Child Needing Nursing Care II PDF

2/15/2024 The Child Needing Nursing Care II NP03L009 ELO E · Version 2.0 The Child with a Metabolic Condition Introduction to Maternity and Pediatric Nursing, 8th ed., pp.719-735 1 TERMINAL LEARNING OBJECTIVE Determine nursing care required for a pediatric patient. 2...

2/15/2024 The Child Needing Nursing Care II NP03L009 ELO E · Version 2.0 The Child with a Metabolic Condition Introduction to Maternity and Pediatric Nursing, 8th ed., pp.719-735 1 TERMINAL LEARNING OBJECTIVE Determine nursing care required for a pediatric patient. 2 ENABLING LEARNING OBJECTIVE The Nervous and Endocrine System and disorders and dysfunctions of the Endocrine System 3 1  2/15/2024 Integration of the nervous and endocrine systems Nervous system and the endocrine system are interdependent Endocrine regulates metabolic processes 4 Tay-Sachs Disease Pathophysiology Deficiency of lysosomal-beta-hexosaminidase Ashkenazi Jewish population Manifestations None until 5-6 months Head lag Inability to sit Cherry-red deposits on the optic nerve (blindness) Mental retardation Treatment Nursing Care 5 Hypothyroidism Pathophysiology Deficiency in thyroid gland secretions Thyroid controls rate of metabolism Thyroxine (T4) and triiodothyronine (T3) Manifestations Sluggish Large tongue Dry skin Treatment Levothyroxine sodium (Synthroid, Levothroid) Nursing Care Medication education (to be taken at the same time) Signs of overdose Signs of inadequate dose 6 2  2/15/2024 Anterior Pituitary Problem: Decreased - hypopituitarism Hormone: Growth hormone Manifestation: Dwarfism Therapy: Synthetic growth hormone replacement 7 Anterior Pituitary Problem: Increased - hyperpituitarism Hormone: Growth hormone Manifestation: Gigantism or acromegaly Therapy: cryosurgery, irradiation, radioactive implants Manifestation: Sexual precocity Therapy: Monthly hormone injections to control secretions until puberty 8 Posterior Pituitary Problem: Decreased - hypopituitarism Hormone: Antidiuretic hormone Manifestation: Diabetes insipidus Therapy: Vasopressin by injection or nasal spray Provide adequate fluids 9 3  2/15/2024 Posterior Pituitary Problem: Increased - hyperpituitarism Hormone: Antidiuretic hormone Manifestation: SIADH, decreased urine output, edema, fluid overload Therapy: Fluid restriction and hormone antagonists 10 Parathyroid Problem: Decreased - hypoparathyroidism Hormone: Parathyroid hormone Manifestation: Decreased blood calcium and increased phosphorus levels, causing tetany and laryngospasm Therapy: Calcium gluconate, vitamin D supplements 11 Parathyroid Problem: Increased - hyperparathyroidism Hormone: Parathormone Manifestation: Elevated blood calcium and lowered phosphorus levels, causing spontaneous fractures and CNS problems Therapy: Restore calcium balance, excise tumor, vitamin D, low-phosphorus diet 12 4  2/15/2024 Adrenal Problem: Decreased – adrenal cortical insufficiency (Addison’s disease) Hormone: Decreased steroids, sex steroids, epinephrine Manifestation: Craving for salt, seizures, neurological and circulatory changes, decreased sexual development Therapy: Replace cortisol and aldosterone, genetic sexual assessment 13 14 Adrenal Problem: Increased – hyperadrenalism (Cushing’s disease) Hormone: Cortisol Manifestation: hyperglycemia, electrolyte problems, pheochromocytoma Therapy: Depends on cause, tumor removal, and hormone replacement 15 5  2/15/2024 16 Diabetes Insipidus Pathophysiology: Posterior pituitary hypofunction resulting in decreased vasopressin resulting in uncontrolled diuresis. Manifestations: Polydipsia, polyuria, loss of weight and growth failure. Treatment: Hormone replacement of vasopressin Nursing Care: Fluids, identification and education 17 Diabetes Mellitus Pathophysiology: Body is unable to use carbs leading to impairment of glucose transport. Types: I formerly known as insulin dependent DM II formerly known as noninsulin dependent DM Gestational 18 6  2/15/2024 Diagnostic Blood Tests Blood glucose Fasting blood glucose Glucose tolerance test Glycosylated hemoglobin test (HgbA1c) 19 Diabetic Ketoacidosis DKA is also referred to as a diabetic coma Can be due to infections, even minor ones Metabolic rate changes Result if untreated can be ketoacidosis 20 21 7  2/15/2024 Treatment Three main goals: 1. Ensure normal growth and development through metabolic control. 2. Enable the child to cope with a chronic illness, have a happy and active childhood, and be well integrated into the family. 