Chapter 31: The Child with a Metabolic Condition

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Questions and Answers

What is the pattern of inheritance for inborn errors of metabolism, such as Tay-Sachs disease?

They are usually multifactorial.

They are usually autosomal recessive. (correct)

They are usually autosomal dominant.

They are usually X-linked recessive.

What is a consequence of inadequate insulin secretion in the body?

Serum glucose levels are markedly decreased.

Increased fat breakdown leads to ketonemia. (correct)

More rapid conversion and storage of carbohydrates to glucose occurs.

Protein synthesis is increased.

What distinguishes type 1 diabetes mellitus from other types of diabetes?

Oral hypoglycemic agents can control it.

There is an absolute deficiency of insulin. (correct)

Insulin deficiency is caused by another disease affecting the pancreas.

Insufficient quantities of insulin are produced by the pancreas.

If a child receives regular and NPH insulin at 8:00 AM but breakfast has not yet arrived, what is the best immediate action?

Give the patient a snack of graham crackers and milk. Signup and view all the answers

Which characteristic is true for Xeroderma Pigmentosum in terms of inheritance?

Inherited in an autosomal recessive manner. Signup and view all the answers

What is the most accurate understanding of type 1 diabetes mellitus?

It is characterized by an absolute deficiency of insulin. Signup and view all the answers

What is likely to happen when there is an insulin deficiency in the body?

The body starts to metabolize fat incompletely. Signup and view all the answers

In a medical scenario, if a patient has a persistent high blood sugar after insulin administration, what should be suspected?

The insulin dose was not administered correctly. Signup and view all the answers

What symptom is typically associated with ketoacidosis?

Fruity breath Signup and view all the answers

Why are children more prone to insulin reactions compared to adults?

They have irregular activities. Signup and view all the answers

What is the recommended time frame for changing insulin pump tubing?

Every 48 hours Signup and view all the answers

What fasting blood glucose level indicates the diagnosis of diabetes mellitus?

126 mg/dL Signup and view all the answers

What does a glycosylated hemoglobin (HbA1c) test measure?

Average glucose levels over a period of 1-2 months Signup and view all the answers

What risk is associated with long-acting insulin administration in children during sleep?

Hypoglycemia Signup and view all the answers

What is a common sign of dehydration related to ketoacidosis?

Decreased level of consciousness Signup and view all the answers

Which of the following is a laboratory value commonly seen in ketoacidosis?

Ketonuria Signup and view all the answers

Which factor contributes to the unstable condition of diabetes in children?

Growth spurts Signup and view all the answers

What type of therapy is used to manage children with diabetes who may not respond well to traditional insulin regimens?

Insulin pumps Signup and view all the answers

What is the most immediate treatment for hypoglycemia?

Administer sugar in some form Signup and view all the answers

Why should the side of the finger be used for blood testing in children?

It has fewer nerve endings. Signup and view all the answers

What is the primary function of an insulin pump?

Provides continuous infusion of insulin Signup and view all the answers

Which type of insulin is classified as long-acting?

Glargine Signup and view all the answers

Which chromosomes are associated with diabetes in children?

6, 7, 12, 20 Signup and view all the answers

Which foods are known to be high in soluble fiber?

Raw fruits and beans Signup and view all the answers

What does soluble fiber help reduce in individuals with diabetes?

Absorption of sugar Signup and view all the answers

Which processes are primarily controlled by the endocrine system?

Maturation and reproduction Signup and view all the answers

What symptom might indicate an overdose of levothyroxine in a child?

Tachycardia Signup and view all the answers

Which factor most complicates diabetes management in adolescents?

Hormonal changes and fast food preferences Signup and view all the answers

During an illness, which symptoms may indicate the risk of ketoacidosis in a child with diabetes?

Nausea and vomiting Signup and view all the answers

Which factor has no impact on diabetes management in adolescents?

Knowledge of diabetes Signup and view all the answers

Which dietary component does soluble fiber significantly affect?

Sugar absorption Signup and view all the answers

Which action is essential when treating a child with hypoglycemia?

Give a quick source of sugar Signup and view all the answers

What does a glycosylated hemoglobin level between 6% and 9% indicate?

Good metabolic control Signup and view all the answers

In which phenomenon does rebound hyperglycemia occur due to the body's counter-regulatory hormones being released?

