An 88-year-old patient with type 2 diabetes is brought to the emergency department by his daughter
The patient is found to have 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. What nursing action would be a priority?
A) Administration of anti-hypertensive 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 level is usually normal. Also, anti-hypertensive medications are not indicated, as hypotension generally accompanies HHNS due to dehydration.
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The nurse is evaluating patients for obesity-related diseases by calculating the waist-to-hip ratios. Which one of these patients would be at increased risk?
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What should be the focus when the family and the patient work with the nurse to plan interventions?
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