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NU 374 > Ch. 31 > Flashcards

Ch. 31 Flashcards

1
Q

which type of diabetes is more common

A

type I is more common than type II in children

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2
Q

covid and diabetes

A

since covid, the amount of children with diabetes has increased
- having covid increased the risk of diabetes

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3
Q

symptomatology of diabetes

A

regressing in developmental milestones
- secondary enuresis

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4
Q

mixing insulins

A

don’t do with children
- do multiple daily injections rather than mixing

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5
Q

___ and ___ alter insulin requirements

A

illness and exercise

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6
Q

calorie vs food restriction if child is overweight

A

limit calories not food if child is overweight

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7
Q

hypo v hyperglycemic episodes

A

hard to differentiate
- ok to assume hypo if personality changes and they don’t have a glucometer
- if they have a glucometer, test before assuming

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8
Q

blood glucose lab values: toddlers/preschoolers (<6 years)

A

before meals: 100-180 mg/dL
bedtime: 100-200 mg/dL
A1C: </= 7.5%

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9
Q

blood glucose lab values: school age (6-12 years)

A

before meals: 90-130 mg/dL
bedtime: 90-150 mg/dL
A1C: < 7%

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10
Q

blood glucose lab values: adolescents and young adults (>12 years)

A

before meals: 90-130 mg/dL
bedtime: 90-150 mg/dL
A1C: < 7%

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11
Q

toddlers and preschoolers < 6 years: blood glucose implications

A

high risk and vulnerability to hypoglycemia

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12
Q

school age 6-12 years: blood glucose implications

A

risks of hypoglycemia and relatively low risk of complications before puberty

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13
Q

adolescents and young adults > 12 years: blood glucose implications

A

risk of hypoglycemia
developmental and psychological issues

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14
Q

rapid acting insulin

A

names: lispro, aspart, glulisine
onset: < 15 min
peak: 30-90 min
duration: 3-4 hr (up to 5)

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15
Q

short-acting insulin

A

names: regular
onset: 30 min
peak: 2-4 hr
duration: 4-8 hr

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16
Q

intermediate insulin

A

names: NPH
onset: 2-6 hr
peak: 4-14 hr
duration: 14-20 hr

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17
Q

long-acting insulin

A

names: glargine, detemir
onset: 6-14 hr
peak: none or small peak after 10-16 hr
duration: 20-24 hr

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18
Q

insulin injection sites: fastest absorption site

A

abdomen

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19
Q

insulin injection sites: a little slower (2nd fastest)

A

the back of the arms

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20
Q

insulin injection sites: even slower (2nd slowest)

A

the legs

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21
Q

insulin injection sites: slowest absorption site

A

the buttocks

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22
Q

injection sites of insulin should

A

rotate/change every week or two to get the most out of your insulin

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23
Q

what happens if you choose the same injection site each time you inject?

A

hard lumps (fat tissue swells) can develop under the skin; insulin is absorbed slowly
- this is called lipohypertrophy

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24
Q

lipohypertrophy can be prevented by

A

rotating injection sites
- horizontal pattern
- curve pattern
- crisscross pattern
- zig zag pattern

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25
Q

injection sites for infants

A

no abdomen!

26
Q

injection sites for children

A

abdomen ONLY if child has at least 1/2” of pinchable skin
otherwise no abdomen

27
Q

injection sites for adolescents

A

abdomen (1/2” of pinchable skin)

28
Q

why can’t we inject insulin into a site that will be exercised?

A

exercise can increase blood flow; makes insulin absorbed at a faster rate

*may have to give a snack with extra carbohydrates for every 45-60min of exercise

29
Q

type II DM: acanthosis nigricans

A

thicker hyperpigmented skin especially seen in the back of the neck, axilla, and groin

resolves overtime when blood sugars are under better control

30
Q

DM: nursing care goals

A
  1. restore euglycemia
  2. reduce urinary ketones
  3. maintain hydration
31
Q

DM: illness management

A
  • Monitor BS q 3 hrs.
  • Monitor urinary ketones q 3 hrs.
  • Continue the usual insulin regimen.
  • Supplemental insulin based on BS.
  • Encourage fluids (force if needed)
  • Call provider if multiple emesis episodes, BS >240 continuously or urine ketones remain high (>3+)
32
Q

DKA: nursing care goals

A
  1. rapid assessment
  2. adequate insulin coverage
  3. reverse dehydration
  4. electrolyte replacement (esp. K+) to correct hydration and acidosis
33
Q

DKA: management

A
  • Cardiopulmonary monitoring
  • Admission weight
  • Serial vitals and labs at bedside
  • CBC with diff, BMP, ABG
  • Strict I/O (Foley)
  • IVF (1.5-2 days) with K+
  • Regular insulin IV (0.1 units/kg/hr.)
  • Decrease BS by 50-100 mg/dL/hr
  • Add dextrose to IVF when BS falls <300
34
Q

hypoglycemia: mild reaction (how to treat)

A

(adrenergic symptoms)
- give child 10-15g of a simple, high-carbohydrate substance (pref. liquid- ie OJ)
- follow with starch-protein snack

