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.
Highlight the conditions requiring immediate follow-up in the “follow-up” category.
Assessment:
Weight:15.9 kg
Height: 41 in
Heart rate: 122 beats per minute
Blood pressure: 96/44
Child is anxious, looks thin, and has dry lips and dry mucous membranes. Upon neck palpation the child has several enlarged cervical lymph nodes and has a “sweet odor to her breath, The remainder of the examination is within normal limits.
Weight:15.9 kg
Height: 41 in
Blood pressure: 96/44
anxious
looks thin
has dry lips and dry mucous membranes
Heart rate: 122 beats per minute
several enlarged cervical lymph nodes
sweet odor to her breath
The Correct Answer is ["A","C","D","E","F","H","I"]
Dry lips and mucous membranes can indicate dehydration, which is common in children with diabetes mellitus type 1 (DM1) due to hyperglycemia. Dehydration in DM1 often results from osmotic diuresis, where excess glucose in the urine draws water out of the body, causing significant fluid loss. Immediate follow-up is needed to assess hydration status and possible management of the child's glucose levels and fluid intake.
The presence of enlarged lymph nodes can suggest an underlying infection or immune response. Although lymphadenopathy is commonly associated with infections, it is also important to investigate whether this could be related to diabetic ketoacidosis (DKA), as children with untreated or poorly controlled diabetes can be more prone to infections. This warrants follow-up for possible infection or other causes of lymphadenopathy.
Unexplained weight loss and an appearance of being thin, despite increased appetite (polyphagia), can be an early sign of diabetes type 1. The body begins breaking down fat and muscle tissue for energy when it cannot use glucose properly due to a lack of insulin. Immediate follow-up is necessary to assess blood glucose levels and determine if the child has undiagnosed diabetes.
A fruity or "sweet" odor on the breath, often described as similar to acetone, is a hallmark sign of diabetic ketoacidosis (DKA), a serious and potentially life-threatening complication of uncontrolled diabetes. This requires immediate follow-up as it indicates that the body is burning fat for fuel due to a lack of insulin, resulting in the production of ketones, which are excreted through the breath.
Anxiety can be associated with an underlying medical condition such as diabetes mellitus. Children with uncontrolled diabetes may feel anxious due to fluctuations in blood glucose levels or the physical symptoms associated with hyperglycemia or DKA. It’s important to address the cause of anxiety to ensure the child is receiving the appropriate treatment and emotional support.
A blood pressure of 96/44 mm Hg is on the lower side, and in the context of a child with suspected diabetes, this could suggest a state of dehydration or possible shock, especially if DKA is developing. Blood pressure changes must be followed up immediately to ensure appropriate treatment of dehydration or any circulatory compromise.
Weight: 15.9 kg: The child's weight (15.9 kg) in combination with the other symptoms (e.g., being thin, increased appetite) could indicate that the child is not gaining weight as expected, possibly due to undiagnosed type 1 diabetes. Immediate follow-up is required to assess growth patterns and consider possible conditions like diabetes that could affect normal weight gain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C","dropdown-group-3":"A","dropdown-group-4":"A","dropdown-group-5":"A"}
Explanation
The elevated heart rate (178 bpm), tachypnea (RR 65), oxygen saturation of 92% on room air, retractions, head bobbing, and restlessness all point to respiratory distress.
The delayed capillary refill (>4 seconds) and inability to stay latched to the breast suggest dehydration, likely from poor oral intake and increased insensible fluid losses through tachypnea.
These interventions help improve oxygenation by clearing mucus obstructing the nasal passages (especially important for obligate nose-breathers like young infants) and providing supplemental oxygen.
Rationale for Incorrect Options:
Deep suctioning: Generally reserved for severe cases and requires provider order; may be too invasive initially.
Hunger: While hunger may cause fussiness, it is not a primary concern in this clinical picture.
Pain: Not supported by the current assessment findings; signs point more clearly to respiratory issues.
Correct Answer is C
Explanation
A. Digoxin improves cardiac contractility but does not directly assess fluid volume status.
B. A gain of 20g/day is often a normal weight gain in infants; excessive gain is typically considered >50g/day in the context of fluid retention.
C. Daily weights on the same scale at the same time are the most accurate method to assess fluid volume status in CHF.
D. Using a car seat may increase energy expenditure in some infants and is not a routine intervention for CHF.
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