Which of the following nursing diagnoses is of highest priority for the client presenting with hyperosmolar hyperglycemic syndrome (HHS)?
• Deficient Fluid Volume
• Altered Nutrition: more than body requirement
• Knowledge Deficit related to diabetic diet
• Noncompliance related to self-management
Deficient Fluid Volume
Rationale: The client with HHS typically has blood glucose levels >600 mg/dL, which leads to profound osmotic diuresis and dehydration. This syndrome may develop more frequently in type 2 diabetics who are ill and have unreplaced fluid losses. While proper diet is important in diabetes management, dietary indiscretion is not the main cause of HHS. Noncompliance with self-management is too broad a category to address in a critically ill client.
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1. Provide information on alcohol cessation programs. 2. Provide teaching about dietary needs. 3. Remind the patient of the implications of recurring jaundice. 4. Provide initial instruction on medication.
A patient who has undergone kidney transplantation is at risk for rejection because:
1. cytotoxic lymphocytes have been activated by anesthesia used during the surgery. 2. the sequence of amino acids in the MHC molecules differs from that in the donor. 3. an allergic response to the natural immunosuppressants the body produces occurs. 4. the immune system cannot activate against foreign antigens after an organ is transplanted.