ATI child chapter 33 diabetes mellitus – Flashcards
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Diabetes is a contributing factor for what other medical conditions
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Cardiovascular disease, HTN, renal failure, blindness, and stroke as individual ages
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What predisposes a person to type I diabetes
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Genetics, Toxins and viruses destroyed beta cells
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What predisposes a person to type 2 diabetes
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Genetics and obesity,physical inactivity, high triglycerides greater than 250, HTN can lead to the development of insulin resistance and type two diabetes
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Assessment for hypoglycemia
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•Blood glucose less than 60 •hunger, lightheaded •HA, shakiness •Anxiety, irritability •diaphoresis, pale cool skin •Normal or shallow respiration a •tachycardia & palpitations
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Hyperglycemia
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• thirst, polyuria, oliguria •nausea, vomiting, ABD pain •skin: warm, dry and flushed with poor turgor • dry mucous membranes, confusion •Weakness, lethargy •Weak pulse, diminished reflexes • rapid, deep respirations with fruity odor (kussmals)
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Lab test for DM
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•8 hr. Fasting 126 or more •glucose of 200 or more with other S&S •oral glucose tolerance test 200 or more in s 2 hr. Sample
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Fasting blood glucose
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•Fast for eight hours •no anti-diabetic meds until after test
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Oral glucose test
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• balanced diet three days prior •Fast eight hours prior to test •blood draw to start test, pt consumes glucose then levels drawn q 30 minutes for 2 hours • Monitor for hypoglycemia during procedure
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Glycosylated hemoglobin A1c
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•Normal 4-6% •Kids with DM may be 6.5-8% •goal < 7%
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Proper foot care
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• cut nails straight across • inspect daily •wash with mild soap• pat dry especially b/t toes •powder w/ cornstarch for sweaty feet • no commercial remedies for callus-corns • nail care after bath •separate overlapping toes with cotton or lambs wool •no open toe/heal shoes • leather shoes, slippers w/ soles, shake out shoes
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Nutritional guidelines
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• count carbs, 15g= 1 carb exchange •avoid high: fat, sugar and carb foods •sports need snack 30 minutes b/f activity
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If a child is sick
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• Monitor glucose level every three hours • continue to take insulin and other meds • test urine for ketones Every three hours • rest
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When to call Dr. When child is sick
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• glucose > 240 •fever >102 that does not go down with medicine or last >12 hours • + ketones in UA • confusion • rapid breathing • vomits >1x •diarrhea >5x or > 24 hr. • sick > 2 days • can't handle liquids
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Treatment for hypoglycemia
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• 10-15g simple carb (1tbsp sugar) : 4 OZ OJ or reg soda, 8oz milk for mild • glucagon if unconscious or not able to swallow
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Treatment for hyperglycemia
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• encourage oral intake •Give insulin as ordered, test UAfor ketones
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Insulin lispro
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• rapid acting < 15 minutes (onset) • peak 30 min- 1hr •duration 3-4 hr
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Regular insulin
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• short acting • 30 min -1 hr onset • peak 2-4 hr •duration 5-7 hr
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NPH insulin
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Intermediate acting • 1-2hr onset • peak 4-12hr •duration 18-14hr
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Insulin glargine
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Long acting •onset 3-4hr •no peak • duration 10.4-24hr
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Do not mix
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Insulin glargine with other insulin d/t incompatibility
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When mixing insulin
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Draw up shorter acting first
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Diabetic ketoacidosis
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Acute, life-threatening condition, characterized by hyperglycemia greater than 300 results and breakdown of body fat for energy and the accumulation of key tones in the blood and urine • onset is rapid and mortality is high
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Cause of diabetic ketoacidosis
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Insufficient insulin, acute stress, and poor management of acute illness
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Nursing care for diabetic ketoacidosis
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ICU, cardiac monitor • rapid isotonic fluid, 0.9% Na chloride to maintain perfusion to vital organs followed by hypotonic fluid 0.45% Na chloride
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S&S of DKA
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•Ketones in blood &Urine • fruity breath • confusion, dyspnea, N&V, dehydration, wt loss, electrolyte imbalance • if not treated coma
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When glucose levels approach 250
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Add glucose to IV fluids to minimize risk of cerebral edema associated w/ drastic changes in osmolarity • give regular insulin 0.1units/kg as bolus then 0.1U/kg/hr
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K+ levels
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monitor, will initially be elevated. With insulin therapy potassium will shift into cells and the child needs monitored for hypokalemia. Make sure output is adequate b/f giving K+
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Treatment for severe acidosis
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pH <7 Give sodium bicarbonate slowly IV • monitor K+ b/c if correction of acidosis occurs too quickly May lead to hypokalemia
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Long-term complications
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Nephropathy, retinopathy, neuropathy, cardiovascular disease, altered thyroid function, limited mobility of small joints
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A nurse is reviewing sick day management with a parent of a kid with type I DM. Which should the nurse include? Select all a. monitor blood glucose q 3 hours b. D/C insulin until feeling better c. drink 8 oz of juice q hour d. test urine for ketones e. Call dr. if >240
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A, D,E
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A nurse is teaching a kid with type I DM about self care. Which if the following statements made indicates understanding? a. I will skip meals if not hungry b. I will ^ my insulin with exercise c. I should drink 8oz of milk if feel irritable d. I will draw up NPH before regular
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C, drink milk
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A nurse is caring for kid with type I DM. Which if the following is a clinical manifestation of DKA. Select all a. blood glucose 58 b. wt. gain c. dehydration d. confusion e. fruity breath
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C,D,E dehydration because of the osmotic diuresis d/t electrolyte shift
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What are the clinical manifestations of hypoglycemia? Select all a. Increased urination b. hunger c. signs of dehydration d. irritability e. sweating and pallor f. kussmaul respirations
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B,D,E
