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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. 

Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided.

While assessing the child the nurse recognizes that

, , and are signs of

, a possible diagnosis. The nurse anticipates the provider will order the following tests, and to help confirm or rule out the diagnosis
Answer and Explanation

The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A","dropdown-group-3":"A","dropdown-group-4":"A","dropdown-group-5":"A","dropdown-group-6":"A"}

While assessing the child, the nurse recognizes that sweet breath odor, dry mucous membranes, and poor weight gain are signs of diabetes mellitus, a possible diagnosis. The nurse anticipates the provider will order the following tests: urinalysis and blood sugar to help confirm or rule out the diagnosis.

Rationale:

Sweet breath odor: A fruity or sweet odor, often described as acetone-like, is a classic sign of diabetic ketoacidosis (DKA), a complication of diabetes mellitus. This occurs due to the breakdown of fats in the absence of sufficient insulin, producing ketones that are exhaled.

Dry mucous membranes: This is a common sign of dehydration, which can be caused by hyperglycemia in diabetes mellitus. High glucose levels lead to increased urine output and fluid loss.

Poor weight gain: Children with diabetes mellitus type 1 often experience unexplained weight loss despite increased appetite (polyphagia) because their bodies break down fat and muscle for energy due to insufficient insulin.

Most Likely Diagnosis:

Diabetes mellitus: The combination of symptoms (sweet breath odor, dry mucous membranes, and poor weight gain) strongly suggests diabetes mellitus, likely type 1 diabetes. This condition often presents with hyperglycemia, dehydration, and weight loss despite increased hunger.

Tests to Confirm or Rule Out the Diagnosis:

Urinalysis: This is used to check for the presence of glucose and ketones in the urine, which can help diagnose diabetes mellitus and diabetic ketoacidosis (DKA).

Blood sugar: A blood glucose test is essential for confirming diabetes mellitus. Elevated blood glucose levels are a hallmark of the disease, and testing will provide insight into the child’s current glucose levels, confirming or ruling out diabetes.


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Related Questions

Correct Answer is D

Explanation

A. Giving an extra dose after a missed dose can lead to toxicity. Parents should skip the missed dose and not give two doses at once.

B. Digoxin should not be mixed with formula because it may affect the absorption of the medication.

C. If the child vomits, do not administer another dose. The nurse should instruct parents to monitor for vomiting and hold the dose if needed.

D. Giving the medication at regular intervals ensures consistent therapeutic levels and reduces the risk of toxicity.

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"A","dropdown-group-3":"A","dropdown-group-4":"E","dropdown-group-5":"E"}

Explanation

Based on the available test results, the nurse suspects the child may be experiencing diabetic ketoacidosis because of ketones and glucose in the urine. The nurse anticipates that the child will need IV fluid replacement and IV regular insulin as soon as possible.

Rationale:

Diabetic ketoacidosis (DKA): The presence of both glucose (over 500 mg/dL) and ketones in the urine is a key indicator of diabetic ketoacidosis (DKA). DKA is a serious complication of diabetes mellitus, particularly type 1, where the body starts breaking down fats due to a lack of insulin, resulting in the production of ketones. When ketones build up in the blood, it leads to metabolic acidosis and a variety of other complications.

Ketones: High levels of ketones in the urine indicate that the body is unable to use glucose for energy and is instead breaking down fat. This is common in DKA, where the lack of insulin leads to fat breakdown and ketone production.

Glucose: The presence of glucose in the urine (glucosuria) suggests hyperglycemia, which is another hallmark of diabetes mellitus and typically present in diabetic ketoacidosis.

Treatment:

IV fluid replacement: In DKA, dehydration is common due to excessive urination from high blood sugar. IV fluids are administered to rehydrate the body and restore normal fluid and electrolyte balance.

IV regular insulin: Regular insulin is essential to lower the blood glucose level and stop the body from producing ketones. Insulin is administered via IV to quickly bring the glucose levels under control and prevent further production of ketones.

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