A 12-year-old female presented to the emergency department with ongoing fatigue and recent weight loss over the past two weeks.
Item 6 of 6
- Nurses’ Notes
1000: A 12-year-old female presented to the emergency department with ongoing fatigue and recent weight loss over the past two weeks. The client’s caregiver states she has been experiencing increased thirst and frequent urination, including throughout the night. The client has no significant past medical history. Upon assessment, the client’s mucous membranes are dry. Pulses are regular and palpable. Lung sounds are clear. The abdomen is soft and nontender. The client is alert and oriented x4, but reports a headache, rated 5/10. Immunizations are up to date. Vital signs are T 98.9°F (37.2°C), HR 112, RR 26, BP 92/54, SpO₂ 98% on room air. Fingerstick glucose level is 396 mg/dL (22.0 mmol/L).
1005: Blood and urine specimens collected and sent to the lab. Client tolerated well.
1010: Provider is at the bedside speaking with the client and their caregiver. The provider confirmed a diagnosis of Type 1 diabetes mellitus. Plans to admit the client for observation and begin initial management.
1030: New orders received to start a consistent carb diet and insulin. Medication education and diet were reviewed with the client and their caregiver.
- Orders
1030
- Consult: Pediatric Endocrinology, Pediatric Diabetes Educator, Registered Dietitian
- Consistent carbohydrate diet
- Administer insulin glargine (Lantus) 12 units subcutaneously once daily at 8:00 PM
- Check blood glucose ACHS and 0200 for 2 nights
- Use insulin lispro (Humalog) subcutaneously before meals and at bedtime per sliding scale:
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- If blood glucose < 70 mg/dL:
- Administer 15 g of rapid-acting carbohydrate (e.g., 4 oz juice, 3–4 glucose tablets) or Glucagon 1 mg IM or subcutaneously if ≥ 20 kg
- Recheck glucose in 15 minutes
- If still < 70, repeat treatment
- Laboratory & Imaging Results
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The nurse evaluates a 12-year-old client and their caregiver after completing education on managing diabetes mellitus (type one).
For each statement, click to indicate whether it demonstrates understanding of diabetes management or indicates a need for further education.
Each row must have only one response option selected.
The nurse evaluates a 12-year-old client and their caregiver after completing education on managing diabetes mellitus (type one).
For each statement, click to indicate whether it demonstrates understanding of diabetes management or indicates a need for further education.
Each row must have only one response option selected.
| Statement | Shows Understanding | Needs Further Education |
|---|---|---|
“If my child feels dizzy and sweaty, we’ll check their blood sugar right away.” | ||
“Glucose tablets are a good option if my child’s blood sugar is low.” | ||
“If we skip a long-acting insulin dose, we’ll double it the next day.” | ||
“We’ll rotate injection sites to prevent skin problems.” | ||
“I’ll call the doctor if my child is sick and can’t keep food down.” |
Statistics
Subject/Lesson
Subject
Child Health
Lesson
Endocrine
Client Need
Test Plan
Management of Care
Related Topic
Case Management
Item Type
Item Type
EvaluateOutcomes
Explanation
- The statement, “If my child feels dizzy and sweaty, we’ll check their blood sugar right away,” shows the caregiver recognizes early signs of hypoglycemia and knows that confirming it with a blood glucose check is essential for safe insulin use. Likewise, glucose tablets are a fast-acting, measured response to hypoglycemia, and the caregiver correctly identifies an effective intervention.
- The client correctly identifies that rotating injection sites helps prevent lipodystrophy, which can impair insulin absorption.
- Finally, knowing when to notify the provider, especially during illness, is critical because vomiting or missed meals can lead to ketone buildup and rapid destabilization.
- In contrast, the statement “If we skip a long-acting insulin dose, we’ll just double it the next day” indicates a need for further education.
- Long-acting (basal) insulin provides essential background coverage, and doubling the dose the next day increases the risk of severe hypoglycemia. Missed doses should never be compensated for without provider guidance.
Related Videos
2 Key Topics
Diabetes Mellitus Type I
