Page 955 - Saunders Comprehensive Review For NCLEX-RN

Instruct the parents to notify the primary health care provider when the following
occur:

▪ Blood glucose results remain elevated (usually > 200 mg/dL (> 11.4 mmol/L)
▪ Moderate or high ketonuria is present
▪ Child is unable to take food or fluids
▪ Child vomits more than once

▪ Illness persists

Box 32-6

Sick Day Rules for a Diabetic Child

▪ Always give insulin, even if the child does not have an appetite, or contact the
primary health care provider (PHCP) for specific instructions.
▪ Test blood glucose levels at least every 4 hours.
▪ Test for urinary ketones with each voiding.
▪ Notify the PHCP if moderate or large amounts of urinary ketones are present.

▪ Follow the child’s usual meal plan.
▪ Encourage liquids to aid in clearing ketones.
▪ Encourage rest, especially if urinary ketones are present.
▪ Notify the PHCP if vomiting, fruity odor to the breath, deep rapid respirations,
decreasing level of consciousness, or persistent hyperglycemia occurs.

Adapted from Hockenberry M, Wilson D: Nursing care of infants and children, ed 9, St.
Louis, 2011, Mosby.

Practice Questions

323. A school-age child with type 1 diabetes mellitus has soccer practice and the
school nurse provides instructions regarding how to prevent hypoglycemia
during practice. Which should the school nurse tell the child to do?
1. Eat twice the amount normally eaten at lunchtime.
2. Take half the amount of prescribed insulin on practice days.
3. Take the prescribed insulin at noontime rather than in the
morning.
4. Eat a small box of raisins or drink a cup of orange juice before
soccer practice.
324. The mother of a 6-year-old child who has type 1 diabetes mellitus calls a
clinic nurse and tells the nurse that the child has been sick. The mother
reports that she checked the child’s urine and it was positive for ketones. The
nurse should instruct the mother to take which action?
1. Hold the next dose of insulin.

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