1229 Exam 7: Diabetic Child

Question 1

What is Diabetes melitus?

Answer 1

Characterized by chronic hyperglycemia due to problems with insulin secreation and/or the effectiveness of endogenous insulin.

Question 2

What is endogenous insulin?

Answer 2

Insulin resistance

Question 3

What are risk factors for Diabetes type one?

Answer 3

genetics

toxins and viruses can predispose an individual to diabetes by destroying the beta cells

Question 4

WHat are risk factors for Diabetes type two?

Answer 4

genetics
obesity
physical inactivity
high triglycerides
hypertension 
all lead to development of insulin resistance and type two diabetes.

Question 5

hypo glycemia

Answer 5

blood glucose levels less than 70mg/dl

Question 6

Hypoglycemia (autonomic nervous system responses) —Rapid onset

Answer 6

hunger
lightheadedness
shakiness
nausea
anxiety 
pale
cool skin
diaphoresis
irratbility
normal or shallow
respirations
tachycardia
palpitations

Question 7

hypoglycemia (impaired cerebral function) —Gradual onset:

Answer 7

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

Question 8

Hyperglycemia

Answer 8

blood sugars greater than 250mg/dl

Question 9

What are symptoms of hyperglycemia?

Answer 9

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

Question 10

How do you diagnose diabetes?

Answer 10

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

Question 11

Fasting blood glucose- client education

Answer 11

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.

Question 12

Oral glucose tolerance test–client education

Answer 12

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

Question 13

Glycosylated hemoglobin (HbA1c)

Answer 13

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%.

Question 14

Self monitored blood glucose (SMBG)

Answer 14

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.

Question 15

Client education for self monitored blood glucose

Answer 15

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

Question 16

Nursing Care– Monitor the following:

Answer 16

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

Question 17

Teach proper foot care:

Answer 17

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

Question 18

Nutritional guidelines:

Answer 18

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.

Question 19

Teaching for SMBG for when sick:

Answer 19

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.

Question 20

call provider if:

Answer 20

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

Question 21

How to treat hypoglycemia:

Answer 21

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.

Question 22

What if child is hypoglycemic and is unconscious or unable to swallow?

Answer 22

administer glucagon and notify the heath care provider.

Question 23

How do you administer glucagon emergency?

Answer 23

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!)

Question 24

How to respond to hyperglycemia:

Answer 24

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

Question 25

Rapid Insulin:

Answer 25

Insulin lispro (Humalog/Novolog)
Onset: less than 15 mins
Peak: 30 mins -one hour
Duration: 3-4 hours

Question 26

Short acting Insulin:

Answer 26

Regular insulin (Humulin R)
Onset: 30 mins -1 hour
Peak: 2-3 hours
Duration: 5-7 hours

Question 27

Intermediate acting insulin:

Answer 27

NPH insulin (Humulin N)
Onset: 1-2 hours
Peak: 4-12 hours
Duration: 18-24 hours

Question 28

Long acting insulin:

Answer 28

Insulin glargine (Lantus)
Onset: 1 hour
Peak: none
Duration: 10.4-24 hours

Question 29

Nursing considerations for insulin:

Answer 29

Do not mix insulin glargine with other insulins due to incompatibility.
**Give separately

Question 30

Client Education for insulin:

Answer 30

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.

Question 31

Client Outcomes:

Answer 31

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

Question 32

Diabetes Ketoacidosis: DKA

Answer 32

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.**

Question 33

Causes of DKA:

Answer 33

insufficient insulin
acute stress
poor management of acute illness.

Question 34

Nursing actions for DKA:

Answer 34

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

Question 35

What are signs/symptoms for DKA:

Answer 35

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

Question 36

What is the Somogi effect?

Answer 36

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