TE
RM 02
COMMON HEALTH PROBLEMS IN SCHOOL AGE
DIABETES MELLITUS
DIABETES IN CHILDREN
• ONSET – rapid
• OBESITY – not a definite factor
• DIETARY TREATMENT – rarely adequate
• ORAL HYPOGLYCEMICS – contraindicated
• INSULIN – almost universally necessary
• HYPOGLYCEMIA AND KETOACIDOSIS – quite frequent
DIABETES IN ADULTS
• ONSET – insidious
• OBESITY – predisposing factor
• DIETARY TREATMENT – may be beneficial for some
• ORAL HYPOGLYCEMICS – may be beneficial for some
• INSULIN – may be beneficial for some
• HYPOGLYCEMIA AND KETOACIDOSIS – more uncommon
CLASSIFICATION THERAPEUTIC INTERVENTIONS
IDIOPATHIC OR AUTOIMMUNE DESTRUCTION OF ISLET • Antibiotic therapy to eradicate organism and prevent recurrence
• Prevention of permanent cardiac damage
• INSULIN DEPENDENT (IDDM) – onset usually in childhood but
• Palliation of other symptoms
can be anytime
• NON-INSULIN DEPENDENT (NIDDM) – appears to involve
resistance to insulin action and defective glucose-mediated NURSING CARE OF CHILDREN W/ RHEUMATIC FEVER
insulin secretion ASSESSMENT
SECONDARY • Child/parent compliance with a drug regimen
• Symptom development
• caused by exogenous factors; usually reversible if primary • Nutritional intake
disorder corrected • Activity level
CLINICAL FINDINGS PLANNING OR IMPLEMENTATION
• Juvenile onset diabetes is always type I Insulin-Dependent • Encourage bed rest to reduce workload of the heart
Diabetes Mellitus (IDDM) • Encourage child to do schoolwork and keep up with class
• Onset: rapid, obvious • Stimulate the development of quiet hobbies and collections
• Child usually thin, underweight • Gradually increase activities over a period of weeks to months
• Increased thirst, fluid intake, appetite, & U.O. (under • Handle painful joints carefully
observation) • Maintain proper body alignment to prevent deformities
• Hyperglycemia: ketoacidosis or diabetic coma • Monitor need for pain medication and administer when
o Causes: Decreased insulin; Emotional stress; Fever; necessary
Infection; Increased food intake • Encourage an increased intake of nutritious foods & fluids
o Symptoms: Weakness; drowsiness; Lack of appetite, thirst; • Provide small, frequent, nutritious meals
Abdominal and/or generalized pain
• Prevent invalidism by emphasizing abilities rather than
limitations
• Maintain child's status in home and school by keeping channels
RHEUMATIC FEVER of communication open during illness
• Collagen disease: characterized by damage to connective • Help parents with home problems that may have served as
tissue and usually blood vessels predisposing factors
CLASSIFICATION
JUVENILE RHEUMATOID ARTHRITIS (JRA)
• Autoimmune reaction to group A, §-hemolytic streptococcal
pharyngitis • Inflammatory disease of unknown cause
• Self-limited; involves joints, skin, brain, and heart • Slight tendency to run in families
• Two peak ages of onset: 2 to 5 and 9 to 11 years of age
• Females affected somewhat more frequently than males
CLINICAL FINDINGS
• Heart: mitral and aortic stenosis may occur CLASSIFICATION
• Joints: edema, inflammations, and effusion, especially in
knees, elbows, hips, shoulders, and wrist • Systemic onset
• Skin: erythematous macule with a clear center and wavy • Monoarticular or pauciarticular: involves a few joints; usually
demarcated border usually on trunk and proximal extremities less than five
• Neurologic: chorea • Polyarticular: simultaneous involvement of five or more joints
• Low-grade fever, epistaxis, abdominal pain, arthralgia,
weakness, fatigue, pallor, anorexia, and weight loss
NCM 109: MOTHER AND CHILD AT RISK --- FINALS GILLIAN M.D. 1
