Peds- ENDOCRINE
Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than _____ mg/dl. a. 100 b. 120 c. 180 d. 200
d. 200
The nurse is discussing with a child and family the various sites used for insulin injections. Which site usually has the fastest rate of absorption? a. Arm b. Leg c. Buttock d. Abdomen
d. Abdomen
Hypoglycemia- you want to give them how much of quick carrbs
15 grams
1. The clinic nurse is reviewing hemoglobin A1c levels on several children with type 1 diabetes. Hemoglobin A1c levels of less than _____% is a goal for children with type 1 diabetes. (Record your answer in a whole number.)
7
Hypoglycemia is blood sugar less than
70 Too little food Too much insulin Increase in exercise Skipping or delaying meals
Hyperglycemia s/s
very thirsty peeing a lot blurry vision infection healing more slow
The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. Which of the following would the nurse most likely identify as the priority nursing diagnosis? A) Deficient fluid volume related to dehydration B) Excess fluid volume related to edema C) Deficient knowledge related to fluid intake regimen D) Imbalanced nutrition, more than body requirements related to excess weight
A) Deficient fluid volume related to dehydration
The nurse is preparing a teaching plan for the family and their 6-year-old son who has just been diagnosed with diabetes mellitus. Which of the following would the nurse identify as the initial goal for the teaching plan? A) Developing management and decision-making skills B) Educating the parents about diabetes mellitus type 1 C) Developing a nutritionally sound, 30-day meal plan D) Promoting independence with self-administration of insulin
A) Developing management and decision-making skills
Serum glucose monitoring- when should you monitor?
Before meals At bedtime Not feeling well/shaky Before physical activity
After teaching the parents of a daughter with central precocious puberty about medication therapy, which statement by the parents indicates successful teaching? A) "She needs to use the nasal spray once every day." B) "She'll start puberty again when the medication stops." C) "This medication will slow down the changes but not reverse them." D) "Once therapy is done, she'll need surgery."
B) "She'll start puberty again when the medication stops."
A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dL. Which of the following would the nurse do next? A) Administer a sliding-scale dose of insulin B) Give 10 to 15 grams of a simple carbohydrate C) Offer a complex carbohydrate snack D) Administer glucagon intramuscularly
B) Give 10 to 15 grams of a simple carbohydrate
A group of nursing students are reviewing the components of the endocrine system. The students demonstrate understanding of the review when they identify which of the following as the primary function of this system? A) Regulation of water balance B) Hormonal secretion C) Cellular metabolism D) Growth stimulation
B) Hormonal secretion
A nurse is preparing a presentation for a group of parents with children diagnosed with diabetes type 1. The children are all adolescents. Which of the following issues would the nurse need to address? Select all that apply. A) Self-monitoring of blood glucose levels B) Feelings of being different C) Deficient decision-making skills D) Body image conflicts E) Struggle for independenc
C) Deficient decision-making skills D) Body image conflicts E) Struggle for independenc
The nurse suspects that a 4-year-old with type 1 diabetes is experiencing hypoglycemia based on which of the following? Select all that apply. A) Blurred vision B) Dry, flushed skin C) Diaphoresis D) Slurred speech E) Fruity breath odor F) Tachycardia
C) Diaphoresis D) Slurred speech F) Tachycardia
The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. Which of the following would the nurse correlate with disorder? A) The parents report that their child had "a cold or flu" recently. B) Blood pressure is decreased when checking vital signs. C) The parents report that their son "can't drink enough water." D) Auscultation reveals Kussmaul breathing.
C) The parents report that their son "can't drink enough water."
Diabetes: Monitoring: Nutrition
Timing of consumption must be regulated to correspond to the time and action of the insulin prescribed The total number of calories should be consistent from day to day Provide extra food with exercise to prevent hypoglycemia Avoid high sugar and carbs to prevent hyperglycemia
Acanthosis nigricans
Velvety thickening and darkening of skin found on back of neck, axillae, medial aspect of thighs or any skin folds Present in as many as 80% DM Type 2
The nurse is obtaining a health history from parents whose 4-month-old boy has congenital hypothyroidism. Which of the following would the nurse most likely assess? A) The child has above-normal growth for his age. B) The child is active and playful. C) The skin is pink and healthy looking. D) It is difficult to keep the child awake.
D) It is difficult to keep the child awake.