Somogyi phenomenon Signup and view all the answers

What precaution should a nurse advise a woman concerned about having a child with Tay-Sachs disease?

A screening test can determine carrier status. Signup and view all the answers

Which statement indicates correct administration of levothyroxine (Synthroid) by a parent?

I give the medication at 8:00 AM daily. Signup and view all the answers

After a closed head injury, which condition is suspected in a child who excretes copious amounts of pale urine?

Diabetes insipidus Signup and view all the answers

What symptom should parents be vigilant for regarding water intoxication in a child with diabetes insipidus?

Lethargy Signup and view all the answers

Which type of diabetes is characterized by the body's resistance to insulin?

Type 2 diabetes mellitus Signup and view all the answers

When teaching a 12-year-old to administer insulin, what should the nurse instruct them to do?

Inject the needle at a 90-degree angle. Signup and view all the answers

What behavior demonstrates the understanding of treatment for hypoglycemia by an adolescent?

I will eat six LifeSavers if I feel weak. Signup and view all the answers

What lab finding indicates that a patient has poor metabolic control?

Glycosylated hemoglobin above 9% Signup and view all the answers

Which of the following describes the primary characteristic of the Honeymoon effect?

Temporary remission after initial diagnosis. Signup and view all the answers

What is the primary symptom of ketoacidosis in children?

Hyperglycemia Signup and view all the answers

Which is a key symptom distinguishing diabetes insipidus from diabetes mellitus?

Copious urination Signup and view all the answers

What is the recommended course of action when a child with diabetes insipidus shows signs of dehydration?

Increase fluid intake immediately. Signup and view all the answers

What is the most immediate action the nurse should take for a child with type 1 diabetes who is hungry and drowsy after receiving insulin?

Give her a cup of orange juice. Signup and view all the answers

Which statement suggests that a school-age child needs more education about managing diabetes during exercise?

Sometimes I skip my breakfast when I have a game in the morning. Signup and view all the answers

Which statement indicates that a child with type 1 diabetes needs additional teaching regarding insulin?

My pancreas is sick and needs insulin until it is well. Signup and view all the answers

What dietary approach should a nurse emphasize to a child with type 1 diabetes?

Focus on complex carbohydrates and eat foods high in fiber. Signup and view all the answers

If a child with diabetes presents with flushed skin, drowsiness, and a dry tongue, what condition is most likely?

Ketoacidosis Signup and view all the answers

The lethargy and sleeping 18 hours a day exhibited by a 4-month-old infant suggest which condition?

Hypothyroidism Signup and view all the answers

What key consideration should be made for a school-age child on DDAVP for diabetes insipidus?

Arrange for the child to use the bathroom when needed. Signup and view all the answers

Which laboratory result indicates poor metabolic control for a child with type 1 diabetes mellitus?

Fasting blood glucose level greater than 250 mg/dL Signup and view all the answers

When managing a child with diabetes, which should be prioritized if the child is exhibiting signs of hypoglycemia?

Administer a quick-acting carbohydrate. Signup and view all the answers

What symptom suggests a child might be experiencing ketoacidosis?

Flushed and dry skin with lethargy Signup and view all the answers

What should a child with diabetes be taught regarding meal timing and physical activities?

Always check blood glucose before physical activity. Signup and view all the answers

When a mother reports her child is tiring easily and often has dry skin, what is a likely concern?

Underactive thyroid function Signup and view all the answers

Which is the least appropriate snack for a child with diabetes before exercise?

A candy bar Signup and view all the answers

If a child is experiencing complications from uncontrolled diabetes, what is a mainly observed finding?

Dehydration and excessive thirst Signup and view all the answers

Study Notes

Inheritance Patterns of Inborn Errors of Metabolism

Typically autosomal recessive.

Inadequate Insulin Secretion

Results in increased fat breakdown, leading to ketonemia (elevated ketone bodies in the blood).

Type 1 Diabetes Mellitus

Characterized by an absolute deficiency of insulin.
Insulin production is insufficient.
Insulin deficiency is not related to another disease.
Oral hypoglycemic agents do not control it.

Insulin Reaction Prevention in Children

If food isn't taken within 20 minutes of regular insulin administration, an insulin reaction (hypoglycemia) can occur.
Provide graham crackers and milk as a snack to prevent a hypoglycemic episode.

