450 Unit 4 | Common Illnesses or Disorders in Childhood and Home Care
● Other symptoms that might occur are gradual and may con- sist of a burning sensation of the feet, ankles, and legs; poor wound healing; changes in vision; weight loss; polyuria; polydipsia; and fatigue. Diagnostic Testing The criteria for the diagnosis of diabetes are as follows (ADA, 2021). Diagnosis is made based on results gathered on two sepa- rate occasions. ● Elevated fasting blood glucose levels greater than 126 mg/dL ● Random blood glucose levels greater than 200 mg/dL and symptoms of hyperglycemia ● Elevated hemoglobin A1C level greater than 6.5% ● 2-hour oral glucose tolerance testing greater than 200 Nursing Interventions ● Administer antihyperglycemic medications or insulin as ordered to help decrease high blood glucose levels. ● Educate the child and family on treatment for T2DM. Treat- ment includes diet and exercise modifications and potentially the use of metformin, insulin, and ● For children with normal renal function and A1C <8.5%, metformin is the pharmacological treatment initially offered. Children with blood glucose ≥ 250 or A1C >8.5% who are symptomatic of hyperglycemia but do not present with acidosis are started on basal insulin while metformin is initiated and titrated. Liraglutide may be added to the regi- men if glycemic targets are not met with metformin, with or without basal insulin, in children older than 1 (ADA, 2021). ● Early assessment for risks, detection, and diagnosis is crucial. ● Obtain dietary history and refer to the dietitian for dietary counseling. ● Encourage exercise and refer the parents to a physical thera- pist if indicated. ● Assess for symptoms of psychosocial problems, such as altered body image, depression, and ineffective individual coping, and refer to a psychologist if needed.
Diagnosis is confirmed when the child has a fasting glucose greater than 126 mg/dL or two random blood glucose readings greater than 200 mg/dL. The child's hemoglobin A1C level must also be _6.5% on two laboratory-confirmed tests (Laffel & Svoren, 2020).
SAFE AND EFFECTIVE NURSING CARE: Understanding Medication
Caregiver Education ● Explain to the family that treatment options include dietary compliance and exercise to help lose weight and lower glucose levels. ● Involve the entire family in the dietary and exercise educa- tion, as many patients have obese parents and siblings with prediabetes or T2DM. The concept of working as a team is very important because the child will not adhere to treat- ment unless the family is involved and supportive of the child. ● Educate the child and family regarding the long-term effects of T2DM, such as permanent vision loss, cardiovas- cular disease, hypertension, high cholesterol, and orthopedic problems. ● Teach the parents how to limit sedentary playtime such as playing video games and watching TV and encourage team sports and daily exercise. ● If antihyperglycemics are ordered, the nurse must teach the parents and patient regarding reasons for the medication, dose, route, frequency, and administration. Potential side effects should also be discussed. ● The patient should be taught the symptoms of hypoglycemia, hyperglycemia, and DKA. Metformin Metformin is recommended as the initial pharmacotherapeutic agent for people with diabetes (ADA, 2021). It is approved for children with T2DM older than 10. The drug decreases hepatic glucose production and intestinal glucose absorption while in- creasing the body’s sensitivity to insulin. It is usually started at a dose of 500 mg twice a day and can be titrated to 2,000 mg/ day in divided doses. Metformin is contraindicated in acidosis, heart, liver, and renal failure. If taken with insulin, the patient and caregivers should be counseled on signs and symptoms of hy- poglycemia and treatment. There is a risk of lactic acidosis when used in the setting of dehydration or renal failure. The medica- tion may be held in the setting of surgery, severe infection, and prolonged or severe diarrhea. The mediation should be held before studies with IV contrast and 48 hours after (Vallerand & Sanoski, 2021).
CRITICAL COMPONENT Risk Factors for Type 2 Diabetes Mellitus
Obesity in children and adolescents has led to an increased incidence of insulin resistance and T2DM. As a result, established guidelines have identified certain risk factors that may appear while obtaining a history and physical information. These factors include but are not limited to: • BMI greater than 85th percentile for age and weight • Family history of T2DM • Certain races/ethnic groups: black, Latino, Asian American, American Indian, and Pacific Islanders • Signs of insulin resistance as evidenced by acanthosis nigricans • Maternal history of gestational diabetes or diabetes
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