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