NURS 535 COMPREHENSIVE QUESTIONS AND
ANSWERS SET A+
✔✔Type 1/11 DM Diagnosis - ✔✔Clinical s/sx of hyperglycemia and acidosis if present
Ketonuria and glucosuria may also be present
Laboratory data:
-Fasting plasma glucose of >126mg/dL
-Random serum glucose >200mg/dL
-Glycosylated hemoglobin value (A1C) elevated
✔✔Illness management in Type I and II DM - ✔✔Continue Insulin Treatment
-Illness often increases the amount of insulin the body needs. Instruct parents that
insulin should never be withheld.
Stay close to the meal plan
-If the child has an upset stomach and can not eat, give clear liquids that contain
carbohydrates
Give plenty of liquids
-Encourage the child to drink-increase fluids
Choose medications wisely
-OTC may contain sugar and/or alcohol
✔✔Clinical manifestations of DM - ✔✔Hypoglycemia
-Trembling, sweating, tachycardia, pallor, clammy skin
-Personality change, irritability, slurred speech, decreased LOC, seizures
Hyperglycemia
-3 P's-polyuria, polydipsia, polyphagia
-Fatigue, wt loss, blurred vision, emotional labiality, headache, hunger
Ketoacidosis
,-Hyperglycemia symptoms PLUS abdominal pain, chest pain, Kussmaul respirations,
N/V, acetone breath, dehydration
-Lethargy, decreased LOC, coma
✔✔Insulin therapy - ✔✔Insulin therapy:
Rapid Acting
Humalog; Novolog
Short-acting insulin (Regular)
Humulin R, Novolin R (Regular Insulin)
Intermediate
Humulin N; Novolin NPH
Combinations: NPH/Regular
Long Acting
Glargine (Lantus)
✔✔Diabetic ketoacidosis - ✔✔Acidity of the blood caused by the presence of ketone
bodies produced when the body is unable to burn sugar; thus, it must burn fat for
energy
✔✔Type I DM Illness Management - ✔✔Check blood glucose and ketone levels
frequently
•Diabetic ketoacidosis is a danger when the child is sick
•To prevent the condition or catch it early check the child's blood glucose levels often
(every few hours) while sick
•Check the urine for ketones several times a day. If vomiting or diarrhea are present,
check ketones more frequently.
✔✔Type I DM - Foods for sick days - ✔✔Fluids: Popsicle, sports drink, soup, fruit juice
Solids: Crackers, graham crackers, toast, mashed potatoes, gelatin dessert
✔✔Long term complications of diabetes - ✔✔1. End stage renal disease
2. Lower limb Amputation
3. Eye Complications
4. Neuropathy
5. Retinopathy
6. Nephropathy
✔✔Type I DM Developmental Issues - ✔✔Infant
•Rapid growth
•Continuing brain development
•Trusting relationship with parents
•Erratic eating habits
,•Erratic sleep patterns
•Treatment schedule is difficult to keep because of feeding and sleeping patterns
Toddler
•Can participate in some self care
•Look for parental approval while they test their limits
•Show decreased appetite and picky eating habits
•Begin to show more regular sleep patterns
•Difficult to distinguish a low blood sugar reaction from a normal temper tantrum
Preschool
•Peer issues begin to emerge
•Can understand rules
•Can preform more self care including blood tests under parental supervision
•Eating behavior is less erratic
•Very energetic, hypoglycemia can be a problem
•Regular sleep patterns
•May be more challenging to supply with snacks and meals that match what siblings
and friends eat
School age
•Fear of being different from other children
•Can preform most self-care including blood tests and insulin injections
•Eager to learn
•Beginning to understand consequences of their actions
•Tests independent decision making
•Most time spent away from home
Early Adolescence
•Erratic growth which affects insulin requirements
•Glucose control may be erratic in spite of everyone's best efforts
•Concerned about body image
•Greatly influenced by friends
•May change authority
•Development of self esteem
•Beginning to understand abstract concepts
Adolescence
•Puberty well underway
•Concerned with physical appearance
•Clearer sense of self (able to set goals)
•Increased autonomy
•Risk-taking behaviors
•Many social behaviors are unpredictable
•Counseling regarding contraception, alcohol and smoking
, ✔✔MCV - ✔✔(MCV) "size"
Volume occupied by a single RBC
Increase in MCV is known as Macrocytic anemia.
Decrease in MCV is known as Microcytic anemia.
✔✔MCHC - ✔✔(MCHC) "color"
Measure of the concentration of hemoglobin in an average RBC
Decrease in MCHC is known as Hypochromic anemia
Normal is known as Normochromic anemia.
✔✔Anemias - ✔✔Normocytic anemias
-Blood loss
-Hemolytic anemia
-Anemia of chronic disease
-Aplastic anemia
Microcytic anemias (80fL)
- iron deficiency
Macrocytic anemias (>100 fL)
- Folic acid deficiency
- Vitamin B12 deficiency
- Some COPD patients
✔✔Hemoglobin Concentration - ✔✔Men: 13-18 g/dL
Women: 12-16 g/dL
High at birth (low fetal oxygen tension)
After birth, drop in erythropoietin
First two months: Physiologic anemia
Steady rise
Adolescent male: High hemoglobin (androgen production)
✔✔Physiologic jaundice - ✔✔Elevated unconjugated bilirubin
TSB generally peaks @ 5-6 mg/dL on day 3-4 and then declines to adult levels by day
10
Asian infants peak at higher values (10 mg/dL) Exaggerated physiologic (up to 17
mg/dL)
✔✔Mechanism of Physiologic Jaundice - ✔✔More bilirubin produced
Destruction of HbF
Shorter life span of fetal red blood cells, being apprx 80 - 90 days in a full term infant,
compared to 100 - 120 days in adults
ANSWERS SET A+
✔✔Type 1/11 DM Diagnosis - ✔✔Clinical s/sx of hyperglycemia and acidosis if present
Ketonuria and glucosuria may also be present
Laboratory data:
-Fasting plasma glucose of >126mg/dL
-Random serum glucose >200mg/dL
-Glycosylated hemoglobin value (A1C) elevated
✔✔Illness management in Type I and II DM - ✔✔Continue Insulin Treatment
-Illness often increases the amount of insulin the body needs. Instruct parents that
insulin should never be withheld.