3. Prevent complications. Maintain BG WNL Education Family impact Nursing management Teaching plan 22 Blood Glucose Self Monitoring Test at home Sliding Scale dosage Equipment Preferred site 23 Continuous Glucose Monitoring Sensor pad under the skin Transmits glucose levels every 10-60 seconds Can be used by children 7 and older 24 8  2/15/2024 Insulin Administration Insulin pump Closed loop system Glucose monitor Insulin pump Wireless Intermittent injections Measured in units Special syringes Subcutaneous injections Site must be rotated Lipoatrophy and lipohyperthrophy 25 Types of Insulin 26 Insulin Shock Also known as hypoglycemia Children are more prone due to: The condition itself is more unstable in young people. Children are growing. Children’s activities are more irregular. Symptoms Treatment 27 9  2/15/2024 Somogyi Phenomenon Rebound hyperglycemia Hypoglycemia at night and hyperglycemia in the morning Body response to lowered blood glucose: Epinephrine Cortisol Glucagon Rapid rise in blood glucose Symptoms: May awaken at night Frequent nightmares Early morning sweating Headaches Treatment: Less insulin 28 Dawn Phenomenon Hyperglycemia in the morning NO preceding hypoglycemia Response to growth hormone secreted at night Testing blood glucose levels 29 Nutrition Management Triad of diabetes management Well-balanced diet Precise insulin administration Regular exercise Ensure normal growth and development Caloric intake based on BSA 55% carbs 30% fat 15% protein Dietetic v diabetic 30 10  2/15/2024 Glycemic index of foods low glycemic index value (below 55) take longer to increase blood glucose levels and high glycemic index value (above 70) increase the blood glucose more rapidly 31 DM Home management Exercise Skin Care Foot Care Infections Emotional Upsets 32 Nursing Interventions Age Group Issue Trust versus mistrust Infant Onset and diagnosis particularly difficult during infancy; anxiety can be transmitted to infant Autonomy versus shame and doubt Toddler Is this a temper tantrum or high or low blood glucose? Initiative versus guilt Preschool May view injections as punishment May view denial of sweets as lack of love “Picky eater” Industry versus inferiority Patients may feel they will be cured by hospitalization Grief over lack of cure School Age Rebellion about treatment regimen Rebellion regarding food plan Anxiety about disclosure of condition to friends Embarrassed about reactions in school, missed days Unpredictable effects of exercise “Bouncing” blood glucose levels may make Puberty adolescent feel out of control. Anger at the disease: “Why must I be different?” More frequent hospitalizations 33 11  2/15/2024 Urine Checks Replaced by glucose blood monitoring Still used if urine acetone levels Glucose-insulin imbalances Pt should wear identification Know about hyper v hypo Travel Time changes may affect meals Bring additional supplies Follow up care Regularly Illness or surgery Close monitoring Stress hormones Long Term complications Microvascular macrovascular 34 Type 2 Diabetes Mellitus Insulin resistance and reduces insulin secretion Precipitated by: Obesity Low physical activity Lipid rich diet Risk Factors: Family history of type 2 diabetes mellitus Signs of insulin resistance Acanthosis nigricans Hypertension Increased lipids Repeated vaginal monilial (Candida) infections, from chronic glycosuria Obese is a BMI of 30 or higher. Class I 30–34.9; class II 35–39.9; and class III 40+ 35 Type 2 Diabetes Mellitus Diagnosis: HgbA1c of 6.5% or higher Obesity Treatment: Lifestyle change Antidiabetic medication 36 12  2/15/2024 Diet Therapy in Pediatric Metabolic Disorders Phenylketonuria (PKU) Celiac Disease Cystic Fibrosis Lactose Intolerance Galactose Intolerance Fructose Intolerance Maple Syrup Urine Disease Urea Cycle Defect Acidemia Diabetes insipidus Diabetes mellitus 37 The nervous system and the endocrine system. The term inborn error of metabolism refers to a group of inherited biochemical disorders that affect body metabolism. Diabetes mellitus type 1 is the most common endocrine disorder of children. The symptoms of diabetes mellitus appear more rapidly in children. Insulin resistance causes type 2 diabetes mellitus. The mainstays of the management of diabetes mellitus are insulin replacement, diet, and exercise. The Somogyi phenomenon and the dawn phenomenon. DM Self-management. Continuous glucose monitoring. The glycosylated hemoglobin test (HgbA1c) reflects glucose control through time. Sugar substitutes such as sorbitol and xylitol should not be provided to children. A child with diabetes insipidus requires unlimited access to water. Growth hormone is administered at bedtime to simulate the natural time of hormone release. A deficiency in the secretions of the thyroid gland is termed hypothyroidism. 38 QUESTIONS? 39 13