Chapter 31: The Child with a Metabolic Condition PDF

Chapter 31 The Child with a Metabolic Condition Copyright © 2019, Elsevier Inc. All rights reserved.  Lesson 31.1 Objectives 1. Define each key word listed. 2. Relate why growth parameters are of importance to patients with a family history of endocrine di...

Chapter 31 The Child with a Metabolic Condition Copyright © 2019, Elsevier Inc. All rights reserved.  Lesson 31.1 Objectives 1. Define each key word listed. 2. Relate why growth parameters are of importance to patients with a family history of endocrine disease. 3. List the symptoms of hypothyroidism in infants. 4. Discuss the dietary adjustment required for a child with diabetes insipidus. 5. Differentiate between type 1 and type 2 diabetes mellitus. Copyright © 2019, Elsevier Inc. All rights reserved. 2  Endocrine System (1 of 3)  Two major control systems that monitor the functions of the body are the  Nervous system  Endocrine system  These systems are interdependent.  Endocrine (ductless) glands regulate the body’s metabolic processes. Copyright © 2019, Elsevier Inc. All rights reserved. 3  Endocrine System (2 of 3)  Primary responsibilities  Growth  Maturation  Reproduction  Response of the body to stress Copyright © 2019, Elsevier Inc. All rights reserved. 4  Endocrine System (3 of 3)  Studies that can help in the diagnosis  Radiographic  Serum blood screening tests Phenylketonuria (PKU) Chromosomal studies  Tissue biopsy  Thyroid function  Ultrasound  24-hour urine specimen Copyright © 2019, Elsevier Inc. All rights reserved. 5  Inborn Errors Of Metabolism Tay-Sachs Disease  Deficiency of lysosomal beta- hexosaminidase, an enzyme necessary for the metabolism of fats  Lipid deposits accumulate on nerve cells, causing physical and mental deterioration.  Primarily found in the Ashkenazi Jewish population  Autosomal recessive trait Copyright © 2019, Elsevier Inc. All rights reserved. 6 Endocrine Disorders: Hypothyroidism  Deficiency in hormone secretions of the thyroid gland  May be congenital or acquired  In congenital form, the gland is absent or not functioning.  More common endocrine disorders in children  Controls metabolism in the body  Symptoms may not be apparent for many months.  Screening is performed at birth. Copyright © 2019, Elsevier Inc. All rights reserved. 7  Treatment for Hypothyroidism  Administration of synthetic thyroid hormone  Serum hormone levels monitored regularly  Therapy reverses symptoms and, in an infant, prevents further mental retardation but does not reverse existing retardation.  Children may experience temporary, reversible hair loss, insomnia, and aggressiveness, and their schoolwork may decline during the first few months of therapy.  Hormone replacement for hypothyroidism is lifelong. Copyright © 2019, Elsevier Inc. All rights reserved. 8  Diabetes Insipidus (DI)  Can be hereditary (autosomal dominant) or acquired (e.g., head injury)  Consequence of posterior pituitary hypofunction  Results in decreased secretion of vasopressin (antidiuretic hormone)  Uncontrolled diuresis  Urine does not concentrate during dehydration episodes Copyright © 2019, Elsevier Inc. All rights reserved. 9  Diabetes Mellitus (DM)  Chronic metabolic syndrome—the body is unable to use carbohydrates properly  Leads to impairment of glucose transport  Body unable to store and use fats properly  Decrease in protein synthesis  When blood glucose level becomes dangerously high  Glucose spills into the urine  Diuresis occurs Copyright © 2019, Elsevier Inc. All rights reserved. 10  Criteria for Diagnosing Diabetes Mellitus  Fasting blood glucose level of 126/mg/dL after no caloric intake for 8 hours  Type 1: autoimmune condition with genetic predisposition for child to get  Type 2: resistance to insulin; triggered by sedentary lifestyle and obesity Copyright © 2019, Elsevier Inc. All rights reserved. 11  Type 1 Diabetes Mellitus  Most common metabolic disorder with rate being 1:300 cases  Can occur at any time in childhood; new cases highest among  5- and 7-year-old children: Stress of school and increased exposure to infectious diseases may be a triggering factor.  11- to 13-year-old children: During puberty, rapid growth, increased emotional stress, and insulin antagonism of sex hormones may be implicated.  More difficult to manage in childhood because of growing, energy expenditure, varying nutritional needs  Initial diagnosis may be determined when the child develops ketoacidosis. Copyright © 2019, Elsevier Inc. All rights reserved. 12  Manifestations of Type 1 Diabetes Mellitus  Classic triad of symptoms  Polydipsia  Polyuria  Polyphagia  Symptoms appear more rapidly in children  Insidious onset with lethargy, weakness, and weight loss also common  Skin becomes dry  Vaginal yeast infections may be seen in the adolescent girl Copyright © 2019, Elsevier Inc. All rights reserved. 13  Laboratory Findings in Type 1 Diabetes Mellitus  Glucose in urine (glycosuria)  Hyperglycemia  Occurs because glucose cannot enter the cells without the help of insulin; glucose stays in bloodstream  Cells use protein and fat for energy.  Protein stores in body are depleted.  Lack of glucose in cells triggers polyphagia.  Increase in glucose intake further increases glucose levels in the blood. Copyright © 2019, Elsevier Inc. All rights reserved. 