Phase 1 A 5 year old is brought to her pediatrician for an annual routine checkup. Her grandparents, who are also the legal guardians, are with her. The child has not seen her pediatrician in a year. The child recently had a visit to the urgent care center and was treated for strep throat. The grandparents are concerned about the child’s weight gain. They state no matter how much she eats she cannot gain weight and is hungry all of the time. Phase 2 The primary care office does not have a glucometer available, so the provider orders a urinalysis dip stick test. The urinalysis shows a glucose of over 500mg/dl with blood, leukocytes, and ketones. The results are shared with the grandparents along with the potential diagnosis and complications. The child’s grandparents are visibly upset and start asking the nurse questions about their grandchild. Place each nursing action for the infant’s care during hospitalization into one of the 3 categories: indicated (appropriate or necessary), contraindicated (could be harmful), or non-essential (makes no difference or not necessary)
Explanation & Rationale
Indicated (Appropriate/Necessary): Blood sugar monitoring, carbohydrate counting, and understanding hypo-/hyperglycemia are foundational skills for managing Type 1 Diabetes. Childproof medication storage is vital for all households with children, especially when insulin and other medications are present. Contraindicated (Could Be Harmful): "As long as we monitor what our granddaughter eats, she should not need to use insulin" This is incorrect and dangerous. Children with Type 1 Diabetes require exogenous insulin due to complete insulin deficiency. Diet alone is never sufficient treatment. Non-essential (Not necessary/makes no difference): "The abdomen is the only location for an insulin injection site" While the abdomen is a common site, other areas like the thighs, upper arms, and buttocks are also appropriate for insulin injections. Teaching flexibility in injection sites helps prevent lipodystrophy.