ATI System Disorder-Hyperglycemia.pdf - ACTIVE LEARNING TEMPLATE System Disorder Rachel Vance STUDENT NAME Hyperglycemia DISORDER\/DISEASE PROCESS REVIEW

ATI System Disorder-Hyperglycemia.pdf - ACTIVE LEARNING...

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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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