A nurse on a pediatric unit is reviewing the laboratory results for a group of clients. Which of the following results should the nurse identify as the priority?
A.
An adolescent who has iron-deficiency anemia and an Hgb level of 11 g/dL (10 to 15.5 g/dL)
B.
A school-age child who has diabetes mellitus and an HbA1c of 8% (less than 7%)
C.
A toddler who has moderate dehydration and an RBC count of 5.6/mm3 (4 to 5.5/mm3)
D.
A preschooler who has cystic fibrosis-related diabetes and a WBC count of 15,000/mm3 (5,000 to 10,000/mm3)
The Correct answer and Explanation is:
The priority laboratory result among the options provided is:
B. A school-age child who has diabetes mellitus and an HbA1c of 8% (less than 7%)
Explanation:
In the context of pediatric care, prioritizing laboratory results involves considering both the severity of the condition and the potential impact on the child’s health. Let’s analyze each option to understand why option B should be prioritized:
A. An adolescent who has iron-deficiency anemia and an Hgb level of 11 g/dL (10 to 15.5 g/dL)
- Explanation: An Hb level of 11 g/dL is within the lower end of the normal range for adolescents with iron-deficiency anemia. While this level indicates anemia, it is not immediately life-threatening. The management of iron-deficiency anemia typically involves iron supplementation and dietary changes. Therefore, while this result requires ongoing management, it is not as urgent as others might be.
B. A school-age child who has diabetes mellitus and an HbA1c of 8% (less than 7%)
- Explanation: HbA1c measures average blood glucose levels over the past 2 to 3 months. An HbA1c of 8% indicates poor long-term glycemic control in a child with diabetes mellitus. Chronic hyperglycemia can lead to severe complications, including diabetic ketoacidosis (DKA), neuropathy, retinopathy, and nephropathy. Persistent hyperglycemia increases the risk of acute complications and long-term health issues. Given the potential for serious health consequences and the need for immediate intervention to improve glycemic control, this result is a priority.
C. A toddler who has moderate dehydration and an RBC count of 5.6/mm³ (4 to 5.5/mm³)
- Explanation: The RBC count of 5.6/mm³ is slightly above the normal range for a toddler. While this could indicate mild dehydration or other conditions, the immediate concern in moderate dehydration would typically be to address fluid balance and hydration status. While important, this lab result is less critical compared to managing poor glycemic control in diabetes.
D. A preschooler who has cystic fibrosis-related diabetes and a WBC count of 15,000/mm³ (5,000 to 10,000/mm³)
- Explanation: A WBC count of 15,000/mm³ indicates leukocytosis, which could be a sign of infection or inflammation. In a child with cystic fibrosis, who is at high risk for infections, this result warrants further investigation. However, unless the child shows signs of acute infection or worsening condition, the immediate risk may be less compared to the complications associated with poorly controlled diabetes.
Conclusion:
The child with an HbA1c of 8% is experiencing inadequate control of their diabetes, which can lead to significant short- and long-term health problems. Addressing this high HbA1c is crucial to prevent potential severe complications, making it the priority result to focus on in this scenario.