A 10 year old boy is being started on growth hormone therapy for diagnosed growth hormone deficiency. The parents ask you if he will have to be on growth hormone injections for his whole life. The best response from the nurse is:

Rationale:

A. The child's fluid and salt intake will be restricted until after surgery: Fluid and salt restrictions are not standard for Wilm’s tumor unless the child has concurrent kidney failure or hypertension. Most children maintain normal fluid and electrolyte management.

B. The child's abdomen is not to be palpated, and handling must be gentle: Wilm’s tumor is a kidney tumor that is often encapsulated. Palpation of the abdomen can risk rupturing the tumor capsule, which could lead to tumor seeding in the abdominal cavity and worsening prognosis.

C. Touching or holding the child requires the person to don a gown and mask: Gowns and masks are used for infection control in cases of contagious illness or in immunocompromised patients, not for the presence of a tumor.

D. Blood pressure readings are not to be taken on the left arm: Blood pressure restrictions on a specific arm are usually related to vascular access devices (like PICC lines) or conditions involving circulation in that arm. Wilm’s tumor does not require avoidance of BP measurements on a particular arm unless there is a separate vascular concern.

Rationale:

A. Metformin twice a day, taken with food to prevent GI upset: Metformin is the first-line medication for Type 2 Diabetes and helps improve insulin sensitivity. Taking it with food reduces gastrointestinal side effects, making this a key part of treatment.

B. Long acting lantus before bed to control blood sugar overnight: While insulin may be necessary in some Type 2 Diabetes cases, especially with significant hyperglycemia, it is not typically the initial treatment for newly diagnosed adolescents. It is more common in Type 1 Diabetes or advanced Type 2.

C. Rapid Acting Insulin dosed using a sliding scale before every meal: Sliding scale insulin is generally reserved for Type 1 Diabetes or severe cases of Type 2 Diabetes with uncontrolled glucose. It is not the standard initial treatment in newly diagnosed Type 2 adolescents.

D. Consistent aerobic exercise every day with a goal of 60 minutes per day: Regular physical activity is essential in managing Type 2 Diabetes as it improves insulin sensitivity and aids in weight management.

E. Regular blood sugar monitoring throughout the day: Monitoring blood glucose levels helps track the effectiveness of treatment and guides lifestyle or medication adjustments in Type 2 Diabetes management.

F. Use of a continuous subcutaneous insulin pump to control blood sugar: Insulin pumps are typically used for Type 1 Diabetes. Their use in Type 2 Diabetes is rare and usually reserved for specific cases, not standard treatment.

G. Well balanced diet and monitoring simple sugar intake: Dietary management focusing on balanced nutrition and limiting simple sugars is fundamental in controlling Type 2 Diabetes and preventing glucose spikes.