35
Q

hypoglycemia: moderate reaction

A

(neuroglycopenic symptoms)
- give child 10-15g of a simple, high-carbohydrate substance (pref. liquid- ie OJ)
- repeat in 10-15 min if symptoms persist
- follow with larger snack
- watch child closely

36
Q

hypoglycemia: severe reaction (how to treat)

A

(unresponsive, unconscious, or seizures)
- administer glucagon as prescribed
- follow with planned meal or snack when child is able to eat, or add snack of 10% of daily calories
- consult team re: dosing change

37
Q

hypoglycemia nocturnal reaction: nursing interventions

A

(magic number is 10*)
- give child 10-15g of a simple carbohydrate
- follow with snack of 10% of daily calories

38
Q

central precocious puberty (CPP)

A

type of early onset puberty
- before age of 7 in females with lighter skin or white skin
- before 6 in females of darker skin
- before age 9 in males

39
Q

CPP clinical features

A
  • Begins before age 7 in white girls, before 6 in AA girls and before age 9 in boys
  • Usual progression of puberty
  • Advanced ht., wt., and osseous maturation
  • Early closure of growth plate resulting in less than normal height for age
  • Elevated GH levels (includes FSH and LH)
  • Idiopathic (girls)/ pathologic: ie tumor (boys)
40
Q

growth hormone deficiency (GHD)

A
  • Stunted somatic growth
  • Familial but can be linked with other causes
41
Q

GHD clinical features

A
  • Weight percentile exceeds height
  • Immature facial appearance
  • Frontal bossing
  • Truncal obesity
  • Hypoplastic genitalia
  • High pitched voice
  • Delayed bone maturation
  • Low GH level and possibly others
  • Short stature, but HT and WT are proportional
  • Delayed epiphyseal closure
  • Retarded bone age compared with height
  • Premature aging (later in life)
  • Increased insulin sensitivity
  • Normal intelligence
  • Emotional problems (common)
42
Q

causes of precocious puberty

A

girls: 90-95% are idiopathic- no cause
boys: underlying pathologic cause, ie tumor

43
Q

(goal of) treatment of precocious puberty

A

goal of treatment is to stop and possibly reverse the onset of puberty
- treatment will depend on the type and underlying cause, if known

44
Q

central/idiopathic precocious puberty: s/sx

A

onset of puberty (usual pattern)
gonadotropin levels increase

45
Q

central/idiopathic precocious puberty: treatment

A
  • CT or MRI to r/o tumor. Will x-ray bone growth to evaluate bone maturity and premature epiphyseal plate closure. Blood work. Treatment of any underlying cause if known (ex. Tumor removal).
  • Pharmacology: Lupron Depot (synthetic luteinizing hormone-releasing hormone) injections.
46
Q

peripheral precocious puberty: s/sx

A

some puberty s/sx but not all; out of order
estrogen or testosterone levels increase (not gonadotropin)

47
Q

peripheral precocious puberty: treatment

A
  • Depends on cause of increase in estrogen or testosterone levels. (ex. Tumor removal).
  • Diagnostics to evaluate cause.
  • Blood work.
48
Q

incomplete precocious puberty: s/sx

A

partial development ie unilateral breast development

49
Q

incomplete precocious puberty: treatment

A
  • Wait and see. Usually resolves on its own.
  • Blood work to confirm no activation of GnRH or hormones.
50
Q

advanced bone age

A

the child’s bone structure is that of an older age

51
Q

lupron depot

A

an injection administered monthly or q3months or GnRH analog histrelin implant
(placed SQ in arm)

  • to treat CPP
52
Q

why would dose changes be necessary with lupron depot

A
  • hormone and clinical suppression are not achieved with the starting dose
  • the child’s body weight changes
53
Q

if lupron depot is effective

A

females: breast development will stop and may regress
males: the penis and testicles may shrink back to a size that is normal for their age

54
Q

is missing a dose of lupron depot a problem?

A

yes- can precipitate return of CPP s/sx

55
Q

treatment of GHD

A

Biosynthetic GH subcutaneous injections daily at bedtime
- 80% success rate
- Greatest results in year 1
- Likely to attain less than normal height even with treatment
- May have additional hormone deficiencies

56
Q

when to stop GHD treatment

A
  • Velocity < 1 inch
  • Bone age of 14 (females) and 16 (males)
57
Q

before/during/after treatment of GHD, assess for

A
  • Socioemotional concerns pre-treatment
  • Realistic expectations
  • Effective coping during/post-treatment
58
Q

intramuscular injections: sites and volume amounts

A
  • Vastus Lateralis and Ventrogluteal Sites: 0.5-2 mL volume
  • Deltoid: up to 1 mL
59
Q

intramuscular injections

A
  • Traditional hormone replacement therapy
  • Vaccines
  • Other medications (rabies vaccine, antibiotics etc.)
60
Q

subcutaneous injections: sites

A

Numerous sites (kids usually rotate between 4-8 sites)
- anywhere you can pinch at least an 1/2-1in of skin in the abdomen
- legs (thigh)
- upper outer triceps

61
Q

subcutaneous injections

A
  • hormone replacement (pen)
  • insulin
  • vaccines
62
Q

if the volume of an injections exceeds the warranted amount per injection,

A

divide into multiple injections

NU 374 (18 decks)

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