Stay close to the meal plan
-If the child has an upset stomach and can not eat, give clear liquids that contain
carbohydrates
Give plenty of liquids
-Encourage the child to drink-increase fluids
Choose medications wisely
-OTC may contain sugar and/or alcohol
✔✔Clinical manifestations of DM - ✔✔Hypoglycemia
-Trembling, sweating, tachycardia, pallor, clammy skin
-Personality change, irritability, slurred speech, decreased LOC, seizures
Hyperglycemia
-3 P's-polyuria, polydipsia, polyphagia
-Fatigue, wt loss, blurred vision, emotional labiality, headache, hunger
Ketoacidosis
,-Hyperglycemia symptoms PLUS abdominal pain, chest pain, Kussmaul respirations,
N/V, acetone breath, dehydration
-Lethargy, decreased LOC, coma
✔✔Insulin therapy - ✔✔Insulin therapy:
Rapid Acting
Humalog; Novolog
Short-acting insulin (Regular)
Humulin R, Novolin R (Regular Insulin)
Intermediate
Humulin N; Novolin NPH
Combinations: NPH/Regular
Long Acting
Glargine (Lantus)
✔✔Diabetic ketoacidosis - ✔✔Acidity of the blood caused by the presence of ketone
bodies produced when the body is unable to burn sugar; thus, it must burn fat for
energy
✔✔Type I DM Illness Management - ✔✔Check blood glucose and ketone levels
frequently
•Diabetic ketoacidosis is a danger when the child is sick
•To prevent the condition or catch it early check the child's blood glucose levels often
(every few hours) while sick
•Check the urine for ketones several times a day. If vomiting or diarrhea are present,
check ketones more frequently.
✔✔Type I DM - Foods for sick days - ✔✔Fluids: Popsicle, sports drink, soup, fruit juice
Solids: Crackers, graham crackers, toast, mashed potatoes, gelatin dessert
✔✔Long term complications of diabetes - ✔✔1. End stage renal disease
2. Lower limb Amputation
3. Eye Complications
4. Neuropathy
5. Retinopathy
6. Nephropathy
✔✔Type I DM Developmental Issues - ✔✔Infant
•Rapid growth
•Continuing brain development
•Trusting relationship with parents
•Erratic eating habits
,•Erratic sleep patterns
•Treatment schedule is difficult to keep because of feeding and sleeping patterns
Toddler
•Can participate in some self care
•Look for parental approval while they test their limits
•Show decreased appetite and picky eating habits
•Begin to show more regular sleep patterns
•Difficult to distinguish a low blood sugar reaction from a normal temper tantrum
Preschool
•Peer issues begin to emerge
•Can understand rules
•Can preform more self care including blood tests under parental supervision
•Eating behavior is less erratic
•Very energetic, hypoglycemia can be a problem
•Regular sleep patterns
•May be more challenging to supply with snacks and meals that match what siblings
and friends eat
School age
•Fear of being different from other children
•Can preform most self-care including blood tests and insulin injections
•Eager to learn
•Beginning to understand consequences of their actions
•Tests independent decision making
•Most time spent away from home
Early Adolescence
•Erratic growth which affects insulin requirements
•Glucose control may be erratic in spite of everyone's best efforts
•Concerned about body image
•Greatly influenced by friends
•May change authority
•Development of self esteem
•Beginning to understand abstract concepts
Adolescence
•Puberty well underway
•Concerned with physical appearance
•Clearer sense of self (able to set goals)
•Increased autonomy
•Risk-taking behaviors
•Many social behaviors are unpredictable
•Counseling regarding contraception, alcohol and smoking
, ✔✔MCV - ✔✔(MCV) "size"
Volume occupied by a single RBC
Increase in MCV is known as Macrocytic anemia.
Decrease in MCV is known as Microcytic anemia.
✔✔MCHC - ✔✔(MCHC) "color"
Measure of the concentration of hemoglobin in an average RBC
Decrease in MCHC is known as Hypochromic anemia
Normal is known as Normochromic anemia.
✔✔Anemias - ✔✔Normocytic anemias
-Blood loss
-Hemolytic anemia
-Anemia of chronic disease
-Aplastic anemia
Microcytic anemias (80fL)
- iron deficiency
Macrocytic anemias (>100 fL)
- Folic acid deficiency
- Vitamin B12 deficiency
- Some COPD patients
✔✔Hemoglobin Concentration - ✔✔Men: 13-18 g/dL
Women: 12-16 g/dL
High at birth (low fetal oxygen tension)
After birth, drop in erythropoietin
First two months: Physiologic anemia
Steady rise
Adolescent male: High hemoglobin (androgen production)
✔✔Physiologic jaundice - ✔✔Elevated unconjugated bilirubin
TSB generally peaks @ 5-6 mg/dL on day 3-4 and then declines to adult levels by day
10
Asian infants peak at higher values (10 mg/dL) Exaggerated physiologic (up to 17
mg/dL)
✔✔Mechanism of Physiologic Jaundice - ✔✔More bilirubin produced
Destruction of HbF
Shorter life span of fetal red blood cells, being apprx 80 - 90 days in a full term infant,
compared to 100 - 120 days in adults
