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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 ["A","B","C","D","E","F","G"]

Explanation

Inability to stay latched to the breast is concerning because it reflects increased work of breathing or fatigue. Infants often show feeding difficulties as an early sign of respiratory compromise, and in this case, poor feeding may also contribute to dehydration and hypoglycemia.

Capillary refill greater than 4 seconds suggests delayed peripheral perfusion, which can indicate dehydration or early shock. This is a red flag in infants and requires prompt assessment of circulatory status.

Intermittent wheezing in both lungs is an abnormal breath sound typically associated with airway narrowing or obstruction, as seen in bronchiolitis or reactive airway disease. It requires close monitoring for worsening respiratory effort or decreased air exchange.

Heart rate of 178 beats per minute is elevated for a 10-week-old infant (normal is generally 100–160 bpm). This tachycardia may be a response to fever, hypoxia, respiratory distress, or dehydration, and should be evaluated in the context of other clinical signs.

Oxygen saturation of 92% on room air is below the expected range for a healthy infant (typically ≥95%). This indicates hypoxemia, and supplemental oxygen and further respiratory support may be necessary.

Respiratory rate of 65 breaths per minute exceeds the normal range for this age (30–60 breaths/min). Tachypnea can reflect respiratory distress and is especially concerning when paired with other abnormal findings.

Mild intercostal retractions are a sign that the infant is using accessory muscles to breathe, which indicates increased work of breathing. Even mild retractions in a young infant warrant close observation.

Restlessness and head bobbing are signs of significant respiratory distress. Head bobbing is particularly concerning as it indicates fatigue and the use of neck muscles to assist with breathing, which can precede respiratory failure.

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"C"},"D":{"answers":"B"},"E":{"answers":"A"},"F":{"answers":"A"}}

Explanation

Effective (Helped Meet Expected Outcome)

Infant is pink and responsive to stimulation: Indicates improved oxygenation and neurological status.

Respirations: 69 breaths/min, saturation: 98% on 2L via HHFNC: Oxygenation has improved with supplemental oxygen, though the rate is still elevated. Nonetheless, SpO₂ is now within normal range.

Infant has a wet diaper: Suggests adequate hydration and renal perfusion, which is a positive outcome of supportive care.

Ineffective (Did Not Help Meet Expected Outcome):

Significant nasal congestion remains: Indicates suctioning or airway clearance interventions were insufficient or need to be repeated.

Subclavicular intercostal and subcostal retractions: Continued increased work of breathing means respiratory distress is still present.

Unrelated (Not Related to Expected Outcome):

Temperature is 100.7 °F: Mildly elevated, but not central to assessing respiratory effort or hydration in this scenario. It does not directly reflect effectiveness of current interventions for respiratory distress or hydration.

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