Unformatted text preview: ACTIVE LEARNING TEMPLATE: System Disorder Rachel Vance
STUDENT NAME______________________________________
Hyperglycemia
DISORDER/DISEASE PROCESS___________________________________________________________ REVIEW MODULE CHAPTER__48
__________ Alterations in
Health (Diagnosis) Pathophysiology Related
to Client Problem
occurs when there is not enough insulin
working- may be from severe illness or stress
when the pancreas can not meet the extra
demand for insulin Hyperglycemia- DKA or
HHNS Health Promotion and
Disease Prevention
-take prescribed dose of medication at proper time
-accurately administer insulin, noninsulin injectables, and OA
-make healthy food choices
-follow sick-day rules when ill
-check blood glucose routinely
-wear or carry diabetes identification ASSESSMENT SAFETY
CONSIDERATIONS Risk Factors Expected Findings
-elevated blood glucose
-increased urination
-increase in appetite followed by lack of appetite
-weakness, fatigue
-blurred vision
-nausea and vomiting
-headache
-abdominal cramps
-glycosuria
-progression to DKA or HHNS -illness, infection
-corticosteroids
-too much food
-too little or no diabetes medication
-inactivity
-emotional, physical stress
-poor absorption of insulin Laboratory Tests Diagnostic Procedures -immediate blood glucose
-complete blood count
-pH -ketones -electrolytes
-blood urea nitrogen
-arterial or venous blood gases
-urinalysis: specific gravity, glucose, acetone -history and physical exam
-blood studies, including immediate blood glucose,
complete blood count, pH, ketones, electrolytes,
blood urea nitrogen, arterial or venous blood
gases
-urinalysis: specific gravity, glucose, acetone PATIENT-CENTERED CARE Nursing Care
-Administration of IV fluids
-IV admin. short-acting insulin
-electrolyte replacement
-assessment of mental status
-recording of intake and output
-central venous pressure monitoring
-assessment of BG levels
-assessment of blood and urine for ketones
-ECG monitoring and assessment of cardiovascular or
respiratory distress Therapeutic Procedures
-get medical care
-continue diabetes medication as
prescribed
-check blood glucose freq. and check
urine for ketones; record results
-drink fluids at least on an hourly basis
-contact HCP regarding ketonuria ACTIVE LEARNING TEMPLATES -insulin deficiency
impairs protein
synthesis and causes
excessive protein
degradation
-Results in Nitrogen
losses from tissues,
stimulates production
of glucose from amino
acids (proteins) in the
liver and leads to
further hyperglycemia
-additional glucose
cannot be used and
blood glucose level
rises further, adding to
osmotic diuresis Complications
Medications
-IV fluid and electrolyte
replacement; typically an
infusion of 0.45%-0.9%
NaCl at a rate to restore
urine output to
30-60mL/hr and to raise
BP constitutes initial fluid
therapy regimen
-When blood glucose
levels approach
250mg/dL, add 5% to
10% dextrose to fluid
regimen to prevent
hypoglycemia and
sudden drop in glucose
resulting in cerebral
edema due to
overzealous rehydration
-IV insulin administration
therapy Client Education
-teach to pt and caregivers how to safely
monitor at home: decided by presence of
fever, nausea, vomiting, and diarrhea,
altered mental status, available HCP contact
-proper medication administration
-timing of food and diabetic medication
-importance of fluid intake Interprofessional Care
-Cardiac monitoring
-dietician -may lead to Diabetic
Ketoacidosis (DKA) or
Hyperosmolar Hyperglycemic
Syndrome (HHS)
-if untreated, patient will
develop depletion of sodium,
potassium, chloride,
magnesium, and phosphate
-vomiting caused by acidosis
results in more fluid and
electrolyte loses
-eventually Hypovolemia
followed by shock, causes
retention of ketones and
glucose and acidosis
progresses
-patient becomes comatose
as result of dehydration,
electrolyte imbalance, and
acidosis, if untreated death is
inevitable ...
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