Nursing Care of Children
Experiencing Diabetes Mellitus
A Life Long Challenge
Marydelle Polk, Ph.D., ARNP-CS
Florida gulf Coast University
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).
Session Objectives
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•
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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.
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
Classification
• Type 1 – Absolute insulin deficiency
* Immune-mediated DM
* Idiopathic Type 1
Classification
• Type 2 DM
* Insulin resistance with relative insulin
deficiency
* Maturity-onset diabetes of the young
(MODY)
Etiology
• Multi-focal
*
*
*
*
Genetic predisposition
Autoimmune dysfunction
Diet
Viruses
Clinical Manifestations of DM
Early
Late
1. Excessive drinking
(polydipsia)
2. Polyuria
3. Polyphagia
4. Weight loss
5. Enuresis (secondary)
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Vomiting
Dehydration
Abdominal pain
Hypovolemic shock
Hyperventilation due
to _______?
Drowsiness  Coma
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
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
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
Ketoacidosis
Clinical Manifestations
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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
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
Nursing Diagnoses
• Risk for injury r/t insulin deficiency
• Risk for injury r/t hypoglycemia
• Knowledge deficit r/t diabetes management