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Nursing Care of Children Experiencing Diabetes Mellitus
A Life Long Challenge
Marydelle Polk, Ph.D., ARNP-CS
Florida gulf Coast University
Session Objectives
• Review the pathophysiological processes that occur diabetes mellitus.
• Use nursing assessment skills to identify adaptive and non-adaptive behaviors that may be exhibited by the client and client family.
• Use lab/diagnostic data to enhance your nursing assessment(s).
Session Objectives• Identify common nursing diagnoses that can be
drawn after an assessment of a child with diabetes mellitus.
• Identify and specifically describe nursing care given to a pediatric client with diabetes mellitus.
• Identify and specifically describe means of evaluation nursing coventions that correlate with medical orders and interventions for pediatric clients with diabetes mellitus.
Definition of Diabetes Mellitus (DM)• Chronic disorder• Partial or complete absence of insulin• Very common – 20 per 100,000 children &
adolescents• Peak incidence between 10 – 25 years-of-age• Incidence of Type 1 is in whites, boys
than girls
Classification
• Type 1 – Absolute insulin deficiency * Immune-mediated DM
* Idiopathic Type 1
Classification
• Type 2 DM
* Insulin resistance with relative insulin deficiency * Maturity-onset diabetes of the young (MODY)
Etiology
• Multi-focal
* Genetic predisposition
* Autoimmune dysfunction * Diet * Viruses
Clinical Manifestations of DM
Early
1. Excessive drinking(polydipsia)
2. Polyuria
3. Polyphagia
4. Weight loss
5. Enuresis (secondary)
Late
• Vomiting• Dehydration• Abdominal pain• Hypovolemic shock• Hyperventilation due to
_______?• Drowsiness Coma
Aims of Long-term Management
• Normal growth and development• Maintaining as normal a home and school life
as possible• Good diabetic control through knowledge,
good technique, and self reliance• Avoidance of hypoglycemia• Prevention of long term complications
How DM Interferes with Normal Adolescence
Tasks of adolescence Delayed sexual maturation Invasion of privacy
Conformity with peer group Meals must be eaten on time
Frequent injections and blood tests
Self-image Hypoglycemic attacks show how they are different
How DM interferes with Normal Adolescence
Self-esteem Impaired body image
Independence from parents Parental protection and reluctance to allow to allow their child to be away from home Battles over diabetesEconomic independence Loading of insurance premiums
Discrimination by employers
Ketoacidosis Clinical Manifestations
• Kussmaul Respirations with acetone breath• Polyuria with ketouria pH with hyperkalemia Blood glucose • Dry skin, mucus membranes (dehydration)• Confused, lethargic coma • Weak pulse, diminished reflexes
KetoacidosisClinical Management
The aim is to restore adequate hydration, blood glucose levels and electrolyte balance
• Obtain a venous access line• Laboratory studies• Fluid, insulin and electrolyte replacement*** Before administering potassium – always
make sure the child has an adequate urinary output – 25-30 mL/hr
Nursing Diagnoses
• Risk for injury r/t insulin deficiency
• Risk for injury r/t hypoglycemia
• Knowledge deficit r/t diabetes management