A nurse is providing teaching to a school-age child who has a diagnosis of type 1 diabetes mellitus. Which of the following statements by the child indicates a need for additional teaching?

A. "I will report changes in breathing or signs of confusion." Correct action as changes in breathing or confusion can indicate diabetic ketoacidosis or other serious complications.
B. "I will encourage him to drink a half a cup of water or sugar-free fluid every 30 minutes."Ensuring adequate fluid intake helps prevent dehydration and helps manage blood sugar levels during illness.
C. "I will notify the doctor if his temperature is not controlled with acetaminophen." Correct action as fever may indicate an infection that needs further medical evaluation and treatment.
D. "I will continue to check his blood sugar two times every day." When a child with diabetes is ill, blood sugar should be monitored more frequently, typically every 3-4 hours, to manage the risk of hyperglycemia or hypoglycemia due to illness.

• Temperature: The child has a fever of 38.9°C (102°F), which is above the normal range for toddlers (36.5°C to 37.5°C or 97.7°F to 99.5°F). A high fever can indicate an ongoing infection or inflammatory process and can lead to serious complications, especially in a toddler. Addressing the fever promptly is crucial to prevent potential febrile seizures, dehydration, and other heat-related complications. Fever management is essential to improving the child's comfort and preventing the worsening of symptoms.
• Pain: Although pain management is important for comfort and to improve quality of life, in this scenario, the child’s pain is rated as a 3 on the FLACC scale, which is moderate. Immediate pain does not seem to be the primary or most urgent concern compared to the high fever and potential underlying conditions.
• Bruising: The presence of bruising in various stages of healing and petechiae suggests a possible underlying hematologic issue or trauma. While concerning and needing further investigation, it does not require immediate intervention compared to the fever.
• Heart rate: The heart rate is elevated at 150 beats per minute, which could be a response to the fever, pain, or anxiety. Addressing the fever may help in normalizing the heart rate.

ii. Follow-up Priority: Laboratory Values

Rationale:

• Laboratory values: The child’s laboratory results show abnormalities that are significant. Hemoglobin is low at 7.6 g/dL (indicating anemia), hematocrit is also low at 21%, and platelets are decreased at 110,000/mm³, which could suggest a hematologic disorder such as leukemia or a severe infection. The elevated white blood cell count further supports the presence of an infection or an inflammatory response. These lab abnormalities are critical and need to be addressed to determine the underlying cause and to plan further treatment.
• Respiratory rate: The respiratory rate is elevated but not critically so (normal for a toddler is 20-30 breaths per minute). There is no increased work of breathing noted, so while monitoring is important, it is not the most immediate priority compared to the fever and lab abnormalities.
• Nasal stuffiness: While nasal congestion can be uncomfortable and contribute to respiratory distress, it is not an immediate threat to the child’s health and can be managed after addressing the fever and the concerning laboratory values.
• Petechiae: Petechiae are small red or purple spots that can indicate bleeding under the skin and may be associated with a bleeding disorder or infection. However, the underlying cause might be revealed through laboratory investigations, which are prioritized after managing the fever. Immediate intervention for petechiae alone is not usually required unless there is evidence of significant bleeding or other acute symptoms.