1. Nursing Care of Children Experiencing Diabetes Mellitus A Life Long Challenge Marydelle Polk, Ph.D., ARNP-CS Florida gulf Coast University

2. 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).

3. 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.

4. 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

5. Classification Type 1 – Absolute insulin deficiency * Immune-mediated DM * Idiopathic Type 1

6. Classification Type 2 DM * Insulin resistance with relative insulin deficiency * Maturity-onset diabetes of the young (MODY)

7. Etiology Multi-focal * Genetic predisposition * Autoimmune dysfunction * Diet * Viruses

8. 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

9. 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

10. 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

11. 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 diabetes Economic independence  Loading of insurance premiums  Discrimination by employers

12. 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

13. Ketoacidosis Clinical 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

14. Nursing Diagnoses Risk for injury r/t insulin deficiency Risk for injury r/t hypoglycemia Knowledge deficit r/t diabetes management