RM 02
COMMON HEALTH PROBLEMS IN SCHOOL AGE
DIABETES MELLITUS
DIABETES IN CHILDREN
• ONSET – rapid
• OBESITY – not a definite factor
• DIETARY TREATMENT – rarely adequate
• ORAL HYPOGLYCEMICS – contraindicated
• INSULIN – almost universally necessary
• HYPOGLYCEMIA AND KETOACIDOSIS – quite frequent
DIABETES IN ADULTS
• ONSET – insidious
• OBESITY – predisposing factor
• DIETARY TREATMENT – may be beneficial for some
• ORAL HYPOGLYCEMICS – may be beneficial for some
• INSULIN – may be beneficial for some
• HYPOGLYCEMIA AND KETOACIDOSIS – more uncommon
CLASSIFICATION THERAPEUTIC INTERVENTIONS
IDIOPATHIC OR AUTOIMMUNE DESTRUCTION OF ISLET • Antibiotic therapy to eradicate organism and prevent recurrence
• Prevention of permanent cardiac damage
• INSULIN DEPENDENT (IDDM) – onset usually in childhood but
• Palliation of other symptoms
can be anytime
• NON-INSULIN DEPENDENT (NIDDM) – appears to involve
resistance to insulin action and defective glucose-mediated NURSING CARE OF CHILDREN W/ RHEUMATIC FEVER
insulin secretion ASSESSMENT
SECONDARY • Child/parent compliance with a drug regimen
• Symptom development
• caused by exogenous factors; usually reversible if primary • Nutritional intake
disorder corrected • Activity level
CLINICAL FINDINGS PLANNING OR IMPLEMENTATION
• Juvenile onset diabetes is always type I Insulin-Dependent • Encourage bed rest to reduce workload of the heart
Diabetes Mellitus (IDDM) • Encourage child to do schoolwork and keep up with class
• Onset: rapid, obvious • Stimulate the development of quiet hobbies and collections
• Child usually thin, underweight • Gradually increase activities over a period of weeks to months
• Increased thirst, fluid intake, appetite, & U.O. (under • Handle painful joints carefully
observation) • Maintain proper body alignment to prevent deformities
• Hyperglycemia: ketoacidosis or diabetic coma • Monitor need for pain medication and administer when
o Causes: Decreased insulin; Emotional stress; Fever; necessary
Infection; Increased food intake • Encourage an increased intake of nutritious foods & fluids
o Symptoms: Weakness; drowsiness; Lack of appetite, thirst; • Provide small, frequent, nutritious meals
Abdominal and/or generalized pain
• Prevent invalidism by emphasizing abilities rather than
limitations
• Maintain child's status in home and school by keeping channels
RHEUMATIC FEVER of communication open during illness
• Collagen disease: characterized by damage to connective • Help parents with home problems that may have served as
tissue and usually blood vessels predisposing factors
CLASSIFICATION
JUVENILE RHEUMATOID ARTHRITIS (JRA)
• Autoimmune reaction to group A, §-hemolytic streptococcal
pharyngitis • Inflammatory disease of unknown cause
• Self-limited; involves joints, skin, brain, and heart • Slight tendency to run in families
• Two peak ages of onset: 2 to 5 and 9 to 11 years of age
• Females affected somewhat more frequently than males
CLINICAL FINDINGS
• Heart: mitral and aortic stenosis may occur CLASSIFICATION
• Joints: edema, inflammations, and effusion, especially in
knees, elbows, hips, shoulders, and wrist • Systemic onset
• Skin: erythematous macule with a clear center and wavy • Monoarticular or pauciarticular: involves a few joints; usually
demarcated border usually on trunk and proximal extremities less than five
• Neurologic: chorea • Polyarticular: simultaneous involvement of five or more joints
• Low-grade fever, epistaxis, abdominal pain, arthralgia,
weakness, fatigue, pallor, anorexia, and weight loss
NCM 109: MOTHER AND CHILD AT RISK --- FINALS GILLIAN M.D. 1
