HYPEROSMOLAR HYPERGLYCEMIC SYNDROME Flashcards
what is hyperosmolar hyperglycemic syndrome?
the body makes enough insulin to prevent ketosis, but not enough insulin to prevent hyperglycemia
what are risk factors for HHS?
- type 2 DM
- older adults aged 50-70
- infection such as urosepsis
- stress
what are clinical manifestations for HHS?
- slow onset
- polyuria, polydipsia, and polyphagia
- blurry vision
- mental status changes and seizures
- reversible paralysis
what occurs due to the slow onset of HHS?
often missed in older adults because of its slow onset due to people thinking that they are just naturally tired or have dementia–> UTI triggers HHS in the elderly
what can be given to treat reversible paralysis?
give fluids and insulin
what are lab findings for HHS?
- hyperglycemia >600
- no ketones in the urine
- osmolarity > 320
- no acidosis because there are no ketones
what are priority nursing interventions for HHS?
- ABCs
- fluid resuscitation to prevent dehydration and shock
- regular insulin IV bolus
what do osmolarity levels greater than 320 mean?
- leads to severe dehydration
- neurological deficits begin around 315
- increase can compound the LOC changes
what medications can be given for treatment of HHS?
- isotonic fluid (3%) follow by hypotonic fluid (0.45% NS) because of the severe dehydration
- regular insulin IV blous
- potassium replacement if necessary during the insulin treatment
what are complications of HHS?
- seizures because of low sodium in the body
- heart attack or stroke
- coma and death if left untreated
what are important patient teachings for these patients with HHS?
- drink 2-3 L/day to decrease risk of dehydration
- monitor glucose every 4hours when sick and continue taking insulin
- check for ketones and DKA with a urine dipstick
- report signs of illness
what are signs of illness to report to the provider with a patient with HHS?
- fever, chills, N/V > 24 hours
- blood glucose >250
- ketones in urine
- temperature > 101.5
