NSG 3600
EXAM 4 STUDY GUIDE
Nursing Practice – Children’s Health
Galen College of Nursing
, Peds Exam #4 Review
UNIT 8:
Diabetes Mellitus-know type 1 and type 2
o TYPE 1: An autoimmune disease that arises when a child with a particular
genetic makeup is exposed to any precipitating event, such as infection,
particularly a virus or other environmental factors such as diet - most common >
40 years.
o Peak at 4-6 years old and in second early puberty (10-14 yrs)
o S/S: polyuria, polydipsia, weight loss, muscle wasting, polyphagia, nocturia,
tachycardia, blurred vision, fatigue, vaginal moniliasis
o S/S with ketoacid: abdominal pain, N/V, fruity smelling breath (acetone),
weakness, mental confusion, coma, slow labored breathing, flushed cheeks and
face, hyperventilation (kussmaul's respiration)
Regular insulin is the only one given through an IV
o Dx: elevated postprandial or random blood glucose higher than 200
Elevated HbA1c; greater than or equal to (7.0)
Fasting blood sugar may be greater than or equal to 126.
Urine glucose and ketones may be increased.
o Nursing care: individualized based on needs of child and family, focus on
monitoring, stabilization and education.
Goals of medical management: optimal glycemic control, normal growth
and development, minimizing complications, attainment of emotional
adjustment of diabetes
Let the child pick their finger for blood sugar test
Urine testing for ketones is performed at least every 3 hrs during the
child's illness- ketones must be checked whenever blood glucose exceeds
240 or when the child has unexplained weight loss even if well.
ADDITIONAL TEACHING QUESTION.
o Discharge: s/s of hypo and hyperglycemia, proper diet, exercise, and stress
management
Monitoring blood glucose and ketone levels
Teach types of insulin and how to give injections.
o TYPE 2: Characterized by the body's resistance to recognizing and utilizing insulin.
o S/S: often asymptomatic until a routine exam reveals high blood sugar or
complications appear.
Numbness or burning sensation of the feet, ankles and legs
Blurred or poor vision
Impotence
Fatigue
Poor wound healing
Obesity
, Unexplained weight loss
Headache
Symptoms of sleep apnea
S/S can mimic type 1: polyuria, polydipsia, nocturnal enuresis,
Nocturia, yeast infections and whole body itching
o Dx: Criteria: Hispanic 90% BMI with sister who was diagnosed with diabetes.
o BMI > 85th percentile for age and sex
o Weight > 85th for height
o Weight > 120% for ideal weight and height
o Plus two: family history, race/ethnicity (native Americans, African
Americans, Latino, Asian American and Pacific Islanders), signs of
insulin resistance associated with insulin resistance such as acanthosis,
polycystic ovary syndrome or small for gestational age, maternal diabetes
or GDM
o Confirmed by: fasting glucose > 126. Two random blood glucose readings
> 200
o Nursing care: monitor for complications, educating those who provide care for
children, manage diet, exercise, lifestyle, promoting medication compliance.
o Can only have metformin and insulin.
o Needs to be at least 10yrs old to take metformin.
o Discharge: teach diet (decreasing caloric intake), encourage behavioral changes
(increasing activity), encourage lifestyle modification, oral hypoglycemic agents
Sick day rules for diabetes – let child and rest & sleep!
o Monitor their blood sugars every 4 hrs. (more often if needed)
o They must take their regular dose of insulin at the usual time.
o If unable to eat, give them something like Kool-Aid (took insulin and need some
carbs to counteract that)
o Check ketones whenever they void - the body isn’t breaking down fat.
o If spilling ketones, offer clear liquids without sugar (to flush out the acid in
their system)
o If this becomes worse (increase ketones being spilled) or s/s become worse, take
the child to the physician or ER especially with a change in LOC.
o IV fluids with normal saline for DKA
Down’s Syndrome S/S- WRONG answer if you know the Signs you can find the
wrong answer.
o S/S: poor muscle tone, hyperflexibility, short broad hands with a single crease
across the palm on one of both hands
Broad feet with increased space between the 1st and 2nd toes
Slanting eyes with folds of skin at the inner folds (epicanthal folds)
Flat (depressed) bridge of the nose, short low set ears, small head
Small oral cavity and airway (snores)- tongue protrudes.
