Metabolic & Endocrine Disorders in Children: Diabetes, PKU, and Fluid Balance | Saunders NCLEX-PN Review Chapter 30

Metabolic & Endocrine Disorders in Children: Diabetes, PKU, and Fluid Balance | Saunders NCLEX-PN Review Chapter 30

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Chapter 30 of Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri focuses on pediatric metabolic and endocrine disorders, providing future nurses with the practical knowledge and NCLEX-style strategies needed to recognize, treat, and educate families about these high-stakes conditions. From managing fever and dehydration to life-changing chronic illnesses like diabetes and phenylketonuria, this chapter delivers clear, evidence-based nursing interventions for safe pediatric care.

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Fever Management and Pediatric Dehydration

  • Fever: Assess using accurate temperature techniques, administer antipyretics (acetaminophen, ibuprofen), use tepid sponge baths, and encourage hydration. Teach parents about signs of serious illness and when to seek medical attention.
  • Dehydration: Recognize warning signs—weight loss, delayed capillary refill, decreased urine output, sunken eyes/fontanels. Oral rehydration is first-line for mild to moderate cases, while IV fluids are indicated for severe dehydration. Monitor input/output and teach caregivers about early symptom recognition.

Phenylketonuria (PKU): Genetic Screening and Diet Management

  • PKU: Autosomal recessive disorder screened for in newborns. Symptoms include vomiting, eczema, musty urine odor, and risk of intellectual disability if untreated.
  • Diet: Strict avoidance of high-phenylalanine foods (meat, dairy, aspartame). Emphasize lifelong adherence and regular neurodevelopmental monitoring.
  • Nursing Education: Teach families about formula options and how to read food labels. Highlight the importance of early diagnosis and intervention to prevent irreversible damage.

Pediatric Diabetes Mellitus: Insulin, Glucose Monitoring, and Sick-Day Rules

  • Type 1 Diabetes: Absolute insulin deficiency requiring daily injections. Focus on blood glucose monitoring, dietary balance (carbohydrates, regular meals/snacks), and exercise.
  • Type 2 Diabetes: Often linked to obesity and family history; managed by lifestyle changes, oral meds, and sometimes insulin.
  • Insulin Administration: Teach proper injection techniques, insulin types, site rotation, and dilution for infants when needed. Glucagon is essential for treating severe hypoglycemia.
  • Glucose Monitoring: Daily checks, ketone monitoring when sick or glucose is high, and maintaining a Hemoglobin A1C within target range (per provider recommendations).
  • Sick-Day Management: Never stop insulin, increase monitoring, maintain hydration, and check for ketones. Watch for DKA symptoms (Kussmaul respirations, fruity breath, confusion) and know when to seek urgent care.

Hypoglycemia, Hyperglycemia, and Diabetic Ketoacidosis (DKA)

  • Hypoglycemia: Signs include tremors, irritability, lethargy, headache, slurred speech. Treat with rapid-acting glucose sources (juice, glucose tablets), and follow with complex carbs/protein.
  • Hyperglycemia: Signs include polyuria, polydipsia, blurred vision, fatigue. Correct by adjusting insulin per protocol and increasing fluids.
  • DKA: Life-threatening emergency with high glucose, ketonuria, acidosis. Watch for dehydration, abdominal pain, Kussmaul respirations. Treat with IV fluids, insulin, and potassium monitoring in a hospital setting.

Developmental and Family-Centered Education for Lifelong Management

  • Support independence in diabetes management as children age, using age-appropriate education for blood glucose checks, insulin injections, carb counting, and sick-day rules.
  • Emphasize Medic-Alert identification, importance of school and caregiver education, and psychological support for both child and family adjusting to chronic illness.
  • Encourage consistent routines, regular follow-up appointments, and community resources for continued care.

Conclusion:
Mastering metabolic and endocrine disorders—including PKU, dehydration, fever, and diabetes—is crucial for NCLEX-PN success and safe, confident nursing practice. This chapter’s clinical priorities and education strategies ensure effective care and support for children and their families.

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