Hyperglycemia in Children with Type 1 Diabetes

Immediate treatment involves giving orange juice to raise blood glucose levels.
Walking exercise will use up more glucose, and more insulin would worsen the condition.
Treatment is increasing insulin levels.

Diabetic Education for School-Age Children

Skipping breakfast before exercise could result in hypoglycemia.
Children should carry emergency money for unexpected events, including exercise after dinner.

Type 1 Diabetes Mellitus Instruction for a 7-Year-Old

Insulin is required as the pancreas is not functioning effectively to produce insulin on its own.

Dietary Measures for Type 1 Diabetes

Focus on complex carbohydrates and foods containing high fiber for the nutritional requirements of diabetic children (same as non-diabetic children)
Reduce consumption of concentrated carbohydrates such as sugar.
Fiber reduces blood glucose levels.

Ketoacidosis Symptoms in Children

Children with ketoacidosis will likely present with dry skin, flushed face, perspiration, restlessness, and rapid breathing (no rest between breaths).

Hypothyroidism Symptoms in Infants

Infants with hypothyroidism exhibit lethargy, 18-hour sleep patterns, and snoring.
Enlarged tongues can cause noisy respiration.

Diabetes Insipidus Considerations in School-Age Children

Ensure the child has easy access to restrooms and water.
Arrange for the child to use the restroom as needed.

Metabolic Control for Type 1 Diabetes

Glycosylated hemoglobin (HbA1c) values between 6%-9% indicate good metabolic control.
Low fasting blood glucose level (less than 140 mg/dL) suggests good metabolic control.
Absence of glucose and ketones in urine shows good control.

Somogyi Phenomenon

Rebound hyperglycemia caused by the body's counter-regulatory hormones being released due to very low blood glucose.

Tay-Sachs Disease Genetic Screening

Genetic screening can identify carriers of the gene for Tay-Sachs disease.
Tay-Sachs is autosomal recessive.

Levothyroxine (Synthroid) Administration

Administer at the same time daily, preferably in the morning.

Diabetes Insipidus (after head injury)

Causes copious pale urine output, leading to a drop in blood pressure.
Dehydration can occur rapidly.

Water Intoxication Symptoms

Symptoms include edema, lethargy, nausea, and central nervous system signs.

Type 2 Diabetes Mellitus

Characterized by insulin resistance.
The body is unable to use insulin efficiently.

Insulin Administration Techniques

Inject at a 90 degree angle.

Adolescent Understanding of Hypoglycemia

Eating sugar is the most immediate treatment for hypoglycemia
Avoid using insulin when blood sugar is low.

Blood Glucose Testing Technique

Test using the sides of fingers to prevent using the nerve-rich fingertip, for less discomfort to the child (fewer nerve endings).

Insulin Pump Function

Continuous insulin infusion.

Long-Acting Insulin

Insulin glargine.

Chromosomal Defects Linked to Diabetes

Chromosomes 6, 7, 12, and 20 are associated with diabetes.

High-Soluble Fiber Foods

Raw fruits, beans, and bran cereal.

Soluble Fiber Benefits

Reduces blood glucose, serum cholesterol, and sugar absorption.
Reduces insulin requirements.
Not linked to infection rate.

Endocrine System Functions

Controls maturation, reproduction, stress response, and growth.
Does not control sexual identity.

Levothyroxine (Synthroid) Overdose Symptoms

Tachycardia.
Irritability.
Diaphoresis.

Adolescent Diabetes Challenges

Hormonal changes.
Developmental conflicts.
Preference for fast food.
Growth spurts.

Ketoacidosis Signs in Children with Cold Symptoms

Fruity breath.
Nausea.

Insulin Reaction Proneness in Children

Instability of the condition in younger children.
Irregular activities.
Growth patterns.

Insulin Pump Tubing Change Frequency

Every 48 hours.

Diabetes Diagnosis Criteria

Fasting blood glucose level of 126 mg/dL on two separate occasions.
History indicating the disease.

Glycosylated Hemoglobin (HbA1c) Test Evaluation

Measures average glucose levels over 3-4 months.

Long-Acting Insulin Precautions

Danger of hypoglycemia.

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Description

Explore the key concepts related to managing Type 1 Diabetes in children, including insulin treatment, prevention of insulin reactions, and dietary interventions. This quiz covers inheritance patterns of metabolic errors and immediate actions for hyperglycemia. Enhance your understanding of diabetic education specifically designed for school-aged children.