“Does your kid snore?”
, Short, high pitched cries in infancy
o Health related: heart defects (VSD most common), decreased immune function,
GI anomalies, visual and hearing difficulties, speech difficulties (due to
protruding tongue) , hypothyroidism, laryngomalacia (most common cause of
inspiratory stridor often due to floppy or softened larynx)
Sleep apnea
Cervical spine - need to get X-rays done.
ADHD- 2 questions.
o One of the most publicized and prevalent psychiatric conditions of childhood. A
child can have ADHD with or without hyperactivity.
o ADHD without hyperactivity has symptoms of distractibility. While ADHD
without hyperactivity garners much less attention that ADHD with hyperactivity,
it can cause just as much difficulty in the life of the child and family.
o S/S: Inattention
Often fails to give close attention to details or makes careless mistakes in
schoolwork, work, or other activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish
schoolwork, chores, or duties.
Difficulty organizing tasks and activities.
Often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort.
Often loses things necessary for tasks or activities.
Is often easily distracted by extraneous stimuli.
If often forgetful in daily activities
o Six or more of the following symptoms of hyperactivity- impulsiveness have
persisted for 6 months to a degree that is maladaptive and inconsistent with
developmental level.
Hyperactivity
Often fidgets with hands or feet or squirms in seat.
Often leaves seat in classroom or in other situations in which
remaining seated is expected.
Often runs about or climbs excessively in situations which is
inappropriate.
If often “on the go” or often acts as if “driven by a motor”
Often talks excessively.
Impulsivity
Often blurts out answers before the question has been completed.
Often has difficulty awaiting a turn.
Often interrupts or intrudes on other.
o Dx: When the criteria is met, the final diagnosis requires evidence of the child's
behavior in a variety or settings such as the classroom, during homework or
playtime. Evidence is obtained by asking parents, teachers, and other caregivers to
EXAM 4 STUDY GUIDE
Nursing Practice – Children’s Health
Galen College of Nursing
, Peds Exam #4 Review
UNIT 8:
Diabetes Mellitus-know type 1 and type 2
o TYPE 1: An autoimmune disease that arises when a child with a particular
genetic makeup is exposed to any precipitating event, such as infection,
particularly a virus or other environmental factors such as diet - most common >
40 years.
o Peak at 4-6 years old and in second early puberty (10-14 yrs)
o S/S: polyuria, polydipsia, weight loss, muscle wasting, polyphagia, nocturia,
tachycardia, blurred vision, fatigue, vaginal moniliasis
o S/S with ketoacid: abdominal pain, N/V, fruity smelling breath (acetone),
weakness, mental confusion, coma, slow labored breathing, flushed cheeks and
face, hyperventilation (kussmaul's respiration)
Regular insulin is the only one given through an IV
o Dx: elevated postprandial or random blood glucose higher than 200
Elevated HbA1c; greater than or equal to (7.0)
Fasting blood sugar may be greater than or equal to 126.
Urine glucose and ketones may be increased.
o Nursing care: individualized based on needs of child and family, focus on
monitoring, stabilization and education.
Goals of medical management: optimal glycemic control, normal growth
and development, minimizing complications, attainment of emotional
adjustment of diabetes
Let the child pick their finger for blood sugar test
Urine testing for ketones is performed at least every 3 hrs during the
child's illness- ketones must be checked whenever blood glucose exceeds
240 or when the child has unexplained weight loss even if well.
ADDITIONAL TEACHING QUESTION.
o Discharge: s/s of hypo and hyperglycemia, proper diet, exercise, and stress
management
Monitoring blood glucose and ketone levels
Teach types of insulin and how to give injections.
o TYPE 2: Characterized by the body's resistance to recognizing and utilizing insulin.
o S/S: often asymptomatic until a routine exam reveals high blood sugar or
complications appear.
