end-stage renal disease. It is the result of the inability of the kidney to respond to ADH and not from a pituitary gland problem. LH is produced from the anterior pituitary. In females, it stimulates ovulation and the development of the corpus luteum. TSH is secreted by the thyroid gland. ACTH is secreted by the anterior pituitary.
The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease? glucagon adrenocorticotropic hormone insulin glycogen
insulin Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted. Glycogen is stored in the liver and muscles. It is released to provide energy when the blood glucose levels fall. Glucagon is also produced by the pancreas. Its job is to force the liver to release stored insulin when the body has a need for more insulin. The adrenocorticotropic hormone is produced by the anterior pituitary. Its function is to regulate cortisol. This is needed so the adrenal glands can function properly. It also helps the body respond to stress.
The nurse is caring for a child with type 1 diabetes mellitus. The nurse notes the child is drowsy, has flushed cheeks and red lips, a fruity smell to the breath, and there has been an increase in the rate and depth of the child's respirations. Which prescription from the primary health care provider will the nurse question? intravenous fluid replacement regular insulin per sliding scale IV serum ketone testing monitor glucose level every 3 hours
monitor glucose level every 3 hours The client is experiencing diabetic ketoacidosis (DKA), which is the result of fat catabolism. It is characterized by drowsiness, dry skin, flushed cheeks and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements). The nurse would question only checking the glucose level every 3 hours as it should be assessed at least hourly to ensure the client's level does not fall more than 100 mg/dL (5.55 mmol/L) per hour. A too-rapid decline in blood glucose predisposes the child to cerebral edema. Fluid therapy is given to treat dehydration, correct electrolyte imbalances (sodium and potassium due to osmotic diuresis), and improve peripheral perfusion. Administration of regular insulin, given intravenously, is preferred during DKA. Ketones would be assessed either in the urine or blood to see how much the client is spilling.
