Page 359 - Critical Care Nursing Demystified

344 CRITICAL CARE NURSING DeMYSTIFIED

Secondary causes of HHNS include other illnesses such as stroke, MI, pan-
creatitis, trauma, sepsis, burns, or pneumonia. Dietary supplements such as TPN
(a prolonged intravenous hypertonic glucose infusion), excessive carbohydrate
intake from tube feedings, or peritoneal and hemodialysis can also create this
syndrome.
Most of the signs are the same as with DKA except for the absence of
Kussmaul’s respirations and it takes longer to develop as compared to DKA.
Volume depletion is usually greater in HHNS than in DKA but fluids should
be replaced gradually to prevent fluid overload. Patients should be placed on
seizure precautions.

Prognosis
There is a mortality rate of 10–40% primarily because of delays in seeking
medical help, underlying illnesses and vulnerability of the elderly patient.

4 Nursing Diagnosis for DM Expected Outcomes
Risk for infection related to Signs of infection will be resolved
hyperglycemia and an open, Wound foot ulcer will show signs of healing
unhealed foot ulcer
Glucose levels will be within normal limits Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

Nursing Interventions

Use fingerstick glucose testing to obtain and evaluate blood glucose levels
daily.

Administer prescribed antidiabetic and antibiotic medications.
Provide sterile wound care daily to open foot ulcer.
Examine wound for signs of infection, for example, warmth, redness, swell-
ing, pain, odor, and purulent drainage.
Teach the benefits of proper foot care, for example, wash feet daily with warm
soap and water. Do not walk barefoot. Do not wear tight-fitting shoes. Cut
toenails straight across. Examine for unusual discoloration and openings.

1 Adrenal Glands
There are two glands, one each perched on top of each kidney and composed
of an
1. Outer layer or cortex – Produces aldosterone (mineralcorticoids) that regu-
late sodium and potassium balance and cortisol (glucocorticoids)
that regulates metabolism, increases in blood glucose levels, and CNS
responses to stress. Also produced are the androgens, which contribute to male
and female growth and development and to sexual activity in adult women.