Chapter 22: Care of children and young people with endocrine problems

ACTIVITY 22.1: CRITICAL THINKING

Critically reflect with your mentor on placement on how a child may present with DKA. How would you assess them, and how would you plan their care?

Answer: Go to BSPED website:

www.bsped.org.uk/clinical/docs/DKAguideline.pdf

ANSWERS TO SCENARIO 22.1: ADAM

A 15-month-old boy, Adam, presents to the local Accident and Emergency department with a history of polyuria, polydipsia and lethargy. His blood glucose level is 23mmols/l and he is ketotic and acidotic. Type 1 diabetes is diagnosed and he is admitted to the ward. Once Adam has stabilised, a discussion is had with his parents about the best insulin regimen for him to go on, and together the diabetes team and family decide that continuous subcutaneous insulin pump therapy is the way they would like to proceed. Adam and his parents meet with the different members of the diabetes team to learn about the diagnosis. They meet with the dietician and begin to learn about carbohydrate counting and the diabetes specialist nurses to learn about Type 1 diabetes and how to use the insulin pump and test blood glucose levels. Adam often stays at his maternal grandparents’ house so they are also invited to the ward to learn about the diagnosis and treatment. Prior to discharge, the parents’ knowledge is assessed and they are deemed ready to go home. There is regular telephone contact with the diabetes nurses and Adam comes to weekly multidisciplinary clinic appointments whilst the family get used to managing diabetes at home.

  • Who else might need to be educated to help the family manage diabetes?

Answer: Nursery staff or babysitters may need to have training in diabetes management so that Adam can be safe in their care. It is important that parents have support from other adults who can help manage diabetes and that Adam can be left with other people as he would have been prior to diagnosis.

  • What other healthcare professionals might it be useful for the family to meet with at diagnosis?

Answer: Psychologists can be useful in helping parents and young people sort through their feelings and emotions and diagnosis and as they begin to get to grips with living with this life-long condition.

ANSWERS TO SCENARIO 22.2: JOHNNY

Johnny is a 21-month-old boy referred to the paediatric endocrine and growth clinic for poor growth.  Johnny was referred by his health visitor who reported his growth was within the lower end of normal range but his parent had ‘insisted’ on the referral. On assessment at his first clinic appointment Johnny was below the 1st centile on his growth chart, but his projected height in accordance with his parents’ heights was on the 31st centile.

Johnny’s growth was monitored in clinic over the next year and he continued just below the first centile. Johnny’s growth hormone production was assessed through the use of a Glucagon stimulation test, showing his highest GH (growth hormone) level to be only 4.4micrograms/L (normal range: >7micrograms/L) which qualified him for GH treatment.

The PEN (paediatric endocrine nurse) then met with Johnny’s parents in clinic to demonstrate a range of GH delivery devices. There was discussion about the pros and cons of each device, plus nursing and prescription support offered by each of the homecare delivery companies.

  • Good compliance to GH treatment is essential for it to work effectively. What factors do you think contributed to Johnny’s good compliance?

Answer:

  1. Support and supervision from parents
  2. Training and follow-up visits at home from homecare nurse
  3. Telephone and clinic support from PEN
  4. GH delivery device recorded doses administered
  • Growth hormone is delivered by subcutaneous injection. What are some nursing considerations regarding subcutaneous injections in children?
  1. Regular injection site rotation
  2. Appropriate needle length and gauge depending on the age and size of the child
  3. Assessment of the appropriate injection site, again taking into consideration the age and size of the child

ANSWERS TO ACTIVITY 22.2: CRITICAL THINKING

  • Have a look at the NHS screening programme guide to testing for congenital hypothyroidism

Answer:  Go to www.bsped.org.uk/clinical/docs/128977_Congenital_Booklet_A4_12pp-5LO.pdf

  • What other conditions are screened for during the newborn screening test?

Answer: Go to www.nhs.uk/conditions/pregnancy-and-baby/pages/newborn-blood-spot-test.aspx