The nurse is preparing to discharge an 11 year old patient newly diagnosed with type 1 diabetes. Which of the following statements by the parents indicate that they are safe for discharge? Select ALL that apply

We will make sure that we have enough metformin when we go on vacation

We may have to check blood sugars more frequently when he is sick

We should rotate insulin injection sites frequently to reduce scar tissue forming

We will check glucose levels once he starts to eat

We will always need to check ketones when his blood sugar is above 100

Answer and Explanation

Correct Answer : B,C

Rationale:

A. We will make sure that we have enough metformin when we go on vacation: Metformin is an oral antidiabetic medication used for type 2 diabetes, not type 1. A child with type 1 diabetes will require insulin for glucose control.

B. We may have to check blood sugars more frequently when he is sick: Illness can raise blood glucose levels due to stress hormones, so more frequent monitoring helps guide insulin adjustments and prevent complications like diabetic ketoacidosis (DKA).

C. We should rotate insulin injection sites frequently to reduce scar tissue forming: Repeated injections in the same location can cause lipodystrophy (scar tissue or fat changes) which can impair insulin absorption. Rotating sites helps maintain consistent medication effectiveness.

D. We will check glucose levels once he starts to eat: Glucose monitoring for type 1 diabetes is often done before meals, not just after eating. Pre-meal checks guide insulin dosing and help maintain better blood glucose control.

E. We will always need to check ketones when his blood sugar is above 100: This is incorrect because ketone testing is not needed at such a low blood sugar threshold. Ketone testing is typically done when glucose levels are above 240 mg/dL or if the child is ill, to monitor for DKA risk.

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Correct Answer is B

Explanation

Rationale:

A. "The ductus arteriosus is a shunt that allows oxygenated blood in the umbilical vein to bypass the liver and go to the heart.": The ductus arteriosus connects the pulmonary artery to the aorta, allowing blood to bypass the fetal lungs, not the liver.

B. "The ductus venosus is a shunt that allows oxygenated blood in the umbilical vein to bypass the liver and go to the heart.": The ductus venosus carries well-oxygenated blood from the placenta past the liver and into the inferior vena cava, directing it toward the fetal heart.

C. "The foramen ovale is a shunt that allows deoxygenated blood in the umbilical vein to bypass the liver and go to the heart.": The foramen ovale is an opening between the right and left atria that bypasses the lungs and it carries mixed oxygen blood not solely deoxygenated blood.

D. "The ductus aorta is a shunt that allows deoxygenated blood in the umbilical artery to bypass the liver and go to the heart”: There is no fetal shunt called the “ductus aorta,” and the umbilical arteries carry deoxygenated blood from the fetus to the placenta not to the heart.

A. "I understand that my baby will be given multiple IV medications. Some of these medications might include opioids for pain management and antibiotics to protect her from infection." B. "I understand that I will need to be careful when picking up my baby, I will need to pick her up by the head and bottom to protect her sternum." C. "I understand that it is important my baby continues to do tummy time once a day so her motor development does not suffer while in the hospital." D. "I understand that we will be in the hospital for a couple of weeks for treatment and monitoring post-op and then we will need close follow up with cardiology and the surgery team."

Correct Answer is C

Explanation

Rationale:

B. "I understand that I will need to be careful when picking up my baby, I will need to pick her up by the head and bottom to protect her sternum.": Sternal precautions are critical to prevent strain on the healing sternum.

C. "I understand that it is important my baby continues to do tummy time once a day so her motor development does not suffer while in the hospital.": Tummy time after recent sternotomy can place pressure on the chest incision and stress the healing sternum, increasing risk of complications. It should be delayed until cleared by the surgical team.

D. "I understand that we will be in the hospital for a couple of weeks for treatment and monitoring post-op and then we will need close follow up with cardiology and the surgery team.": Post-op recovery often requires extended hospitalization and long-term follow-up to monitor cardiac function and surgical healing.

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The nurse is preparing to discharge an 11 year old patient newly diagnosed with type 1 diabetes. Which of the following statements by the parents indicate that they are safe for discharge? Select ALL that apply

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