*VII

(6 pts.)

List all meds (Scheduled & PRN) and pediatric dosage

WEIGHT:__ 76.8 kg__

Drug
Name
(pharm)
Insulin
Glargine
(Lantus)

Dose/Route/Frequency/
other possible routes (total
amount received per dose/per
day)
0.5 units / kg / day
SubQ
At dinner time

Total amount: 30 units per day

received / 24 hours: 30 units

Insulin
1 unit per 10 grams
Aspart
carbohydrates
(novoLOG) For elevated pre-meal blood
glucose give insulin SQ 1 unit
per every 50 mg/dl over 150
mg/dl blood glucose
For elevated pre-bedtime
glucose (obtained before bedtime
snack) give insulin SQ 1 unit per
every 50 mg/dl over 200mg/dl
blood glucose
Total amount: Varies with meals
received / 24 hours: Varies with meals

Show calculations for

safety range

Classification &
why patient
receiving (specific)

Major Side
Effects

Nursing
Implications &
Special Precautions

Administer 5075% of
daily insulin requirements
once daily
(range 2100 units/day)

Pharmacologic: pancreatics

Endo:
HYPOGLYCEMIA.
Local: lipodystrophy,
pruritis, erythema,
swelling.
Misc: allergic
reactions including
ANAPHYLAXIS.

Assess patient for

signs and symptoms
of hypoglycemia and
hyperglycemia
periodically during
therapy.

Endo:
HYPOGLYCEMIA.
Local: lipodystrophy,
pruritis, erythema,
swelling.
Misc: allergic
reactions including
ANAPHYLAXIS.

Assess patient for

signs and symptoms
of hypoglycemia and
hyperglycemia
periodically during
therapy.

safe: Y
Total insulin dose
determined by needs of
patient; generally 0.5 1
unit/kg/day; 50 70% of
this dose may be given as
meal-related boluses of
rapid-acting insulin

safe: Y

Control of hyperglycemia
in patients with type 1 or
type 2 diabetes mellitus.
Patient is receiving this for
control of his type 1
diabetes mellitus
Pharmacologic: pancreatics
Control of hyperglycemia
in patients with type 1 or
type 2 diabetes mellitus.
Patient is receiving this for
control of his type 1
diabetes mellitus

*PRN doses calculated per dose

Tylenol:
10 15 mg/kg/dose
*All scheduled doses calculated per day (24 hour period)
Ibuprofen:
5 10 mg/kg/dose
*VIII (35 pts)
Proposed Nursing Care (Include 3 priority diagnoses, interventions & rationale)
Nursing Diagnosis
Imparied Metabolic
Function
R/T: Insufficient insulin
secondary to ineffective
beta cells in pancreatic
islets

Nursing Interventions
(Specific)

Assess and record vital signs and neurological status

every 1 to 4 hours and PRN
Assess and record blood glucose levels as ordered
and PRN. (Fasting, preprandial, peak postprandial,
and 3 a.m. blood glucose levels may be needed)
Teach patient how to better recognize the S/S of
hypo and hyperglycemia and how to counter them.

Rationale for Nursing Care

(Specific)

If the child experiences altered

metabolic function the vital signs will
be out of normal range (can increase of
decrease)
The child can ezperence decreased level
of consciousness as a result of glucose
being unable to enter cells.
By being more learned in the possible
onset of hypo and hyperglycemia he
will better be able to know what to do
when he starts to feel those explained
feelings and will know what to do next
to treat them.

Nursing Diagnosis

Nursing Interventions
(Specific)

Risk for Infection

R/T: High glucose

levels, decreased
leukocyte function,
alterations in
circulation

Observe for signs of infection and inflammation,

e.g., fever, flushed appearance, wound drainage,
purulent sputum, cloudy urine.
Promote good hand washing by staff and patient.
Provide conscientious skin care; gently massage
bony areas. Keep the skin dry, linens dry and
wrinkle-free.
Encourage adequate dietary and fluid intake
(approximately3000 mL/day if not contraindicated
by cardiac or renal dysfunction), including 8 oz of
cranberry juice per day as appropriate.
Administer antibiotics as appropriate.

Rationale for Nursing Care

(Specific)

Patient may be admitted with infection,

which could have precipitated the
ketoacidotic state, or may develop a
nosocomial infection.
Reduces risk of cross-contamination.
Peripheral circulation may be impaired,
placing patient at increased risk for skin
irritation/breakdown and infection.
Decreases susceptibility to infection.
Increased urinary flow prevents stasis
and aids in maintaining urine
pH/acidity, reducing bacteria growth
and flushing organisms out of system.
Note: Use of cranberry juice can help
prevent bacteria from adhering to the
bladder wall, reducing the risk of
recurrent UTI.
Early treatment may help prevent
sepsis.

Nursing Diagnosis

Nursing Interventions
(Specific)

Deficient Fluid Volume

R/T: Osmotic diuresis

secondary to
hyperglycemia

Nursing Diagnosis

Keep accurate record of I/Os. When indicated,

encourage oral fluids
Weigh child daily on same scale at the same time of
day. Document results and compare to precious
weight.
Teach child and family about care. Assess and record
childs and familys knowledge of participation in
care regarding monitoring intake and output, etc.

Rationale for Nursing Care

(Specific)

Nursing Interventions
(Specific)

Powerlessness

R/T: Longterm/progressive illness

that is not curable

Encourage patient/SO to express feelings about

hospitalization and disease in general.
Acknowledge normality of feelings
Encourage patient to make decisions related to care,
e.g., ambulation, time for activities, and so forth.
Support participation in self-care and give positive
feedback for efforts.

Increased urinary output may indicate

hyperglycemia is present.
Weight loss is due to dehydration as
well as the inability of glucose to inter
the cell, which triggers catabolism and
results in weight loss.
Education of the child and family will
allow for better and more accurate care.

Rationale for Nursing Care

(Specific)

Identifies concerns and facilitates

problem solving.
Recognition that reactions are normal
can help patient problem-solve and seek
help as needed. Diabetic control is a
full-time job that serves as a constant
reminder of both presence of disease
and threat to patients health/life.
Communicates to patient that some
control can be exercised over care.
Promotes feeling of control over
situation.

IX. (1 pt.)

Evaluation of Nursing Care (Reflect on your experience. Were you able to meet your goals?):

This clinical experience was one of the best clinical days I have had so far. The nurse I was with was extremely knowledgeable and
took time to teach me procedures and explain things I did not know and then allow me to be involved in treatment as much as
possible. I was able to give medications, do a full assessment, give insulin shots, practice charting, and work with the patients family
during teaching. Working with kids who have diabetes can be very difficult and heart wrenching at times but it can also be so uplifting
to see the positive attitudes and the smiles that these kids have. I was able to meet both of my goals; I was able to practice my clinical
skills as well and learn and apply what I know about diabetes treatment in a clinical setting.