Which of the following would the nurse expect to assess in a child with hypothyroidism? A) Nervousness B) Heat intolerance C) Smooth velvety skin D) Weight gain
D) Weight gain
Treatment for type 2 diabetes (3 things)
Diet Exercise PO Medication-- Metformin: increased insulin sensitivity, suppresses appetite, improves lipid profile, and reduces hepatic glucose output Help utilize the existing supply of insulin
When do you test urine ketones during _____ when glucose is > ____
During illness When glucose is > 240
Precocious Puberty what is it ages happens more in?
Early physical sex characteristic development Girls: <8 years old Boys: <9 years old happens in girls more than boys
Insulin Pump
Electromechanical device designed to deliver fixed amounts of regular or lispro insulin continuously (basal rate) Closely imitates the release of the hormone by the islet cells Pump must be programmed to deliver a dose before each meal
In precocious puberty you want to monitor
FSH, LH, testosterone, estrogen
Fasting glucose Random glucose Oral glucose tol A1C for type 2 DM
Fasting glucose > 126 Random glucose > 200 (with symptoms) Oral glucose tolerance test (OGTT) > 200 Hemoglobin A1C > 6.5%
Diabetes Impact on the Family and Child
Fear/anxiety Continual drain on emotional and financial resources Feelings of guilt Parents may feel they have lost their ability to protect their child from physical harm and suffering Restricted independence Stressful daily planning Adolescents: difficulty adjusting, compliance issues
Hypothyroidism
Involves the thyroid gland and the anterior pituitary gland Low or no production of T4 Congenital or acquired
Type II Diabetes Mellitus: Signs and Symptoms (4)
Ketonuria Recurrent infections Increase in thirst and/or urination Acanthosis nigricans
Hypothyroidism: Signs and Symptoms
Large fontanelles Protruding tongue Umbilical hernia Lethargy/fatigue Constipation Prolonged jaundice Dry skin Brittle hair/nails Goiter
Diabetic Ketoacidosis
Life threatening complication resulting from excessive ketone production and lack of insulin Ketones are produced when the body breaks down fat for energy Ketone bodies are strong acids: lower serum pH Causes metabolic acidosis
Diabetes: Monitoring: Exercise
Maintain cardiovascular fitness Control weight and help body use insulin more efficiently Children with diabetes should participate fully in physical education classes and sports
Diabetes: Signs and Symptoms
Polyuria- Excessive urinary output Enuresis- Frequent urination Polydipsia- Excessive thirst Polyphagia- Excessive hunger Weight loss
Long Term Complications of Diabetes
Retinopathy Potential of vision loss Nephropathy Leads to renal failure Peripheral neuropathy Foot ulcers and amputations Autonomic neuropathy GI, GU, Cardio, and sexual dysfunction Atherosclerotic cardiovascular, peripheral, arterial and cerebrovascular disease HTN
Insulin injections
Rotate sites Delivered SQ May use syringe, injector, or pen Skin does not need to be pinched if short needles are used Always count to 5 after injection***** No "set" age appropriate for administration By school-age
People with hypothyroidism take daily
Synthroid serum T4 + TSH tested at every well visit
Which statement made by a 7-year-old child with type 1 diabetes mellitus indicates a need for more teaching? a. "My pancreas is sick and needs insulin until it is well." b. "I will need to take my insulin every day." c. "I need to keep a piece of candy in my pocket in case I start to feel shaky." d. "My mom has to give me insulin shots twice a day."
a. "My pancreas is sick and needs insulin until it is well."
The nurse discussed treatment of hypoglycemia with an adolescent. Which statement by the adolescent leads the nurse to determine the patient understood the instructions? a. "When my blood glucose is low or if I begin to feel hungry and weak, I will eat six LifeSavers." b. "When my blood glucose is low or if I begin to feel hungry and weak, I will give myself Lispro insulin." c. "When my blood glucose is low or if I begin to feel hungry and weak, I will have a slice of cheese." d. "When my blood glucose is low or if I begin to feel hungry and weak, I will drink a diet soda."
a. "When my blood glucose is low or if I begin to feel hungry and weak, I will eat six LifeSavers."
The nurse is implementing care for a school-age child admitted to the pediatric intensive care in 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.
