Curing Diabetes

As you begin your care, focus on stabilizing your patient’s condition, ensuring adequate ventilation, and treating shock, as appropriate. In most cases, your nursing activities and plan of care will revolve around fluid and electrolyte replacement, administering insulin, and preventing such complications as fluid overload.During fluid replacement, assess your patient’s vital signs, intake and output, breath sounds, skin turgor, and mucous membranes. Also, assess her for signs of central venous overload, including jugular vein distention, heart sounds, tachycardia, increased central venous pressure, dyspnea, and pulmonary crackles. Monitor her electrolyte levels-especially her potassium, sodium, phosphate, and magnesium levels-and assess her for signs and symptoms of electrolyte imbalances.

Assess your patient’s neurologic status hourly. If she has a seizure, take seizure precautions: Ensure a patent airway and protect the patient from injury.

If your patient is vomiting, you may have to insert a nasogastric tube. Assess her for bowel sounds and abdominal tenderness. Some patients with autonomic neuropathy develop gastroparesis, which delays gastric emptying. Provide frequent oral care to help moisten her dry lips and mucous membranes and to provide comfort.

Before starting the insulin infusion, flush the tubing with 50 ml of insulin solution to saturate it with insulin. Remember, insulin adheres to I.V. tubing, so if you don’t saturate it with insulin, your patient won’t receive the full insulin dose. Use an infusion pump to ensure insulin delivery at the prescribed rate.

Monitor the blood glucose level hourly. As it falls, monitor your patient closely for signs and symptoms of hypoglycemia.

Patient Teaching

If your patient is confused or unconscious, address your early teaching to her family. During the acute phase of treatment, provide information on the need for fluid and electrolyte replacement, invasive lines, and frequent monitoring.

After your patient’s condition stabilizes, teach her about the causes of HHNK syndrome, the signs and symptoms of hyperglycemia, and strategies for preventing HHNK syndrome. Give her complete instructions on using oral antidiabetic drugs and insulin, as appropriate. Explain their expected effects and possible adverse effects. If insulin has been prescribed, observe the patient’s administration technique and comment on how she can improve it. Also, be sure she knows how to properly use glucose monitoring equipment.

Reinforce the importance of following the prescribed diet and being aware of the signs and symptoms of hyperglycemia and hypoglycemia. Instruct your patient and her family on emergency care for both conditions.

For an elderly patient with diabetes, help prevent episodes of HHNK syndrome by providing the addresses and telephone numbers of community resources. Many organizations can supply the services of a caregiver or companion to make sure the patient adheres to the drug regimen and prescribed diet.

Filed under: Acute Complication