14  Honeymoon Period of Type 1 Diabetes Mellitus  After initial diagnosis, the child is stabilized by insulin dosage, and condition may appear to improve.  Insulin requirements decrease; child feels well  Supports parents’ phase of “denial”  Lasts a short time; therefore, parents must closely monitor blood glucose levels to avoid complications Copyright © 2019, Elsevier Inc. All rights reserved. 15  Diagnostic Tests for DM  Random blood glucose  Fasting blood glucose  Glucose tolerance test  Glycosylated hemoglobin (HbA1c): Copyright © 2019, Elsevier Inc. All rights reserved. 16  Lesson 31.2 Objectives (1 of 2) 6. List three precipitating events that might cause diabetic ketoacidosis. 7. Compare the signs and symptoms of hyperglycemia and hypoglycemia. 8. Outline the educational needs of the parents and the child with diabetes mellitus in the following areas: nutrition and meal planning, exercise, blood tests, glucose monitoring administration of insulin, and skin care. Copyright © 2019, Elsevier Inc. All rights reserved. 17  Lesson 31.2 Objectives (2 of 2) 9. Discuss the preparation and administration of insulin to a child, highlighting any differences between pediatric and adult administration. 10. List three possible causes of insulin shock. 11. Explain the Somogyi phenomenon. 12. List a predictable stress that the disease of diabetes mellitus has on children and families during the following periods of life: infancy, toddlerhood, preschool age, elementary school age, puberty, and adolescence. Copyright © 2019, Elsevier Inc. All rights reserved. 18  Diabetic Ketoacidosis (DKA)  Signs and symptoms include  Ketonuria  Decreased serum bicarbonate concentration (decreased CO2 levels) and low pH  Hypertonic dehydration  Fruity odor to breath  Nausea  ALOC  Symptoms range from mild to severe  Occur within hours to days Copyright © 2019, Elsevier Inc. All rights reserved. 19  Treatment Goals of Diabetes Mellitus  Ensure normal growth and development through metabolic control.  Enable child to cope with a chronic illness, have a happy and active childhood, and be well-integrated into the family.  Prevent complications through tight blood glucose control Copyright © 2019, Elsevier Inc. All rights reserved. 20  Nursing Care of a Child with Diabetes Mellitus  Parent and child education  Patient’s age, financial, educational, cultural, and religious situations must be considered when developing a teaching plan For example, pork-based insulin may not be accepted by some religions; therefore, compliance with treatment may be reduced Copyright © 2019, Elsevier Inc. All rights reserved. 21  Triad of Management for Diabetes Mellitus  Well-balanced diet  Precise insulin administration  Regular exercise Copyright © 2019, Elsevier Inc. All rights reserved. 22  Teaching Plan for a Child with Diabetes Mellitus  Physiology of the pancreas and its function  Foot care  Function of insulin  Infections  Blood glucose self-  Emotional upsets monitoring  Urine check  Diet therapy (glycemic  Glucose–insulin index of foods and imbalances cholesterol intake)  Travel  Insulin management  Follow-up care  Exercise  Illness or surgery  Skin care Copyright © 2019, Elsevier Inc. All rights reserved. 23  Insulin Administration  Teach parents and child.  Insulin cannot be taken orally because it is a protein and would be broken down by the gastric juices.  Usual method of administration is subcutaneously.  Insulin pump (closed loop system) Copyright © 2019, Elsevier Inc. All rights reserved. 24  Insulin  Main difference is in the amount of time required for it to take effect and the length of protection time.  The response to any given insulin dose is highly individualized and depends on may factors, such as site of injection, local destruction of insulin by tissue enzymes, and insulin antibodies.  Insulin can also be given through a pump device. Copyright © 2019, Elsevier Inc. All rights reserved. 25  Insulin Shock (1 of 2)  Also known as hypoglycemia  Blood glucose level becomes abnormally low.  Caused by too much insulin  Factors  Poorly planned exercise  Reduced diet  Errors made because of improper knowledge of insulin and the insulin syringe Copyright © 2019, Elsevier Inc. All rights reserved. 26  Insulin Shock (2 of 2)  Immediate treatment  Administering sugar in some form, such as orange juice, hard candy, or a commercial product.  Begins to feel better within a few minutes and then may eat a small amount of protein or starch to prevent another reaction  Glucagon is recommended in cases of severe hypoglycemia. Copyright © 2019, Elsevier Inc. All rights reserved. 27  Somogyi Phenomenon  Rebound hyperglycemia  Blood glucose levels are lowered to a point at which the body’s counterregulatory hormones (epinephrine, cortisol, glucagon) are released.  Glucose is released from muscle and liver cells which leads to a rapid rise in blood glucose levels. Copyright © 2019, Elsevier Inc. All rights reserved. 28  Type 2 Diabetes Mellitus (DM)  Thought to be precipitated by  Obesity  Low physical activity  Lipid-rich diet resulting in insulin resistance  Diet is main emphasis of management along with exercise and other weight control measures.  Insulin and oral hypoglycemic medications contribute to stable control of blood glucose level. Copyright © 2019, Elsevier Inc. All rights reserved. 29