448 Unit 4 | Common Illnesses or Disorders in Childhood and Home Care
● Correct electrolyte imbalance by administering IV fluids with electrolytes. ● Monitor laboratory values. ● Frequently check blood sugar and vital signs. ● Frequently assess for signs of further complications. ● Assess respiratory status for signs of complications, such as Kussmaul breathing. This type of breathing is very deep and laborious and means that the patient is trying to correct the metabolic acidosis and “blow off” excess carbon dioxide (CO 2 ). ● Frequently assess IV site, because multiple infusions of fluids, electrolytes, and insulin will increase chances of infiltration. The nurse must use an IV Y-Port to allow for multiple infusions at the same time. The nurse must also check drug compatibility before infusing multiple infusions through the same IV tubing. ● Patients in DKA may have a “fruity” or “sweet” odor to their breath, which smells similar to Juicy Fruit gum.
• Caregiver lack of competence regarding insulin management • Insulin pump failure • Insulin that is out of date • Underlying illness, surgery, or trauma
CRITICAL COMPONENT Family Teaching Guidelines: Dealing With a Hypoglycemic Crisis How To: Recognize the signs of hypoglycemia—child is pale, sweaty, dizzy, "shaky" (tremors), confused, irritable, numb on lips or mouth, irritable, suddenly very sleepy, hungry, difficult to wake up, unconscious, seizing. Causes: Taking too much insulin, not eating enough carbohydrates, exercising without eating extra carbohydrates, injecting insulin into muscle, skipping meals, illness. Essential Information: • Check blood glucose level. • If blood glucose is below 70 mg/dL, rapidly give one of the following sources of carbohydrates (about 10 to 15 grams each), in the right amount to treat hypoglycemia: • ½ to ¾ cup of orange or grape juice (a juice box is good when away from home) • 2 glucose tablets or 2 doses of glucose gel • 2 to 4 pieces of hard candy • Gumdrops • 1 to 2 tablespoons of honey • 1 small box of raisins • 6 oz regular (not diet) soda (about half a can) • 2 tablespoons of cake icing • Recheck blood glucose in 15 minutes. If the reading is still below 70 mg/dL, then: • Give another glass of juice, etc. • Recheck blood glucose again after another 15 minutes. • When blood glucose returns to at least 80 mg/dL, a more substantial snack (nonconcentrated sugar) may be given (i.e., cheese and crackers, bread and peanut butter, etc.) if the next meal is more than 30 minutes away or if a physical activity/ exercise is planned. • If the child is unconscious, glucagon should be given either subcutaneously or intramuscularly (ADA, 2017a, 2017b). Safety Note: If the child is conscious, a 4-oz glass of orange juice will help increase blood sugar levels. When a child is severely hypoglycemic and cannot take glucose tablets by mouth because of confusion or loss of consciousness, a dose of glucagon must be given IM or IV. In most cases the drug is given IM in the home or school setting to reverse the effects of severe hypoglycemia. The recommended dose to administer for children <25 kg or older than 6 years old and of unknown weight is 0.5 mg, and for children >25 kg or older than 6 years old and of unknown
CLINICAL JUDGMENT Diabetes and Pregnancy
Diabetes poses a maternal and fetal risk related to hyperglycemia and chronic complications and comorbidities of diabetes. Hyperglycemia may case spontaneous abortions, fetal anomalies, preeclampsia, macrosomia, and fetal death (ADA, 2021). Because of the hormones released during pregnancy, there may be wide variations in blood sugar, and diabetes regimens must be evaluated and adjusted frequently. The ADA (2021) recommends that preconception counseling be incorporated into all routine diabetes care starting at puberty in girls who have reproductive potential.
CRITICAL COMPONENT Diabetic Ketoacidosis
In 2018 the International Society for Pediatric and Adolescent Diabetes (Wolfsdorf et al, 2018) defined DKA according to the following parameters: • Hyperglycemia—blood glucose of more than 200 mg/dL (11 mm/L) • Metabolic acidosis—venous pH less than 7.3 or a plasma bicarbonate less than 15 mEq/L (15 mmol/L) • Ketosis—determined by the presence of ketones in the blood or urine (Wolfsdorf et al, 2018) DKA is a complex, emergent condition that combines hyperglycemia, acidosis, and ketosis, resulting in severely deficient insulin levels that alter the metabolism of carbohydrates, protein, and fat. Some of the precipitating factors that the nurse must assess are: • Poor compliance with insulin regimens • Patients entering puberty and beginning of the menstrual cycle
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