Numbness or burning sensation of the feet, ankles and legs
Blurred or poor vision
Impotence
Fatigue
Poor wound healing
Obesity
, Unexplained weight loss
Headache
Symptoms of sleep apnea
S/S can mimic type 1: polyuria, polydipsia, nocturnal enuresis,
Nocturia, yeast infections and whole body itching
o Dx: Criteria: Hispanic 90% BMI with sister who was diagnosed with diabetes.
o BMI > 85th percentile for age and sex
o Weight > 85th for height
o Weight > 120% for ideal weight and height
o Plus two: family history, race/ethnicity (native Americans, African
Americans, Latino, Asian American and Pacific Islanders), signs of
insulin resistance associated with insulin resistance such as acanthosis,
polycystic ovary syndrome or small for gestational age, maternal diabetes
or GDM
o Confirmed by: fasting glucose > 126. Two random blood glucose readings
> 200
o Nursing care: monitor for complications, educating those who provide care for
children, manage diet, exercise, lifestyle, promoting medication compliance.
o Can only have metformin and insulin.
o Needs to be at least 10yrs old to take metformin.
o Discharge: teach diet (decreasing caloric intake), encourage behavioral changes
(increasing activity), encourage lifestyle modification, oral hypoglycemic agents
Sick day rules for diabetes – let child and rest & sleep!
o Monitor their blood sugars every 4 hrs. (more often if needed)
o They must take their regular dose of insulin at the usual time.
o If unable to eat, give them something like Kool-Aid (took insulin and need some
carbs to counteract that)
o Check ketones whenever they void - the body isn’t breaking down fat.
o If spilling ketones, offer clear liquids without sugar (to flush out the acid in
their system)
o If this becomes worse (increase ketones being spilled) or s/s become worse, take
the child to the physician or ER especially with a change in LOC.
o IV fluids with normal saline for DKA
Down’s Syndrome S/S- WRONG answer if you know the Signs you can find the
wrong answer.
o S/S: poor muscle tone, hyperflexibility, short broad hands with a single crease
across the palm on one of both hands
Broad feet with increased space between the 1st and 2nd toes
Slanting eyes with folds of skin at the inner folds (epicanthal folds)
Flat (depressed) bridge of the nose, short low set ears, small head
Small oral cavity and airway (snores)- tongue protrudes.
“Does your kid snore?”
, Short, high pitched cries in infancy
o Health related: heart defects (VSD most common), decreased immune function,
GI anomalies, visual and hearing difficulties, speech difficulties (due to
protruding tongue) , hypothyroidism, laryngomalacia (most common cause of
inspiratory stridor often due to floppy or softened larynx)
Sleep apnea
Cervical spine - need to get X-rays done.
ADHD- 2 questions.
o One of the most publicized and prevalent psychiatric conditions of childhood. A
child can have ADHD with or without hyperactivity.
o ADHD without hyperactivity has symptoms of distractibility. While ADHD
without hyperactivity garners much less attention that ADHD with hyperactivity,
it can cause just as much difficulty in the life of the child and family.
o S/S: Inattention
Often fails to give close attention to details or makes careless mistakes in
schoolwork, work, or other activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish
schoolwork, chores, or duties.
Difficulty organizing tasks and activities.
Often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort.
Often loses things necessary for tasks or activities.
Is often easily distracted by extraneous stimuli.
If often forgetful in daily activities
o Six or more of the following symptoms of hyperactivity- impulsiveness have
persisted for 6 months to a degree that is maladaptive and inconsistent with
developmental level.
Hyperactivity
Often fidgets with hands or feet or squirms in seat.
Often leaves seat in classroom or in other situations in which
remaining seated is expected.
Often runs about or climbs excessively in situations which is
inappropriate.
If often “on the go” or often acts as if “driven by a motor”
Often talks excessively.
Impulsivity
Often blurts out answers before the question has been completed.
Often has difficulty awaiting a turn.
Often interrupts or intrudes on other.
o Dx: When the criteria is met, the final diagnosis requires evidence of the child's
behavior in a variety or settings such as the classroom, during homework or
playtime. Evidence is obtained by asking parents, teachers, and other caregivers to
