Juvenile Diabetes

Keperawatan Anak II
 Type 1 Diabetes (IDDM)

• Juvenile Diabetes = IDDM = Type 1 Diabetes.

• Occurs in about 1 in 500-600 children
• Results from autoimmune destruction of
pancreatic cells that produce insulin, resulting in
permanent insulin deficiency
• Insulin regulates glucose metabolism, which is
essential for growth, activity, wound healing, and
brain function
 Blood Glucose Level
• As a result of insulin deficiency, blood glucose levels
often deviate from normal range, resulting in…
• Hyperglycemia (high blood glucose level)
• Too much food
• Too little insulin
• Illness
• Stress
• Hypoglycemia (low blood glucose level)
• Too little food
• Too much insulin
• Extra exercise
 Hyperglycemia: Symptoms

•Extreme Thirst •Blurred Vision

•Frequent Urination •Drowsiness
•Dry Skin •Nausea
•Hunger •Ketones
• Acid in blood
 Hypoglycemia: Symptoms

•Shaking •Impaired Vision

•Fast Heartbeat •Weakness
•Sweating •Fatigue
•Anxiety •Headache
•Dizziness •Irritability
•Hunger
 Long Term Complications

• Heart attack due to • Diabetic retinopathy

reduced blood flow caused by broken
to heart blood vessels in eye
(loss of vision)
• Stroke due to reduce • Diabetic
blood flow to brain nephropathy (kidney
• Loss of circulation damage/failure)
causing slow wound • Neuropathy (nerve
healing disease) can cause
pain, loss of feeling
 Good News: Treatments

• Treatment to manage blood glucose levels

• Eat healthy foods
• Too many carbohydrates raise blood glucose levels
• Get exercise daily
• Check blood glucose levels
• Take medications
• Different types of insulin medications
 Diabetes Management

• Knowledge
• Skills
• Treatment adherence
• To all parts of regimen!!!
 Diabetes Assessment
• Self-report instruments
• Johnson’s 24-hour Recall Interview
• Reconstruct diabetes-related events
• Conducted separately with child/parent
• Self-Care Inventory
• Completion of 14 diabetes-related tasks
• Caution of over-reporting
• Direct Observation
• Meal-time Observation Schedule
• Interaction Behavior Code
• Family interactions
 Diabetes Assessment

• Technological Alternatives
• Memory in blood glucose meter
• Family measures of functioning
• Responsibility measures
• Communication
 The Psychology of Diabetes: Risk
Factors
• Adherence is related to family factors
• Perceived nagging
• Conflict
• Ineffective communication
• Stress may affect glycemic control and
adherence
• Patients in poor metabolic control have been found
to exhibit maladaptive ways of coping with stress
 The Psychology of Diabetes: Risk
Factors
• Adolescents with T1 may be at higher risk of eating
disorders, due in part to weight gain associated
with the initiation of insulin treatment
• Purposeful omission of insulin treatment
 The Psychology of Diabetes: Risk
Factors
• Degree of perceived interference in daily life
• Management requires adherence to multiple daily tasks
at home, school, and in other social settings
• Social pressure may negatively affect adherence
 How Psychologists Can Help:
Family Factors
• Supportive (but not “nagging”) parental
involvement
• Praise, warmth, encouragement, and empathy
• Appropriate for child’s maturity level
• Examples
• Gentle reminding
• Assistance in diabetes tasks
• Balance with needs for autonomy
• Gradual yielding of responsibility associated with increased
self-confidence and personal ownership of regimen
 How Psychologists Can Help:
Family Factors
• Family problem solving and conflict resolution
1. Define problem
2. Set a goal
3. Brainstorm ways to accomplish goal
4. Evaluate Ideas
5. Action plan
6. Revise the goal
 How Psychologists Can Help:
Family Factors
• Communication
• Didactic Instruction
• Feedback
• Modeling
• Behavioral Rehearsal
• Monitoring
 How Psychologists Can Help:
Family Factors
• Communication
• Encourage members to talk directly to one another
rather than using third parties
• “I” statements
• Decrease interruptions, yelling, name-calling, “mind
reading”
• Improve non-verbal communication
• Eye contact, fidgeting, smiling
 How Psychologists Can Help:
Coping with Stress
• Support from health care professionals
• Encouraging, empathetic, flexible
• Coping skills training for maladaptive coping
responses
• Social support
• Problem solving skills
• Cognitive restructuring
• “It’s not fair that I have diabetes and can’t eat what I want.”
• Psychotherapy for psychiatric disorders
 How Psychology Can Help:
Advocate
• Talk with day care/school/camp officials to
advocate for special needs
• Provide general information
• Describe child’s regimen and its potential impact on the
setting
• Identify barriers to adherence and problem-solve ways to
overcome them
• Address problems that may arise
 UF Telehealth Program

