Pediatric Nursing: Metabolic and Endocrine Problems

Question 1

Fever

Answer 1

• abnormal body temp elevation.
• a child’s temp can vary depending on activity, emotional stress, disease processes, medications, type of clothing, and temp of the environment. Fever in infant less than 1 month old is an emergency.
• assessment: Normal 36.4 to 37C (97.5 to 98.6F); fever >38C (>100.4F). Flushed skin, warm to touch, diaphoresis, chills, restlessness or lethargy.
• Interventions: remove excess clothing and blankets, reduce room temp, increase air circulation, apply cool compress (forehead). Adm sponge bath for 20 to 30 min. Adm antipyretics (aspirin should not be adm because of the risk of Reye’s syndrome). Retake temp 30 to 60 min after. Provide adequate fluid intake, monitor for signs of dehydration. Instruct parents on care.

Question 2

Dehydration

Answer 2

• common fluid and electrolyte imbalance. Infants and children are at risk for volume deficit because the organs that conserve water are immature, and their body water is in the extracellular fluid compartment.
• causes can include decreased fluid intake, diaphoresis, vomiting, diarrhea, diabetic ketoacidosis, and extensive burns or other serious injuries.
• assessment include: weight loss, pulse, RR, BP, behavior, thirst, mucous membranes, tears, anterior fontanel, external jugular vein, skin (capillary refill), and urine specific gravity (>1.020, oliguria or anuria).
• Interventions: treat and eliminate the cause, monitor VS, weight, intake and output, level of consciousness, skin turgor, mucous membranes. Provide oral rehydration therapy with pedialyte or other similar solution as prescribed (for mild to moderate). For severe, maintain NPO status and provide fluid and electrolyte by IV as prescribed.

Question 3

Phenylketonuria

Answer 3

• a genetic disorder that results in CNS damage from toxic levels of phenylalanine (an essential amino acid) in the blood.
• characterized by levels above 20 mg/dL (normal is 0 to 2 mg/dL).
• all 50 states require routine screening of all newborns for this disorder.
• assessment: digestive problems, vomiting, seizures, musty odor of the urine, and mental retardation. In older children eczema, hypertonia, hyperactive behavior, hypopigmentation of hair, skin, and irises.
• interventions: screening of NB (after begun formula or breast-feeding). If positive, a repeat test is necessary. Rescreen NB by 14 days if the initial screening was done before 48h of age.
  If diagnosed: restrict phenylalanine intake, high-protein foods, and aspartame. Monitor physical, neurological, and intellectual development. Educate the parents on the use of special formulas and about the diet.

Question 4

Childhood Obesity

Answer 4

• condition where excess body fat negatively impacts the health and well-being of the child.
• Body Mass Index (BMI) is a screening tool.
• obesity can lead to problems later in life.
• asthma, sleep apnea, bone and joint problems, type 2 DM, and risk factors leading to heart disease, hyperlipidemia, can occur.
• a obese child is more likely to be an obese adult.

Question 5

Diabetes Mellitus: description

Answer 5

• Type 1 DM is characterized by the destruction of the pancreatic beta cells, which produce insulin; this results in absolute insulin deficiency.
• type 2 DM usually arises because of insulin resistance, in which the body fails to use the insulin properly, combined with relative insulin deficiency.
• the number 1 risk factor for developing type 1 DM in childhood is obesity and rate is increasing.
• insulin deficiency requires the use of exogenous insulin.
• diagnosis is based on the presence of classic symptoms and an elevated blood glucose level (normal is 70-99mg/dL).

Question 6

DM: assessment

Answer 6

• polyuria, polydipsia, polyphagia, hyperglycemia, weight loss, unexplained fatigue or lethargy, headaches, occasional enuresis in a previously toilet-trained child, vaginitis (caused by candida), fruity odor to breath, dehydration, blurred vision, slow wound healing, changes in level of consciousness.
• long-term effects: failure to grow at a normal rate, delayed maturation, recurrent infections, neuropathy, cardiovascular, renal and retinal microvascular disease.
• complications: hypoglycemia, hyperglycemia, diabetic ketoacidosis, coma, hypokalemia, hyperkalemia, microvasccular changes, cardiovascular changes.

Question 7

DM: Diet

Answer 7

• normal healthy nutrition is encouraged, and the total number of calories is based on age and growth.
• children with DM need no special types of food or supplements.
• should include 3 well-balanced meals per day, eaten at regular intervals, a mid-afternoon snack and a bedtime snack.
• concentrated sweets are discouraged; fat is reduced 30% or less of the total caloric requirement.
• instruct children and parents to carry a source of glucose at all times.

Question 8

DM: Exercise

Answer 8

• dietary adjustments are necessary when exercising.
• extra food needs to be consumed for increased activity, usually 10-15g of carbohydrates for every 30-45 min of activity.
• instruct child to monitor the blood glucose level before exercising.

Question 9

DM: Insulin

Answer 9

• diluted insulin may be required for some infants to provide small doses.
• lab evaluation of HgbA1c should be performed every 3 months (normal <6%).
• illness, infection, and stress increase the need for insulin.
• instruct parents and child in the adm and recognizing symptoms of hypo or hyperglycemia. Also when and how to adm glucagon IM or SC if child is hypoglycemic and unable to consume anything orally.

Question 10

DM: Blood Glucose Monitoring

Answer 10

• provide information needed to maintain good glycemic control.
• more accurate than urine testing.
• instruct child and parents on the proper procedure.
• stress the importance on following manufacture’s instructions, calibrate and check expiration date.
• if result does not seem reasonable, instruct to reassess.
  tips: hold the finger on warm water few seconds before puncture (enhances blood flow), and use the side of the finger pad (more vessels).

Question 11

DM: Urine testing

Answer 11

• instruct parents and child on the procedure and that the second voided urine specimen is more accurate.
• the presence of ketones may indicate impending ketoacidosis.
• should be used to test for ketones when child is ill or blood glucose level is consistently > 200mg/dL.
• encourage intake of liquids if ketone present.

Question 12

Hypoglycemia

Answer 12

< 70mg/dL.

• results from too much insulin, not enough food, or excessive activity.
• signs include headache, nausea, sweating, tremors, lethargy, hunger, confusion, slurred speech, tingling around the mouth, and anxiety.
• correct with oral glucose or IV infusion of dextrose or glucagon IM/SC.

Question 13

Hyperglycemia

Answer 13

> 200mg/dL

- signs include polydipsia, polyuria, polyphagia, blurred vision, weakness, weight loss, and syncope.

Question 14

Diabetic Ketoacidosis

Answer 14

• life-threatening condition, complication of DM that develops when a severe insulin deficiency occurs and a hyperglycemic state progresses to metabolic acidosis (takes over several hours to days).
• blood glucose level > 300mg/dL.
• manifestations include signs of hyperglycemia, kussmaul’s respirations, acetone breath odor, increasing lethargy, and decreasing level of consciousness.
• intervention: restore blood volume, correct with IV infusions of 0.9% or 0.45% saline as prescribed. Correct hyperglycemia with IV infusion of regular insulin as prescribed. Monitor VS, urine output, mental stauts, overload, blood glucose level, serum potassium level (if K replacement is necessary, child should be voiding). Adm oxygen as prescribed and treat the cause.
  IV dextrose is added when the blood glucose reaches an appropriate level.