HHS Concept Map - Hyperosmolar Hyperglycemia Disorder PDF

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Summary

Hyperosmolar Hyperglycemia Disorder...

Description

 65 years or older  Infection  Drugs that impair glucose tolerance  Newly diagnosed type 2 diabetes  Nonadherence to diabetes treatment

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 Severe osmotic diuresis  Hypovolemia  Hyperviscous blood  Decreased sodium and potassium levels

Vision changes/mental impairment Coma Seizures Hemiparesis Aphasia Excessive thirst N/V Warm, dry, flushed skin

Hyperosmolar Hyperglycemic Syndrome Definition: a life-threatening syndrome that can occur in the pt. with diabetes who is able to produce enough insulin to prevent diabetic ketoacidosis, but not able to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion. In HHS, pt. insulin levels remain available in sufficient amounts to inhibit lipolysis and ketogenesis but insufficient enough to prevent hyperglycemia. The condition most commonly occurs in pts. With Type 2 diabetes who have a concomitant illness that leads to reduced fluid intake, with the elderly and the chronically ill being the most at risk.

 Blood glucose level greater than 600 mg/dL  Marked increase serum osmolarity  Minimal or absent ketone bodies in blood and urine

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Risk for fluid volume deficit Risk for infection Deficient knowledge Imbalanced nutrition: less than body requirements

 Immediate IV administration of insulin and either 0.9% or 0.45% of NaCl.  Fluid replacement  IV fluids w/ dextrose @ blood glucose of 250 mg/dL  Electrolyte monitoring and replacement  Assess vitals, I&O, tissue turgor, lab values, & cardiac  Adequate ventilation...