Please respond to your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:

• Do you agree with your peers’ assessment?
• Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
• Share your thoughts on how you support their opinion and explain why.
• Present new references that support your opinions.

Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles. Also, be sure you are italicizing titles of online sources.

Kshwanda’s Response:

1. You are managing the primary care services for a 14-year-old with Type I diabetes. She has been diabetic for the last three years. What information will you obtain? What are some of the complications of poorly managed diabetes in the adolescent population?

Type 1 diabetes is an autoimmune disease that occurs when the pancreas stops producing insulin. Insulin is the substance that breaks down food to produce enjoy for your body. Type 1 diabetes can occur in any age and can affect anyone. The early symptoms in adolescence are increase appetite and unexpected weight loss (JDRF, 2019). In teenager’s body isn’t able to get the proper energy it needs from food he or she may feel more hungry than normal. If the child is losing weight—especially when eating more—it could be a sign that his or her body isn’t getting enough calories from their food(JDRF, 2019). These early signs can be huge indicator of Type 1 Diabetes.

During this visit I would obtain an a1c, CBC, and urinalysis. The a1c will provide me with the information of the patient average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin) (Mayo, 2019). The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached (Mayo, 2019). An A1C level of 6.5 percent or higher on two separate tests indicates diabetes (Mayo, 2019). With this information I can determine if the patient is being complaint or if the teen requires an adjustment in her diabetes management. The CBC and urinalysis will provide information about the teen’s cholesterol levels, thyroid function, liver function and kidney function. If the child is being non-complaint can cause these functions to change and cause other issues that could be prevented.

Reference

Mayo Clinic (2019). Type 1 Diabetes retrieved from https://www.mayoclinic.org/diseases-conditions/typ…

JDRF International (2019). Signs of Diabetes in Teens and Young Adults retrieved from https://www.jdrf.org/t1d-resources/about/symptoms/…

Amanda’s Response:

You are managing the primary care services for a 14-year-old with Type I diabetes. She has been diabetic for the last three years.

What information will you obtain?

In meeting this patient for the first time, I would inquire how she discovered she was diabetic. For instance, was there a precipitating episode such as a hospitalization that she learned she was diabetic. I would ask about prior medications and management strategies that she has tried in the past. I would discuss her management goals and what is important to her. For example, I would ask how comfortable she felt frequently checking her blood sugar. I would assess her cognitive, motor, and emotional function. Diabetic children are often responsible for injecting their insulin during school hours. It is important to assess the patient’s function in order to successfully complete this task. I would inquire as to this child’s schedule, extracurricular activities, and exercise regimen. Another important question would be the patient’s level of understanding of her condition. Does she require additional education?

What are some of the complications of poorly managed diabetes in the adolescent population?

Poorly managed diabetic adolescent patients may experience a spectrum of complications related to their disease. Several acute complications include; diabetic ketoacidosis, rhabdomyolysis, and a hyperglycemic/hyperosmolar state (Peters, & Laffel, 2011). Complications which may develop overtime include; hypertension, neuropathy, microalbuminuria, and retinopathy (Pinhas-Hamiel, & Zeitler, 2007). In order to prevent both these acute and chronic complications, patients must achieve tight glycemic control (Peters, & Laffel, 2011). Frequent follow-up is essential for successful management of pediatric diabetes. Depending on this patient’s current A1C, I would follow her monthly until our glycemic goal was met. Diabetic adolescents are at a far higher risk of complications when they engage in risky behavior such as alcohol consumption, tobacco use, substance abuse, and unprotected sex (Peters, & Laffel, 2011). I would frequently counsel this patient regarding behavior risk reduction. I would offer this patient contraception in a form that she would be most likely to adhere too. The Depo Provera injection is a good alternative to oral contraceptives as it provides 3 months of contraceptive coverage.

References

Peters, Anne, M.D., C.D.E., & Laffel, Lori, M.D., M.P.H. (2011). Diabetes care for emerging adults: Recommendations for transition from pediatric to adult diabetes care systems: A position statement of the american diabetes association. Diabetes Care, 34(11), 2477-85.

Pinhas-Hamiel, O., & Zeitler, P. (2007). Acute and chronic complications of type 2 diabetes mellitus in children and adolescents. The Lancet, 369(9575), 1823-31. Retrieved from https://prx-herzing.lirn.net/login?url=https://sea…