442 Unit 4 | Common Illnesses or Disorders in Childhood and Home Care
Caregiver Education ● Preoperative education begins with providing information re- garding the cause, symptoms, and treatment options for the condition. ● If surgery is not an option, the nurse must provide thorough education regarding medications used for the treatment of the condition. ● Parents should provide a low-stress environment for the child during the preoperative and postoperative periods.
PHEOCHROMOCYTOMA
Pheochromocytoma rarely occurs in children; when it does, it is usually caused by a childhood tumor that originates in the chromaffin tissue of the adrenal medulla. The most common location is in the right adrenal gland. The peak incidence is be- tween 6 and 14 years of age. When the tumor occurs, excessive amounts of catecholamines are produced. Pheochromocytoma may mimic the symptoms of hyperthyroidism and diabetes mellitus (Young, 2021). Assessment Assessment for pheochromocytoma includes the following measures. Clinical Presentation ● Typical symptoms include increased heart rate (tachycardia), headache, palpitations, dizziness, poor weight gain, nausea and vomiting, and growth failure. ● Other symptoms may include abdominal pain, profuse sweat- ing, cool extremities, polydipsia, and polyuria. Diagnostic Testing ● 24-hour urine to assess the presence of catecholamine metabolites ● MRI or CT scan to determine the location of the tumor Nursing Interventions ● Preoperative administration of medications to inhibit the release of catecholamines may begin 1 to 3 weeks before surgery. ● If surgery is not an option, administration of medications such as alpha-adrenergic blocking agents is used to provide medical management. This medication may be combined with beta-adrenergic blocking agents to maximize the efficacy of treatment. ● Careful assessment of vital signs, especially blood pressure, is crucial. ● Blood glucose levels should be taken and assessed daily preop- eratively and postoperatively, because blood sugar levels may be higher than normal. ● Postoperatively, the patient should be placed in a minimally stimulating environment.
TYPE 1 DIABETES MELLITUS INSULIN DEPENDENT DIABETES
Type 1 diabetes mellitus (T1DM) is caused by destruction of the beta cells in the pancreas. The pancreas produces insulin that regulates blood sugar levels in the body. When the beta cells are destroyed, the pancreas can no longer produce insulin, so glu- cose levels in the bloodstream are too high. People with T1DM must have exogenous insulin to survive. The clinical syndrome of diabetes mellitus results from a variety of causes, including genetic influence, autoimmune mechanisms that negatively af- fect the pancreatic islet cells, and viral illnesses that attach and destroy pancreatic function (American Diabetes Association [ADA], 2021). Assessment Assessments for T1DM include the following. Clinical Presentation ● Polyuria, polydipsia, and polyphagia ● Unintentional weight loss over several days or weeks ● High glucose levels in the blood and urine ● Nausea and vomiting, excessive fatigue, abdominal pain, increased susceptibility to infections (Sonawalla & Jafri, 2021). Diagnostic Testing ● Criteria for the diagnosis of diabetes are listed here (ADA, 2021). The diagnosis is made based on results gathered on two separate occasions. ● Fasting blood sugar >126 ● Elevated blood glucose levels greater than 200 mg/dL with symptoms of hyperglycemia ● Elevated hemoglobin A1C levels greater than 6.5 ● Decreased serum insulin levels ● Presence of serum and urine ketones ● Positive autoantibodies (Sonawalla & Jafri, 2021): ● Insulin antibodies (anti-insulin), ideally this is drawn before insulin is given. ● Glutamic acid decarboxylase antibodies (anti-GAD). ● Islet tyrosine phosphatase 2 antibodies (anti-IA2). ● Zinc transporter protein 8 antibodies (anti-ZnT8)
CRITICAL COMPONENT Avoid Palpating the Adrenal Glands
During physical assessment of patients, the nurse should avoid palpating the area of the adrenal glands where the tumor is located because it can cause an elevated release of catecholamines, which will increase metabolism and produce a hypertensive crisis or tachydysrhythmias.
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