446 Unit 4 | Common Illnesses or Disorders in Childhood and Home Care
● Assessment of laboratory values ● Assess laboratory values such as phosphorus, magnesium, and potassium, because insulin may decrease serum levels. ● Frequently monitor hemoglobin A1C levels to assess average blood glucose levels over a 90-day period. This will also help to identify whether the insulin regimen is appro- priate or requires adjustment. ● Psychosocial support ● Provide psychosocial support to the patient, parents, and family, taking into consideration the age-appropriate devel- opmental needs of the patient. ● Refer the patients to diabetes support organizations: ● ADA ● Juvenile Diabetes Foundation ● Encourage participation in diabetes education classes and diabetes support groups provided by the institution. ● Make a referral to social services or psychosocial counselor if indicated. Caregiver Education ● Patient and family education regarding the administration of insulin (Fig. 18–3; Box 18-1)
FIGURE 183 Wearing an insulin pump allows children to control the release of insulin throughout the day, more closely resembling the body’s natural response.
BOX 181 | Teaching Parents How to Inject Insulin
Purpose To teach parents how to inject insulin Equipment Insulin bottle from refrigerator (remove up to 1 hour before injec- tion to allow it to warm to room temperature) Appropriate insulin syringe (0.3 mL, 0.5 mL, or 1 mL) Alcohol wipes Container for the dirty, used syringe Steps 1. Check the expiration date on the insulin bottle. RATIONALE: Ensures that the insulin has not expired. 2. Wash hands. RATIONALE: Prevents the spread of bacteria. 3. Clean rubber stopper on insulin bottle with alcohol wipe. RATIONALE: Promotes asepsis. 4. Remove syringe cap and pull air into the syringe; line up the end of the black plunger to the exact amount the insulin dose will be. RATIONALE: Ensures accurate dosage of insulin will be drawn up. 5. Put the syringe needle through the bottle rubber top and push syringe plunger so that all the air goes from the syringe into the bottle.
6. Turn the insulin bottle upside down and pull the syringe plunger so that the insulin enters the syringe until the top of the black plunger exactly lines up with the dose of insulin to be given. 7. Remove every air bubble, always checking that the dose is exact. RATIONALE: Exact dosing is essential in managing the child’s condition. 8. Choose (or let the child choose) the site of the injection. RATIONALE: Allowing the child to participate may help the child feel more in control of the condition. 9. Clean the injection site with an alcohol swab. RATIONALE: Alcohol will decrease the presence of microorganisms. 10. Pinch up the skin slightly and gently, with the syringe at a 90-degree angle (perpendicular) to the skin; with a dart-like motion, insert the needle into the skin; release the skin. RATIONALE: Ensures proper medication administration. 11. Slowly inject the dose of insulin. 12. Discard the used syringe in a hard, rigid container with a tight- fitting lid. Clinical Alert The nurse teaches the parents to evaluate the child for the signs and symptoms of either hypoglycemia or hyperglycemia. In understand- able terms, explain these signs and symptoms to the parents so they can watch for them at home.
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