1229 Exam 7: Diabetic Child Flashcards
What is Diabetes melitus?
Characterized by chronic hyperglycemia due to problems with insulin secreation and/or the effectiveness of endogenous insulin.
What is endogenous insulin?
Insulin resistance
What are risk factors for Diabetes type one?
genetics
toxins and viruses can predispose an individual to diabetes by destroying the beta cells
WHat are risk factors for Diabetes type two?
genetics obesity physical inactivity high triglycerides hypertension all lead to development of insulin resistance and type two diabetes.
hypo glycemia
blood glucose levels less than 70mg/dl
Hypoglycemia (autonomic nervous system responses) —Rapid onset
hunger lightheadedness shakiness nausea anxiety pale cool skin diaphoresis irratbility normal or shallow respirations tachycardia palpitations
hypoglycemia (impaired cerebral function) —Gradual onset:
strage or unusual feelings decreasing level of consciousness difficulty to think and inability to concentrate change in emotional behavior slurred speech headache blurred vision seizures leading to coma
Hyperglycemia
blood sugars greater than 250mg/dl
What are symptoms of hyperglycemia?
thirst frequent urination hunger skin that is warm, dry, and flushed with poor turgor dry mucous membranes soft eyeballs weakness malaise rapid, weak pulse; hypotension rapid, deep respirations with acetone/ fruity odor due to ketones
How do you diagnose diabetes?
symptoms of daibetes plus a casual plasma glucose concentration of greater than 200 mg/dl (without regard to time since last meal)
a fasting blood glucose greater than 126 mg/dl
a 2 hour glucose of greater than 200 mg/dl with an oral glucose tolerance test
Fasting blood glucose- client education
ensure that the child has fasted (no food or drink other than water) for 8 hours prior to the blood draw. Antidiabetic medications should be postponed until after the level is drawn.
Oral glucose tolerance test–client education
instruct the client to consume a balanced diet for the 3 days prior to the test. then instruct the client to fast for the 10-12 hr prior to the test. a fasting blood glucose level is drawn at the start of the test. The client is then instructed to consume a specified amount of glucose. blood glucose levels are drawwn every 30 minutes for 2 hours. the child must be assessed for hypoglycemia throughout the procedure
Glycosylated hemoglobin (HbA1c)
the expected reference range is 4-6%, but an acceptable target for children who have diabetes may be 6.5-8% with a total target goal of less than 7%.
Self monitored blood glucose (SMBG)
follow or ensure that the child follows the proper procedure for blood sample collection and use of a glucose meter. Supplemental short acting insulin may be prescribed for elevated pre meal glucose levels.
Client education for self monitored blood glucose
instruct the child to check the accuracy of the strips with the control solution provided.
advise the child to keep a record of the SMBG that includes time, date, serum glucose level, insulin dose, food intake, and other events that may alter glucose metabolism, such as activity level or illness
Nursing Care– Monitor the following:
blood glucose levels and factors affecting levels (other medication)
- I&O and weight
- skin integrity and healing status of any wounds, paying close attention to the feet and folds of skin.
- sensory alterations (tingling or numbness)
- visual alterations
- presence of recurrent infections
- dietary practices
- exercise patterns
- the child’s proficiency at self monitoring blood glucose
- child’s proficiency at self-administering meds
Teach proper foot care:
inspect feet daily.
-wash feet daily with mild soap and warm water
-pat feet dry gently, especially between toes.
-use mild foot powder on sweaty feet.
-do not use commercial remedies for the removal of calluses or corns.
-perform nail care after a bath/shower if possible
-separate overlapping toes with cotton
-avoid open toe or heal shoes
-wear clean, absorbent socks
do not use hot water bottles or heating pads to warm feet.
-avoid prolonged sitting, standing, and crossing legs
Nutritional guidelines:
plan meals to achieve appropriate timing of food intake, activity, onset, and peak of insulin.
- eat at regular intervals and do not skip meals
- count carbs consumed
- avoid concentrated sweets
- keep fat content below 30% of the total caloric intake
- include fiber in the diet to increase carbhydrate metabolism and to help control cholesterol levels.
Teaching for SMBG for when sick:
monitor every 3-4 hours.
continue to take insulin or oral antidiabetic
consume at least 4oz of sugar free, non caffeinated liquid every 1/2 hour to prevent dehydration.
meet carb needs by eating soft foods if possible.
test urine for ketones and report if abnormal
rest.
call provider if:
blood glucose is higher than 240. fever higher 102F fever for 12+ hours disorientation or confusion occurs rapid breathing is experienced vomiting occurs more than once diarrhea occurs more than five times or for longer than 24hr liquids cannot be tolerated illness last longer than 2 days
How to treat hypoglycemia:
check blood sugar. treat with 15-20 grams of carbs recheck sugar if 15 minutes if still low (less than 70) give 15 more grams of carb recheck in 15 minute if blood glucose is in normal limits, take in 7 grams of protein if next meal is more than an hour away.
What if child is hypoglycemic and is unconscious or unable to swallow?
administer glucagon and notify the heath care provider.
How do you administer glucagon emergency?
Turn to side. May cause n/v.
reconstitute in vile, mix, and draw back into syringe
IM injection.
usually given in the vastis lateralis.
(she talked about this in lecture, but i couldn’t find it anywhere–useful information at the least though!)
How to respond to hyperglycemia:
encourage oral fluid intake
administer insulin as prescribed.
restrict exercise when BG is greater than 250
test urine for ketones and report if findings are abnormal
consult the heath care provider if symptoms progress
Rapid Insulin:
Insulin lispro (Humalog/Novolog)
Onset: less than 15 mins
Peak: 30 mins -one hour
Duration: 3-4 hours
Short acting Insulin:
Regular insulin (Humulin R)
Onset: 30 mins -1 hour
Peak: 2-3 hours
Duration: 5-7 hours
Intermediate acting insulin:
NPH insulin (Humulin N)
Onset: 1-2 hours
Peak: 4-12 hours
Duration: 18-24 hours
Long acting insulin:
Insulin glargine (Lantus)
Onset: 1 hour
Peak: none
Duration: 10.4-24 hours
Nursing considerations for insulin:
Do not mix insulin glargine with other insulins due to incompatibility.
**Give separately
Client Education for insulin:
Rotate injection sites. (at least two finger breaths away from belly button)
inject at 90 degree angle
Draw up short acting before you draw up long acting.
Client Outcomes:
The child will have blood glucose levels within an acceptable range.
The child will be able to self administer insulin
the child will be able to monitor for complications and intervene as necessary
The child will maintain adequate dietary intake to support growth and development
Diabetes Ketoacidosis: DKA
is an acute, life-threatening condition characterized by hyperglycemia (bg greater than 300) resulting in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine. The onset is rapid, and the mortality rate is HIGH.**
Causes of DKA:
insufficient insulin
acute stress
poor management of acute illness.
Nursing actions for DKA:
Assess sub/obj data
provide rapid isotonic fluid (NS)
follow with a hypotonic fluid
when serum glucose levels approach 250, add glucose to IV
monitor glucose levels hourly.
monitor serum potassium levels
adminster sodium bicarbonate by slow IV infusion for sever acidosis
What are signs/symptoms for DKA:
n/v and abdominal pain reports of frequent urination, thirst, and hunger reports confusion change in mental status signs of dehydration rapid and deep respirations
What is the Somogi effect?
Rebound hyperglycemia-- Example: Goes to bed at 10pm, blood sugar is 120. while sleeping at 2am, blood sugar is 50. (did not wake up) body makes the blood sugar go up. wakes up at 8am and blood sugar is 260. **easiest way to explain it was by example. lol
