Page 947 - Saunders Comprehensive Review For NCLEX-RN

4. Instruct children and parents to carry a source of
glucose, such as glucose tablets, with them at all times
to treat hypoglycemia if it occurs.
5. Incorporate the diet into the individual child’s needs,
likes and dislikes, lifestyle, and cultural and
socioeconomic patterns.
6. Allow the child to participate in making food choices
to provide a sense of control.

F. Exercise

1. Instruct the child in dietary adjustments when
exercising.
2. Extra food needs to be consumed for increased
activity, usually 10 to 15 g of carbohydrates for every
30 to 45 minutes of activity.
3. Instruct the child to monitor the blood glucose level
before exercising.
4. Plan an appropriate exercise regimen with the child,
taking the developmental stage into account.

G. Insulin

1. Diluted insulin may be required for some infants to
provide small enough doses to avoid hypoglycemia;
diluted insulin should be labeled clearly to avoid
dosage errors.
2. Laboratory evaluation of glycosylated hemoglobin
(HgbA1c) should be performed every 3 months.
Reference interval for HgbA1c is less than 6%.
3. Illness, infection, and stress increase the need for
insulin, and insulin should not be withheld during
illness, infection, or stress, because hyperglycemia
and ketoacidosis can result.
4. When the child is not receiving anything by mouth for
a special procedure, verify with the PHCP the need to
withhold the morning insulin, and when food, fluids,
and insulin are to be resumed.
5. Instruct the child and parents in the administration of
insulin.
6. Instruct the child and parents to recognize symptoms
of hypoglycemia and hyperglycemia.
7. Instruct the parents in the administration of glucagon
intramuscularly or subcutaneously if the child has a
hypoglycemic reaction and is unable to consume
anything orally (if semiconscious or unconscious).
8. Instruct the child and parents always to have a spare
bottle of insulin available.
9. Advise the parents to obtain a MedicAlert bracelet

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