Case Study Diabetes Mellitus Type 1 Scenario: A 5-year-old is brought to her pediatrician for
Case Study Diabetes Mellitus Type 1 Scenario: A 5-year-old is brought to her pediatrician for an annual routine checkup. Her grandparents, who are also her legal guardians, are with her. The child has not seen her pediatrician in a year. The child recently had a visit to an urgent care center and was treated for strep throat. The grandparents are concerned about the child’s weight gain. They state that no matter how much she eats she cannot gain weight and is hungry all the time. Assessment: Weight: 15.9 kg Height: 41 in. Heart rate: 122 beats per minute Blood pressure: 96/44 mmHg The child is anxious, looks thin, and has dry lips and dry mucous membranes. Upon neck palpation the child has several enlarged cervical lymph nodes and has a “sweet” odor to her breath. The remainder of the examination is within normal limits. 1. Highlight or place a check mark next to the assessment findings that require immediate follow-up by the nurse. 2. Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. While assessing the child, the nurse recognizes that ___________1_____________, __________1___________, and ______________1______________ are signs of _________2__________, a possible diagnosis. The nurse anticipates the provider will order the following tests, _________3____________ and _________3___________ to help confirm or rule out the diagnosis. Options for 1 Options for 2 Options for 3 Dry mucous membranes Diabetes mellitus Urinalysis Poor weight gain Metabolic alkalosis Blood sugar Sweet breath odor Respiratory alkalosis Complete blood count Anxiety Hyperaldosteronism Ultrasound Enlarged cervical lymph nodes Hypothyroidism Thyroid test Scenario: The primary care office does not have a glucometer available, so the provider orders a urinalysis dip stick test. The urinalysis shows a glucose of over 500 mg/dL with blood, leukocytes, and ketones. The results are shared with the grandparents along with the potential diagnosis and complications. The child’s grandparents are visibly upset and start asking the nurse questions about their grandchild. 3. Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. Based on the available test results the nurse suspects the child may be experiencing _________1_________, because of the ________1________ and _________1________in the urine. The nurse anticipates that the child will need ___________2__________ and _________2___________ as soon as possible. Options for 1 Options for 2 Diabetic ketoacidosis PO glucagon Metabolic alkalosis IV regular insulin Respiratory alkalosis Fruit juice Respiratory acidosis IV long acting insulin Glucose IV fluid replacement Ketones 5% dextrose Leukocytes Chocolate milk Blood 4. Use an X to indicate whether the nurse’s responses to the child’s grandparents are Therapeutic or Nontherapeutic. Nurse’s Response Therapeutic Nontherapeutic “There is no need to worry, this diagnosis is common in children.” “By administering IV insulin and IV fluids, we can help your grandchild to feel better.” “I understand all of this can be overwhelming, but we are here to support you through this new diagnosis.” “Yes, you could have attributed to this problem by not limiting the amount of sugar your grandchild eats.” “It is important that you understand that this is not something you could have prevented.” Scenario: The child is admitted to local children’s hospital with diabetes mellitus type 1 for continued care, further evaluation, and education about her new diagnosis. After several days, the child is ready for discharge. While the nurse is providing discharge education to both the child and her grandparents, the child asks if she will be ever be a normal kid again. 5. Which of the following responses by the nurse are appropriate? Select all that apply. “You will always have diabetes mellitus type 1, but this does not mean that you cannot be a normal child.” “You may have a hard time making friends who understand your diagnosis.” “You will need to monitor your blood sugar and carbohydrate intake, but you can still participate in your favorite activities.” “It will be hard for you to continue taking dance and gymnastics now that you have been diagnosed with diabetes mellitus type 1.” 6. After providing discharge instructions to the grandparents, the nurse assess the grandparents understanding. For each statement, use an X to indicate whether the nurse’s discharge instructions were Effective (helped the grandmother understand the discharge instructions), Ineffective (did not help the grandmother understand the discharge instructions), or Unrelated (not related to the discharge instructions). Statements Effective Ineffective Unrelated “We will need to help our granddaughter monitor her blood sugar levels on a daily basis.” “We will keep our medications in child proof containers and out of reach.” “We will help our granddaughter plan out her daily meals and count carbohydrates.” “We will ensure she understands that the abdomen is the only location for an insulin injection site.” “As long as we monitor what our granddaughter eats, she should not need to use insulin.” “It is important that we understand the signs and symptoms of hypoglycemia and hyperglycemia.”
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