ATI child chapter 33 diabetes mellitus

Diabetes is a contributing factor for what other medical conditions
Cardiovascular disease, HTN, renal failure, blindness, and stroke as individual ages
What predisposes a person to type I diabetes
Genetics, Toxins and viruses destroyed beta cells
What predisposes a person to type 2 diabetes
Genetics and obesity,physical inactivity, high triglycerides greater than 250, HTN can lead to the development of insulin resistance and type two diabetes
Assessment for hypoglycemia
•Blood glucose less than 60
•hunger, lightheaded
•HA, shakiness
•Anxiety, irritability
•diaphoresis, pale cool skin
•Normal or shallow respiration a
•tachycardia & palpitations
Hyperglycemia
• 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)
Lab test for DM
•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
Fasting blood glucose
•Fast for eight hours
•no anti-diabetic meds until after test
Oral glucose test
• 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
Glycosylated hemoglobin
A1c
•Normal 4-6%
•Kids with DM may be 6.5-8%
•goal < 7%
Proper foot care
• 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
Nutritional guidelines
• count carbs, 15g= 1 carb exchange
•avoid high: fat, sugar and carb foods
•sports need snack 30 minutes b/f activity
If a child is sick
• Monitor glucose level every three hours • continue to take insulin and other meds • test urine for ketones Every three hours • rest
When to call Dr. When child is sick
• 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
Treatment for hypoglycemia
• 10-15g simple carb (1tbsp sugar) : 4 OZ OJ or reg soda, 8oz milk for mild
• glucagon if unconscious or not able to swallow
Treatment for hyperglycemia
• encourage oral intake •Give insulin as ordered, test UAfor ketones
Insulin lispro
• rapid acting
< 15 minutes (onset) • peak 30 min- 1hr •duration 3-4 hr
Regular insulin
• short acting
• 30 min -1 hr onset
• peak 2-4 hr
•duration 5-7 hr
NPH insulin
Intermediate acting
• 1-2hr onset
• peak 4-12hr
•duration 18-14hr
Insulin glargine
Long acting
•onset 3-4hr
•no peak
• duration 10.4-24hr
Do not mix
Insulin glargine with other insulin d/t incompatibility
When mixing insulin
Draw up shorter acting first
Diabetic ketoacidosis
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
Cause of diabetic ketoacidosis
Insufficient insulin, acute stress, and poor management of acute illness
Nursing care for diabetic ketoacidosis
ICU, cardiac monitor
• rapid isotonic fluid, 0.9% Na chloride to maintain perfusion to vital organs followed by hypotonic fluid 0.45% Na chloride
S&S of DKA
•Ketones in blood &Urine • fruity breath • confusion, dyspnea, N&V, dehydration, wt loss, electrolyte imbalance
• if not treated coma
When glucose levels approach 250
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
K+ levels
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+
Treatment for severe acidosis
pH <7 Give sodium bicarbonate slowly IV • monitor K+ b/c if correction of acidosis occurs too quickly May lead to hypokalemia
Long-term complications
Nephropathy, retinopathy, neuropathy, cardiovascular disease, altered thyroid function, limited mobility of small joints
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
A, D,E
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
C, drink milk
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
C,D,E
dehydration because of the osmotic diuresis d/t electrolyte shift
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
B,D,E