An 83-year-old patient with type 2 diabetes presents to the emergency room with a blood glucose level of 623 mg/dL
The patient's daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is made. The nurse gives priority to which nursing action?
A) Administration of antihypertensive medications
B) Administering sodium bicarbonate intravenously for low bicarbonate levels
C) Reversing acidosis by administering insulin
D) Fluid and electrolyte replacement
Ans: D
Feedback: The overall approach to HHNS includes fluid replacement, correction of electrolyte imbalances and insulin administration. Insulin administration plays a less important role in the treatment of HHNS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA). Sodium bicarbonate is not administered to patients with HHNS, as their plasma bicarbonate levels are usually normal. Also, antihypertensive medications are not indicated, as hypotension generally accompanies HHNS due to dehydration.
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