Question

The nurse is caring for Martin, a 12-year-old with Type 1 diabetes Mallitus who has been sick for the last few days with vomiting 4-5 times a day and states that his right lower belly hurts when he moves. he presents to the emergency room .

1) describe the clinical manifestations of dehydration Martin may exhibit.

2) identify the precautions the mother must take in caring for her son with Type 1 diabetes when dehydration occurs what is the nursing priority?

3) Martin may have appendicitis: define the physical assessment the nurse would perform in assessing for this diagnosis and include any diagnostic tests?

4) Martin does not have appendicitis but an obstructed bowel due to constipation, with Miralax ordered. what are the nursing considerations for Miralax, including teaching, based on the patient age?

5) The physician orders regular insulin drip 100 units/100ml. He orders a sliding scale to keep blood sugar between 150-200. if it ordered to start the drip at 2units/hour. how many ml will the. nurse administer?

Answer 1

Martina is a 12 year old WITH tYPE 1 Diabetes Mellitus,currently having vomiting (4-5times a day)and right lower abdominal pain.

1)clinical manifestation may child exhibit are :

• Sunken eyes
• Dry skin
• weak,rapid pulse
• excessive thirst
• low urine volume
• dark coloured urine
• low blood pressure
• dizziness and light headedness
• dry buccal mucosa

2)Precautions from mothers side while caring a child with Dm type 1:

• Monitor fluid intake of child
• Monitor for urine colour of the child
• Strict adherence to dietary and medicational management
• Avoid giving salty foods.
• Avoid exposing child to hot weather

Nursing priorities in preacutionary measures while caring dehydrated child due to DM Type 1

• Educate the mother about early recognition of signs of dehydration.
• Educate mother to monitor fliud intake and urine output.
• Advice to give 6-8 glasses of water daily.
• Educate about strict adherence to diet and medicines.

3)Physical assessment to rule out Appendicitis:

Tenderness on palpation in the right illiac fossa over the Mcbourneys point.

Diagnostic Test:

Complete blood count:incresed white blood cell count,increased neutrophil count noted most of the time.

C- REACTIVE PROTEIN:Elevated CRP level due to inflamation.

Urine Routine

Imaging studies:Abdominal USG,Abdominal Xray,CT SCAN

4)

Martin is diagnosed with obstructed bowel due to constipation,and he is ordered to take Miralax.

Miralax is a laxative drug which increses the amount of water in the intestinal tract to stimulate bowel movements.

• Miralax powdered sholud be mixed with liquid beverages and consumed sip by sip.
• Miralax sholud not be used more than 7 days.
• Child should take plenty of water

5) Regular insulin drip of 100units /100ml

So 1unit each in 1ml

To administer 2units /hour the nurse has to administer 2ml of insulin drip per Hour