What condition does the nurse suspect when a child with type 1 diabetes mellitus has hyperglycemia, diaphoresis, and headaches in the morning?

Choice A reason: NPH insulin has an onset of 1-2 hours, peaking at 4-12 hours. At 0900, 2 hours post-administration, the effect is minimal, with low hypoglycemia risk. Peak action, when hypoglycemia is most likely due to maximum glucose-lowering effect, occurs later, making this time less critical for monitoring.

Choice B reason: At 0730, only 30 minutes post-NPH insulin, the medication’s onset has not occurred, as it takes 1-2 hours to begin lowering glucose. Hypoglycemia is unlikely this early, as insulin levels are not yet significant. Peak effect at 4-12 hours is when monitoring is critical, making 0730 incorrect.

Choice C reason: NPH insulin peaks at 4-12 hours, with significant glucose-lowering effects by 1100 (4 hours post-0700 injection). Hypoglycemia risk is highest during this period due to insulin’s maximum activity, reducing blood glucose. Monitoring at 1100 is critical to detect and treat low glucose, preventing symptoms like tremors or seizures.

Choice D reason: At 0715, only 15 minutes post-NPH insulin, the medication has not reached its onset (1-2 hours). Hypoglycemia is unlikely, as insulin has not significantly lowered glucose. The peak effect at 4-12 hours is when hypoglycemia risk is highest, making 0715 an incorrect time for monitoring.

Choice A reason: Intussusception involves bowel telescoping, causing obstruction. A barium enema is the treatment of choice, as it applies hydrostatic pressure to reduce the invagination, restoring bowel continuity. This non-invasive method is effective in 80-90% of pediatric cases, avoiding surgical risks, and is prioritized unless perforation or peritonitis is present.

Choice B reason: IV fluids support hydration in intussusception but do not address the mechanical obstruction causing bowel ischemia. Fluids manage dehydration from vomiting or reduced intake, but only a barium enema or surgery corrects the telescoping, making fluids a supportive, not primary, treatment for resolving the underlying pathology.

Choice C reason: Immediate surgery is reserved for intussusception cases with perforation, peritonitis, or failed non-operative reduction. While effective, it carries risks like infection or adhesions. A barium enema is preferred as a less invasive option, successfully reducing the intussusception in most children, making surgery a secondary choice unless complications arise.

Choice D reason: Gastric lavage clears stomach contents but is irrelevant for intussusception, which involves intestinal obstruction. It does not reduce the telescoped bowel or relieve ischemia. A barium enema directly addresses the mechanical blockage, making lavage inappropriate, as it fails to correct the underlying anatomical issue causing the condition.