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This Concept Map, created with IHMC CmapTools, has information related to: Brandy Royalty, 15 year old boy Type I Diabetes Mellitus, diagnosed @ age 12 5'9", 120 lbs. IBW: 145 Current HgbA1c Dated 8/24/2011- 135 Diet: 2000 Calorie ADA Diet ???? Modifiable Risk Factors: Diet, Weight Exercise regimen Knowledge deficit Lab results, 15 year old boy Type I Diabetes Mellitus, diagnosed @ age 12 5'9", 120 lbs. IBW: 145 Current HgbA1c Dated 8/24/2011- 135 Diet: 2000 Calorie ADA Diet ???? Non-Modifiable Risk Factors: Age Diabetes Mellitus Male Height, 15 year old boy Type I Diabetes Mellitus, diagnosed @ age 12 5'9", 120 lbs. IBW: 145 Current HgbA1c Dated 8/24/2011- 135 Diet: 2000 Calorie ADA Diet Actual Deficient Knowledge R/T in appropriate monitoring of daily finger stick, lack of insulin knowledge, poor diet, unaware of s/sx of hypo/hyperglycemia 2ndary to Type 1 Diabetes Mellitus (Ackley & Ladwig, 2011), Deficient Knowledge R/T in appropriate monitoring of daily finger stick, lack of insulin knowledge, poor diet, unaware of s/sx of hypo/hyperglycemia 2ndary to Type 1 Diabetes Mellitus (Ackley & Ladwig, 2011) ???? Assessment: 1.) B.S. taken AC and HS: Average blood sugars are greater than 110 daily 2.) 2000 ADA diet- chooses to eat foods high in sugars, carbs, and fats daily 3.) Is not able to acknowledge when glucose levels are dropping 4.) Requires assistance to calculate dose of insulin to administer 5.) Cannot recall the name of insulin to administer for AC and HS after completing B.S. check results Interventions: The nurse will: 1.) Encourage child and parents to attend Diabetic education classes within the next 3 weeks 2.) Have child perform B.S. and insulin dosing while being monitored by educated person over the next 3 weeks 3.) Educate both child/parents/teachers/ and close friends on s/sx of Hypo/Hyperglycemia within the week 4.) Educate child and coaches on DM and importance of allowing for rest periods/proper hydration/and encouragement of snacks during heavy conditioning before next practice 5.) Educate child/parents/teachers/ and close friends on obtaining a blood sugar and how to administer insulin injections before next practice (Ignatavicius & Workman, 2010) Rationales: 1.) Attending education classes can help both child and parents to learn more of the disease and how to better control disease, by understanding proper diet, exercise and compliance 2.) Having the child perform B.S. checks and handling insulin helps buld confidence in child and reinforceses adequate knowledge of child to the educator 3.) Making sure those around the child are aware of syptoms of both hypo/hyperglycemia will ensure proper treatment if child is unable to care for self or is in a hypo/hyperglycemic state 4.) Making sure coaches understand DM and how it can affect the body is improtant to help prevent complications that could be life threatening 5.) Making sure all those who interact with the child understand how to obtain a blood sugar and administer insulin can help if emergency situation occurs (Ignatavicius & Workman, 2010) Ouctomes: The child will: -Short: Child will be able to identify correct dose of insulin required within 3 days AEB: Child can demonstrate reading B.S. results and identify the appropriate type of insulin as well as draw correct dose without cues from educator -Intermediate: Child will be able to identify foods that are appropriate to eat by the end of a 3 week Diabetic Educations Classes. AEB: child can identify 5 items that are appropriate to eat on a 2000 Calorie ADA Diet -Long: Childs blood sugars will be within the 70-110 range within the next 3 months: AEB: HgbA1c will be within therapeutic range at 3 month follow-up with the Diabetic doctor, Assessment: 1.) B.S. taken AC and HS: Average blood sugars are greater than 110 daily 2.) 2000 ADA diet- chooses to eat foods high in sugars, carbs, and fats daily 3.) Is not able to acknowledge when glucose levels are dropping 4.) Requires assistance to calculate dose of insulin to administer 5.) Cannot recall the name of insulin to administer for AC and HS after completing B.S. check results Interventions: The nurse will: 1.) Encourage child and parents to attend Diabetic education classes within the next 3 weeks 2.) Have child perform B.S. and insulin dosing while being monitored by educated person over the next 3 weeks 3.) Educate both child/parents/teachers/ and close friends on s/sx of Hypo/Hyperglycemia within the week 4.) Educate child and coaches on DM and importance of allowing for rest periods/proper hydration/and encouragement of snacks during heavy conditioning before next practice 5.) Educate child/parents/teachers/ and close friends on obtaining a blood sugar and how to administer insulin injections before next practice (Ignatavicius & Workman, 2010) Rationales: 1.) Attending education classes can help both child and parents to learn more of the disease and how to better control disease, by understanding proper diet, exercise and compliance 2.) Having the child perform B.S. checks and handling insulin helps buld confidence in child and reinforceses adequate knowledge of child to the educator 3.) Making sure those around the child are aware of syptoms of both hypo/hyperglycemia will ensure proper treatment if child is unable to care for self or is in a hypo/hyperglycemic state 4.) Making sure coaches understand DM and how it can affect the body is improtant to help prevent complications that could be life threatening 5.) Making sure all those who interact with the child understand how to obtain a blood sugar and administer insulin can help if emergency situation occurs (Ignatavicius & Workman, 2010) Ouctomes: The child will: -Short: Child will be able to identify correct dose of insulin required within 3 days AEB: Child can demonstrate reading B.S. results and identify the appropriate type of insulin as well as draw correct dose without cues from educator -Intermediate: Child will be able to identify foods that are appropriate to eat by the end of a 3 week Diabetic Educations Classes. AEB: child can identify 5 items that are appropriate to eat on a 2000 Calorie ADA Diet -Long: Childs blood sugars will be within the 70-110 range within the next 3 months: AEB: HgbA1c will be within therapeutic range at 3 month follow-up with the Diabetic doctor ???? At risk for: Hypoglycemia Hyperglycemia Glaucoma Diabetic Ulcers CAD (Ignatavicius & Workman, 2010), Assessment: 1.) B.S. taken AC and HS: Average blood sugars are greater than 110 daily 2.) 2000 ADA diet- chooses to eat foods high in sugars, carbs, and fats daily 3.) Is not able to acknowledge when glucose levels are dropping 4.) Requires assistance to calculate dose of insulin to administer 5.) Cannot recall the name of insulin to administer for AC and HS after completing B.S. check results Interventions: The nurse will: 1.) Encourage child and parents to attend Diabetic education classes within the next 3 weeks 2.) Have child perform B.S. and insulin dosing while being monitored by educated person over the next 3 weeks 3.) Educate both child/parents/teachers/ and close friends on s/sx of Hypo/Hyperglycemia within the week 4.) Educate child and coaches on DM and importance of allowing for rest periods/proper hydration/and encouragement of snacks during heavy conditioning before next practice 5.) Educate child/parents/teachers/ and close friends on obtaining a blood sugar and how to administer insulin injections before next practice (Ignatavicius & Workman, 2010) Rationales: 1.) Attending education classes can help both child and parents to learn more of the disease and how to better control disease, by understanding proper diet, exercise and compliance 2.) Having the child perform B.S. checks and handling insulin helps buld confidence in child and reinforceses adequate knowledge of child to the educator 3.) Making sure those around the child are aware of syptoms of both hypo/hyperglycemia will ensure proper treatment if child is unable to care for self or is in a hypo/hyperglycemic state 4.) Making sure coaches understand DM and how it can affect the body is improtant to help prevent complications that could be life threatening 5.) Making sure all those who interact with the child understand how to obtain a blood sugar and administer insulin can help if emergency situation occurs (Ignatavicius & Workman, 2010) Ouctomes: The child will: -Short: Child will be able to identify correct dose of insulin required within 3 days AEB: Child can demonstrate reading B.S. results and identify the appropriate type of insulin as well as draw correct dose without cues from educator -Intermediate: Child will be able to identify foods that are appropriate to eat by the end of a 3 week Diabetic Educations Classes. AEB: child can identify 5 items that are appropriate to eat on a 2000 Calorie ADA Diet -Long: Childs blood sugars will be within the 70-110 range within the next 3 months: AEB: HgbA1c will be within therapeutic range at 3 month follow-up with the Diabetic doctor ???? Other Potential Nursing Diagnosis: -At risk for skin breakdown R/T non-compliance of maintenace of Diabetes 2ndary to DM -At risk of pain R/T frequent B.S. checks and insulin administration 2ndary to DM -Imbalanced Nutrition: Less than body body requirements R/T actual weight 120lbs/IBW 145 2ndary to DM -At risk of Social Isolation R/T frequent B.S. checks, insulin injection 2ndary to DM -At risk for Unstable blood glucose levels R/T blood sugars greater than 110 daily 2ndary to DM -Ineffective coping R/T lack of compliance with diet and medical regimen 2ndary to DM (Ackley & Ladwig, 2011)