After a closed head injury, the unconscious 10-year-old child begins to excrete copious amounts of pale urine with an attendant drop in blood pressure (BP). Based on these symptoms, what does the nurse suspect has developed? a. Diabetes insipidus b. Diabetes mellitus c. Hypothyroidism d. Hyperthyroidism
a. Diabetes insipidus
Which laboratory result indicates good metabolic control for a child with type 1 diabetes mellitus? a. Glycosylated hemoglobin value of 8% b. Fasting blood glucose level less than 140 mg/dL c. Glucose tolerance test result of 190 mg/dL d. No glucose or ketones present in the urine
a. Glycosylated hemoglobin value of 8%
A mother reports that her 4-month-old infant is lethargic, sleeps 18 hours a day, and snores. The nurse recognizes these signs are characteristic of what? a. Hypothyroidism b. Hyperthyroidism c. Type 1 diabetes mellitus d. Tay-Sachs disease
a. Hypothyroidism
A nurse is planning interventions for a toddler with juvenile hypothyroidism. Which interventions should the nurse plan to implement for this child? (Select all that apply.) a. Moisturizer for dry skin b. Antidiarrheal medications c. Medications to help with insomnia d. Implementation of thyroxine therapy
a. Moisturizer for dry skin d. Implementation of thyroxine therapy
On what understanding does the nurse plan the care of a child with a new diagnosis of type 1 diabetes mellitus? a. There is an absolute deficiency of insulin. b. Insufficient quantities of insulin are produced by the pancreas. c. Oral hypoglycemic agents can control it. d. Insulin deficiency is caused by another disease affecting the pancreas.
a. There is an absolute deficiency of insulin.
A goiter is an enlargement or hypertrophy of which gland? a. Thyroid b. Adrenal c. Anterior pituitary d. Posterior pituitary
a. Thyroid
Dagnosis hypothyrpoidism we want an early diagnosis to prevent ?
as an infant new born screening Early diagnosis to prevent cognitive deficits
The nurse is caring for a 14-year-old boy with type 1 DM. He takes NPH insulin every morning at 7:30 AM. Which assessment data will the nurse use to evaluate the therapeutic effectiveness of the medication? a. Presence of signs and symptoms of hypoglycemia or hyperglycemia during the morning physical assessment b. Blood glucose level at 1630 c. Appetite and food intake at lunch d. Blood glucose level before breakfast
b. Blood glucose level at 1630 NPH is a long-acting insulin used to lower blood glucose levels. Its peak action is at 2to4 hours with a duration of 10to16 hours. Blood glucose monitoring provides evaluation of the therapeutic effectiveness.
Which general dietary measure should the nurse include in a teaching plan for the child with type 1 diabetes mellitus? a. Control intake of carbohydrates and consume fewer calories. b. Focus on complex carbohydrates and eat foods high in fiber. c. Obtain most calories from proteins and fats. d. Eat a diet low in fat and low in complex carbohydrates.
b. Focus on complex carbohydrates and eat foods high in fiber.
The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. Which 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.
What occurs as a result of an inadequate secretion of insulin? a. Protein synthesis is increased. b. Increased fat breakdown leads to ketonemia. c. Serum glucose levels are markedly decreased. d. More rapid conversion and storage of carbohydrates to glucose occurs.
b. Increased fat breakdown leads to ketonemia.
What is the function of an insulin pump? a. Releases insulin as blood glucose rises b. Provides continuous infusion of insulin c. Decreases need for painful glucose monitoring d. Delivers a prescribed amount of insulin twice a day
b. Provides continuous infusion of insulin
The parents of a child newly diagnosed with diabetes mellitus tell the nurse, "Our son's body is resistant to insulin." With what does the nurse recognize this description is consistent? a. Type 1, insulin-dependent diabetes mellitus b. Type 2, non-insulin-dependent diabetes mellitus c. Maturity-onset diabetes of youth d. Drug-induced diabetes
b. Type 2, non-insulin-dependent diabetes mellitus
Which comment made by a school-age child indicates that he needs more teaching about diabetes mellitus and exercise? a. "I carry a piece of hard candy with me in case I start to feel shaky." b. "I make sure I have emergency money when I have soccer practice or a game." c. "Sometimes I skip my breakfast when I have a game in the morning." d. "I play in soccer games that are scheduled after dinner."
c. "Sometimes I skip my breakfast when I have a game in the morning."
Which is 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 20 years. d. Oral agents are often effective for treatment.
c. Age at onset is usually younger than 20 years.
