Nursing%20Care%20of%20Children%20Experiencing%20Diabetes%20Mellitus

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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
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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).

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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.

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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

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Classification

• Type 1 Absolute insulin deficiency
  Immune-mediated DM
• Idiopathic Type 1

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Classification

• Type 2 DM Insulin resistance with relative
  insulin deficiency Maturity-onset
  diabetes of the young (MODY)

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Etiology

• Multi-focal Genetic predisposition
• Autoimmune dysfunction Diet
  Viruses

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Clinical Manifestations of DM

• Early
• Excessive drinking(polydipsia)
• Polyuria
• Polyphagia
• Weight loss
• Enuresis (secondary)

• Late
• Vomiting
• Dehydration
• Abdominal pain
• Hypovolemic shock
• Hyperventilation due to _______?
• Drowsiness ? Coma

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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

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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
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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
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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

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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

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Nursing Diagnoses

• Risk for injury r/t insulin deficiency
• Risk for injury r/t hypoglycemia
• Knowledge deficit r/t diabetes management

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The End...