HHS

Question 1

How does HHS differ from DKA?

Answer 1

1. Ketone levels are low/absent
2. Blood glucose levels are much higher
3. D/T residual insulin secretion

Question 2

BLOOD GLUCOSE levels may EXCEED _____ mg/dL

Answer 2

600

Question 3

BLOOD OSMOLARITY may EXCEED _____ mOsm/L

Answer 3

320

Question 4

The ONSET of HHS is __________.

Answer 4

Gradual

Question 5

Precipitating FACTORS of HHS include infection, stress and ____________.

Answer 5

Poor fluid intake

Question 6

HHS usually OCCURS in patients over the AGE of ____ with TYPE ____ DIABETES.

Answer 6

60 years of age 👵🏽

Type 2 diabetes

Question 7

INSULIN SECRETION in HHS just enough to PREVENT __________ but NOT ENOUGH to prevent __________.

Answer 7

1. Enough to prevent Ketosis

2. NOT enough to prevent Hyperglycemia

Question 8

How will HHS MANIFEST in a patient?

Answer 8

Altered CNS function

Question 9

What are FIVE (5) CAUSES of HHS?

Answer 9

1. MI 💔
2. Sepsis 💩
3. Pancreatitis
4. Stroke
5. Medications 💊

Question 10

What are FIVE (5) MEDICATIONS that can CAUSE HHS?

Answer 10

1. Glucocorticoids
2. Diuretics
3. Phenytoin (Dilantin)
4. Propranolol (Inderal)
5. Calcium Channel Blockers

Question 11

What are some (3) COMPLICATIONS of the CNS seen in patients wit HHS?

Answer 11

1. Seizures
2. Myoclonic jerking
3. Reversible paralysis

Question 12

COMA occurs in an HHS pt with OSMOLARITY greater than ____.

Answer 12

350

Question 13

What is the FIRST PRIORITY of the nurse treating a pt for HHS?

Answer 13

Replace blood loss

Question 14

The expected OUTCOME of FLUID THERAPY for an HHS pt is to restore blood glucose within ____ to ____ hours.

Answer 14

36-72 hours

Question 15

In SHOCK or SEVERE HYPOTENSION give __________ saline.

Answer 15

Normal saline

Question 16

Half of the estimated WATER DEFICIT is REPLACED in the first ____ hours and the REMAINDER is given over the next ____ hours.

Answer 16

1/2 within first 12 hours

Remainder 36 hours

Question 17

What HEALTH ISSUES (3) indicate that the pt being treated for HHS needs to be MONITORED closely?

Answer 17

1. CHF
2. Kidney Disease
3. Acute Kidney Injury

Question 18

What is the BEST evidence that FLUID MANAGEMENT is SATISFACTORY?

Answer 18

Slow but steady improvement in CSN function

Question 19

When providing FLUID THERAPY to a pt with HHS, the nurse notices NO SIGNIFICANT IMPROVEMENT in LOC when performing her hourly assessment. What would be the best intervention?

Answer 19

Increase rate of fluid replacement

Question 20

What do signs of REGRESSION of LOC in a pt AFTER initial IMPROVEMENT indicate?

Answer 20

Too rapid of fluid replacement

Question 21

True or False insulin must be administered prior to fluid replacement.

Answer 21

FALSE, insulin is administered AFTER adequate fluids have been replaced

Question 22

What FIVE (5) factors DETERMINE the RATE of INFUSION for fluid therapy in HHS pts?

Answer 22

1. Body weight
2. UOP
3. Kidney Function
4. Pulmonary congestion
5. Jugular Distention