|
To view the Course Outline and take the test online, click here.
For a printer-friendly version of the test you can print out, complete and mail in to ADVANCE, click here.
Learning Scope #318
2 contact hours
Expires Oct. 26, 2011
The goal of this CE is to provide the most current information about managing the care of pediatric patients living with diabetes, from toddlers to teens. After you have completed reading this article, you will be able to:
1. Identify common issues experienced by children of various ages who have type 1 diabetes.
2. Discuss possible solutions with parents and caregivers whose children are experiencing problems typical of children who have type 1 diabetes.
3. Determine when a child is developmentally ready to take responsibility for different aspects of diabetes care, and when the child is having difficulty managing care.
You can earn 1 contact hour of continuing education credit in three ways: 1) For immediate results and certificate, go to www.advanceweb.com/nurses. Grade and certificate are available immediately after taking the online test. 2) Send this answer sheet (or a photocopy) to ADVANCE for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406. 3) Fax the answer sheet to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice of failure. A certificate of credit will be awarded to participants who achieve a passing grade of 70 percent or better.
Merion Publications Inc. is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association (No. 008-0-07), an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Merion Publications Inc. is also approved as a provider by the California Board of Registered Nursing (No. 13230) and by the Florida Board of Nursing (No. 3298).
Associated Table
Each year, according to the CDC, approximately 13,000 young people are diagnosed with type 1 diabetes. When these are added to the estimated 151,000 people under age 20 nationally who already live with diabetes, the numbers begin to show the diagnosis of type 1 diabetes in children and adolescents is, unfortunately, a common one.
Matching developmental milestones with intensive diabetes management is critical when working with children who have type 1 diabetes. Childhood spans a broad range of ages and, with that, a wide variety of developmental issues and milestones. The ability of children to understand diabetes, learn how to cope and adapt their routine varies with chronological age and developmental age.
Toddlers
Toddlers are challenging individuals. They live in the land of "no" and are learning to assert themselves in every aspect of their lives. It should be no surprise, then, that a toddler would consistently rebel against anything that would cause discomfort. When a toddler cries, squirms, runs and hides from a finger prick or insulin injection, not one of us would be surprised. A newly diagnosed toddler presents a great challenge for parents.
It's best for parents and healthcare professionals dealing with toddlers to remain very organized, doing much of the preparation for testing and injections out of the toddler's sight before addressing the toddler. This age group will not be able to help with preparation, as their fine motor skills are not yet fully developed. These tasks are not something about which the child will have a choice, and you want to remain as matter-of-fact about the entire process as possible. Also, it's best to try to complete the entire process in designated areas and try to keep from doing anything painful in the child's bedroom. If they begin to connect their bed or bedroom with painful procedures, they may begin to have problems sleeping or staying in bed.
Encourage families to be quick about the finger prick. Have the meter prepared and ready to go before you approach the child. The person doing the testing should hold the child in the lap while performing all testing and injections. This helps the child realize this process is not a punishment and no one is angry with them. Children of this age can easily mistake the testing process as the result of bad behavior. Parents can simply explain, "We need to test now. Here's a little pinch." Anticipation on the part of the child and the family member can make the process longer than it needs to be, so it's best to test blood immediately after this statement.
Prepare any insulin out of the sight of the toddler and use the same no-nonsense approach for insulin injections. If the child becomes a true challenge, it will be important for the family to realize this is a process that needs to happen for the health of the child. Sometimes, it will be necessary for two people to hold the child during finger pricks or insulin injections. Fussiness or tantrums often have just as much to do with the interruption in activities as they do with the process.
Children of this age will frequently challenge the parent. Always encourage families to reaffirm their love for the child. A little praise goes a long way, even if the behavior has been challenging. Toddlers will eventually fall into a pattern and accept the routine. Usually this takes about 2-3 weeks. If the situation remains challenging, consider that the child may be experiencing needle phobia and will need a behavioral health referral for desensitization. This is often under-recognized, and the assistance of a behavioral-health diabetes team member can be a tremendous asset for all age groups.
It may be more difficult to recognize the signs and symptoms of hypoglycemia in toddlers, as their behaviors are often erratic. Toddlers may be listless, fussy, irritable or sweaty as a symptom of hypoglycemia. Until parents and families begin to correlate low blood sugar with certain behaviors, it's best to test when there is a question. Hypoglycemia in toddlers can be treated with 5-10 g of carbohydrates. This could be one-third to one-half cup of fruit juice or two sleeves of Smarties candy.
|