A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on which knowledge? a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. Parents are better able to manage the disease.
c. Children are better able to manage the diabetes.
The nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder? a. Insomnia b. Diarrhea c. Dry skin d. Accelerated growth
c. Dry skin
The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. Which should the nurse explain about exercise in type 1 diabetes? a. Exercise will increase blood glucose. b. Exercise should be restricted. c. Extra snacks are needed before exercise. d. Extra insulin is required during exercise.
c. Extra snacks are needed before exercise.
A child with diabetes mellitus is observed to have cold symptoms. What signs and symptoms will alert parents of the possibility of ketoacidosis? (Select all that apply.) a. Chest congestion b. Ear pain c. Fruity breath d. Hyperactivity e. Nausea
c. Fruity breath e. Nausea
A child with diabetes is brought to the emergency department. He is flushed and drowsy, and his skin is dry. His father states that the child has been feeling progressively worse since the morning. What is this child most likely experiencing? a. Somogyi phenomenon b. Dawn syndrome c. Ketoacidosis d. Water intoxication
c. Ketoacidosis
A young mother brings her new baby, diagnosed with congenital hypothyroidism, to the clinic so she can learn how to administer levothyroxine. The nurse should include which of the following instructions? a. Crush the medication and place it in a full bottle of formula to disguise the taste. b. Administer the medication every other day. c. Use an oral dispenser syringe or nipple to give the crushed medication mixed with a small amount of formula. d. Tell the mother that the medication will not be needed after the age of 7.
c. Use an oral dispenser syringe or nipple to give the crushed medication mixed with a small amount of formula.
What statement by a parent leads the nurse to determine a parent is administering levothyroxine (Synthroid) correctly? a. "I stopped giving the medication because my daughter was losing her hair." b. "I am using a different brand now because it costs less money." c. "I don't give the medication on the weekends." d. "I give the medication at 8:00 AM every day."
d. "I give the medication at 8:00 AM every day."
Which is considered a cardinal sign of diabetes mellitus? a. Nausea b. Seizures c. Impaired vision d. Frequent urination
d. Frequent urination
When monitoring the blood glucose level of a 12-year-old child with type 2 DM, your reading is 50 mg/dL. Which is the most appropriate action? a. Encourage the child to get out of bed and increase activity. b. Take the child's vital signs. c. Ask the child about frequent urine output. d. Give the child 4 oz of orange juice.
d. Give the child 4 oz of orange juice.
The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which? a. Glucose is needed before administration of insulin. b. Glucose is needed four times a day. c. Glycosylated hemoglobin is required. d. Ketonuria is suspected.
d. Ketonuria is suspected.
A child will start treatment for precocious puberty. The nurse recognizes that this will involve the injection of which synthetic medication? a. Thyrotropin b. Gonadotropins c. Somatotropic hormone d. Luteinizing hormone-releasing hormone
d. Luteinizing hormone-releasing hormone
. The nurse is caring for an 8-year-old child with type 1 diabetes. The nurse should teach the child to monitor for which manifestation of hypoglycemia? a. Lethargy b. Thirst c. Nausea and vomiting d. Shaky feeling and dizziness
d. Shaky feeling and dizziness
Type 1 Diabetes = what happens
destruction of beta cells in pacrease insulin deficiency Kidneys try to compensate --> increased urination + glucose Protein/fat break down for energy autoimmune- born with it
Treatment DKA
emergency department! Fluids Insulin Close blood monitoring CAT scan--Fear of cerebral edema
Hypoglycemia: treatment
give them quick carbs Fluids Close blood monitoring Give IM glucagon Feed once awake
TSH/T4 in childhood/teens leads to
hashimoto's
Type 1 Diabetes: medication? goal is to maintain near normal blood glucose which is
insulin Goal is to maintain near normal blood glucose (90-130) 4 types of insulin: rapid acting, short acting, intermediate acting, long acting
Type II Diabetes Mellitus
insulin resistance due to BMI >85% family history of DM/ mother with gestational diabetes
treatment of precocious puberty what does it do? what to you teach parents?
monthly Lupron IM Inhibits the release of gonadotropin-releasing hormone (GnRH) from the hypothalamus Teaching parents how to give injections
Causes of precocious puberty
obesity hereditary stress environmental exposures adrenal tumors CNS tumor
Hypoglycemia S/S
shaky sweating anxious dizzy hungry tachycardia headache
