Insulin-dependent diabetes mellitus (IDDM) also known as type 1 diabetes or juvenile diabetes, is a metabolic disorder caused by a lack of insulin. The deficiency is believed to happen in people who are genetically prone to the disease and who have experienced a precipitating event, commonly a viral infection or environmental change, that causes an autoimmune response affecting the insulin-producing cells (beta cells) of the pancreas.
It is treated by injection of insulin and regulation of diet and activity that maintain body functions. Complications that occur from improper coordination of these include hypoglycemia and hyperglycemia which, if untreated, lead to insulin shock or ketoacidosis. Long-term effects of the disease include neuropathy, nephropathy, retinopathy, atherosclerosis, and microangiopathy.
Nurses have an essential role and responsibilities when caring for a client with diabetes such as providing child and family with education about the management of hyperglycemia and hypoglycemia including insulin administration, dietary regimen, and exercise needs for the child, helping the family to adjust to having a chronic disease, and preventing short-term and long-term complications of diabetes.
Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.
May be related to
- Lack of information about the disease condition
Possibly evidenced by
- New diagnosis of IDDM
- Request for information regarding the pathology, blood and urine testing, insulin therapy, activity/exercise needs, dietary regimen, personal hygiene and health promotion
- Client will verbalize understanding of IDDM.
- Client and parents will demonstrate appropriate blood-glucose monitoring insulin administration, dietary management, and exercise plan.
- Client and parents will identify signs and symptoms of hypoglycemia and hyperglycemia and correct response.
|Assess parents and child understanding|
of disease and ability to perform
procedures and care, for educational
level and learning capacity, and for
|Provides information essential to develop a learning program; children ages 8 to 10 may be able to take responsibility for some of the care.|
|Provide a quiet, comfortable|
environment; allow time for teaching small amounts at a time and for reinforcement, demonstrations and return demonstration; start educating one day following diagnosis and limit sessions to 30 to 60 minutes.
|Prevents distractions and facilitates learning.|
|Include as many family members in teaching sessions as possible.||Promotes understanding and support of family and feeling of security for the child.|
|Teach about the cause of disease, disease|
process and pathology; use pamphlets
and other aids appropriate for the age of child and level of comprehension of parents.
|Provides basic information that may be used as a rationale for treatments and care and allows for different teaching strategies.|
|Instruct parents and child in insulin|
administration including drawing up insulin into the syringe, rotating vial instead of shaking, drawing clear insulin first if mixing 2 types in the same syringe, injecting SC, storing insulin, rotating sites,
adjusting dosages, reusing a syringe, and needle, and disposing of them.
|Promotes proper technique of insulin administration to avoid complications.|
|Instruct in use of a syringe-loaded injector.||Provides an alternative method of insulin administration if the child is afraid of skin puncture.|
|Teach parents and child on how to operate a portable insulin pump to regulate insulin delivery.||Provides continuous subcutaneous insulin infusion.|
|Instruct parents and child to monitor blood glucose levels 4 times a day (before meals and before bed), with a lancet and blood-testing meter or a reagent strip compared to a color chart; collection and testing of urine with ketostix or Clinitest.||Monitors blood and urine for the presence of glucose and ketone.|
|Teach parents and child about dietary|
planning with an importance on proper meal times and adequate caloric intake
according to age as ordered. Teach that food intake depends on activity, and describe methods to judge amounts of foods; provide a list of acceptable food items from “fast food” restaurants.
|Provides information about an important aspect of the total care of the child with diabetes.|
|Teach parents and child about the role of|
exercise and changes needed in food and insulin intake with increased or decreased activity.
|Provides information about common activity pattern and effect on dietary intake and insulin needs.|
|Teach parents and child about skin|
problems associated with diabetes, need for regular dental examinations, foot care, protection of and proper care of nails, prevention of infections and exposure to infections, eye examinations, immunizations.
|Provides information about common complications as a result from chronic effects of the disease.|
|Instruct parents and child to keep a record of insulin administration, glucose monitoring, responses to diet and exercise, noncompliance in medical regimen and effects.||Provides a method to improve self-care and demonstrates the need to notify physician for treatment evaluation and possible modification.|
|Instruct the child to wear or carry identification and information about the disease, treatment, and physician name.||Provides information in case of an emergency.|
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