Ten hours after a client with 50% burns is admitted, her blood glucose level is 152 mg/dL. What action by the nurse is most appropriate?
a. Document the finding.
b. Obtain a family history for diabetes.
c. Repeat the glucose measurement.
d. Stop IV fluids containing dextrose.
A
Neural and hormonal compensation to the stress of the burn injury in the emergent phase in-creases liver glucose production and release. An acute rise in the blood glucose level is an ex-pected client response and is helpful in the generation of energy needed for the increased meta-bolism that accompanies this trauma. A family history of diabetes could place her at higher risk for the disease, but this is not a priority at this time. The glucose level is not high enough to war-rant retesting. The cause of her elevated blood glucose is not the IV fluid.
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