• Family focus
• Parent-child interactions
• Positive parenting principles
• Setting reasonable goals
• Changing home environment
• Stimulus control
 UF Telehealth Program

• Child Focus
• Injection strategies (e.g., sliding scale)
• Blood sugar testing (e.g, watch alarm)
• Nutrition (e.g., food intake monitoring, measuring
portions)
• Communicating with medical team
• Handling high/low blood sugar levels
• Exercise (e.g., setting reasonable goals)
 Treatment Effectiveness

• Overall, treatments have been shown to increase

adherence
• However, not all treatments have been proven to
be effective in achieving metabolic control
 KASUS
• Seorang anak laki-laki 10 tahun didiagnosis Diabetes Melitus tipe 1 dirawat di Bangsal
Anak RS. Hasil anamnesis: anak mengatakan ia banyak makan, banyak minum,
banyak kencing, BB turun, enuresis. Ia juga mudah tersinggung, tidak bisa perhatian
lama ketika mengikuti pelajaran sekolah, merasa lelah, penglihatan kabur, sakit kepala,
kalau ada luka sukar sembuh dan mudah terserang flu.
• Hasil pemeriksaan fisik: BB 25,5kg, PB 135 cm, suhu: 37,4oC, HR: 88x/menit. RR: 24x/
menit, TD: 110/70 mmHg. Turgor kulit kembali segera, kulit kering, membran mukosa
lembab. Hasil pemeriksaan laboratorium : Hb: 11,2gr/dl, Hmt: 30%, eritrosit: 4,0(x106/
uL), AT: 210000/mm3, AL: 9.500/uL, glukosa darah 300mg/dl.
• Orang tua mengatakan bahwa mereka sangat terkejut dan tidak percaya ketika
anaknya didiagnosa DM tipe 1, padahal tidak ada anggota keluarga yang menderita
DM. Mereka mengatakan tidak paham tentang DM tipe 1 dan cara perawatannya
terutama setelah pulang dari RS. Orang tua khawatir memikirkan masa depan
anaknya.
• Terapi medis: cek gula darah 2x/hari, insulin 2 IU sebelum makan.
 Analisis Data
DS :
•Anak mengatakan banyak makan, banyak minum, poliuri, berat badan rendah, mudah
tersinggung, merasa lelah, penglihatan kabur, sakit kepala, jika ada luka mudah terserang
dan mudah terkena flu.
•Orangtua mengatakan sangat terkejut dengan diagnose anaknya
•Tidak paham tentang Diabetes Melitus
•Khawatir dengan kondisi anak

DO :
•BB = 25,5 kg, PB =135 cm suhu = 37,4 c nadi = 88 kali/menit, respirasi = 24kali/menit,
tekanan darah = 110/70 mmHg. Turgor kulit kembali segera. Kulit kering, membrane
mukosa lembab. Hasil pemeriksaan laboratorium menunjukkan : Hb : 11,2 gr/dl
haematokrit ; 30% eritrosit : 4,0 (10 6 )
 Diagnosis
Diagnosis: Resiko Cidera berhubungan dengan Hiperglikemia
NOC: Setelah dilakukan tindakan selama 3x24jam.
•Kadar Hb normal, urine normal, keton normal, kadar glukosa darah normal
dengan criteria :
·         Hb = 12-16 g/dl
·         Hematokrit = 35-45%
·         Urine = 52-41/kg/24jam
·         Gula darah = Puasa = 70-110 mg/dl, 2jam setelah makan<140mg/dl, Sewaktu
<140mg/d        Gula darah = 60-100mg/dl (usia 2bulan-12 tahun)
·         Glukosa dalam urine <0,5 g/dl (kuantitatif)
·         Glukosa kualitatif negatif
• Diagnosis: Kurang pengetahuan tentang perawatan anak diabetes
mellitus tipe 1 berhubungan dengan kurangnya informasi
• NOC: Setelah dilakukan tindakan selama 2x24jam akan dicapai :
1.   Orang tua mengetahui tanda dan gejala penyait DM tipe 1
2.   Factor yang menyebabkan Diabetes Melitus 1
3.   Mengetahui cara mengkontrol glukosa darah
4.   Merenanakan diet Diabetes Mellitus tipe 1
5.   Dapat menggunakan insulin
6.   Dapat merencanakan diet makan
7.   Mengenal gejala Hiperglikemia dan Hipoglikemia
 Data diambil dari:
- http://ammeonna.blogspot.com/2011/05/asuhan-
keperawatan-pada-anak-dengan.html (ASKEP)
- https://www.google.com/url?
sa=t&rct=j&q=&esrc=s&source=web&cd=16&ved=2ahUKE
wjola_uprLkAhUNWysKHdNDCUQFjAPegQIBhAC&ur
l=http%3A%2F%2Fusers.phhp.ufl.edu%2Fjhj%2FCCPD.
ppt&usg=AOvVaw05IzBRKt1mGApc-WESt2gi (TEORI)