Hyperglycemia

Hyperglycemia is when blood glucose levels greater than 110 mg / dL. Normal blood sugar levels can be maintained between 70 and 110 mg / dL if there is sufficient balance between supply and demand of insulin. Acutely ill patients, hyperglycemia is often not diagnosed until random testing of serum glucose showed an increase compared to 150-200 mg / dL. Glucose is the main carbohydrate metabolism in the body. The structure consists of polysaccharides, mainly starch, is present in the intestine into the portal vein blood. When the liver converts glucose into glycogen storage, but the body keeps the blood tissue needs.

Insulin from pancreatic beta cells, which is stimulated to release it when blood sugar rises. Insulin transport of glucose, amino acids, potassium and phosphorus on the cell membrane. Insufficient production and inefficient use of insulin leads to elevated levels of blood sugar (hyperglycemia), which supports the movement of water in the blood of the interstitial space and intracellular fluid spaces. When blood glucose increases the renal threshold for glucose reabsorption is exceeded and glycosuria (glucose in urine loss) is present. Glucose in urine is used as an osmotic diuretic, and the patient has an increased production of urine in the reaction, which can lead to severe fluid volume deficit. When blood sugar rises, the blood becomes more viscous and the patient, the risk of thromboembolic events.

Insulin resistance and hyperglycemia associated with critical illness or injury, and the name of the current study found a link between hyperglycemia and poor outcomes from acute illnesses and injuries "diabetes of injury" .. Current thinking is that with better control hyperglycemia, improve patient care during acute illness.

The two main causes of diabetes and hyperglycemia Nonketotic hyperosmolar syndrome (HNKS). Other conditions that a disruption of glucocorticoids (Cushing syndrome) to hyperglycemiainclude may cause to increase adrenaline levels during extreme stress (multiple trauma, surgery), excessive growth hormone, excessive intake or administration of glucose in total parenteral nutrition or enteral nutrition and pregnancy . Patients with extreme stress, such as thermal injury, multiple trauma or shock, serum glucose 200-250 mg / dL is expected to adrenaline, the stress response that accompanies release.

Care Plan assessment and physical examination
Determine whether the patient offenses, the risk factors which hyperglycaemia. Get the full story of drugs, focusing on whether the patient suffered from insulin or oral antidiabetics. Question polyuria (excessive urination) and polydypsia (excessive thirst). For this is usually large amounts of dilute urine, ask the patient a large amount of urine than normal, and the color is light yellow or clear.

The patient may have symptoms if your blood sugar level was high enough volume of fluid and dehydration caused by the deficit. Perform a full assessment from head to toe, including neurological examination. Patients with severe hyperglycemia and elevated serum osmolality (greater concentrations of water particles in the blood), but it's more than 300 mOsm / L, osmolarity caused a decrease in mental status. Assessment of the level of patient awareness and cough and gag reflexes. Make sure signs of dehydration: dry mucous membranes, poor skin turgor, dry flaky skin. Gently press the eyes of the patient, a soft, uncertain. Vital signs of dehydration can detect hypotension and tachycardia. If there has been drying for several days, hot skin and fever. Although the state of dehydration, concentrated urine appears.

Ask the home, occupation, level of knowledge, financial situation and support systems that the information can be used to supply to prevent future episodes to use. Determination of the patient and other important social, economic and human resources to assist or manage chronic diseases like diabetes.

Nursing plan, primary nursing diagnoses: Fluid volume deficit related to the production of urine.

Care plan interventions and treatment
If the serum glucose level above 250 mg / dl and moisture balance is insufficient insulin is usually prescribed, or subcutaneous (SC) injection or intravenous (IV) injection support. Often, patients are placed in a "sliding scale" insulin every 6 hours. If the patient an increased level of glucose in the fluid volume deficit fluid volume deficit is corrected first, often with a saline solution (0.9% sodium chloride) to glucose excess. When the sugar is decreased in patient volume, fluid volume resuscitation, blood volume decreases and patients with hypovolemic shock. If the patient has diabetes or hyperglycemia because HNKS, management based on the severity of symptoms. Since HNKS is associated with unusually high levels of glucose (some reports describing the levels of 1000 mg / dL), the patient usually requires volume resuscitation, followed by insulin injections. Often, patients treated with IV or SC short-acting insulin as well. Should be done with care, but because the blood sugar fell rapidly, the fluid changes in the central nervous system, causing swelling of the brains and death. Whatever the diagnosis, the patient is stabilized and glucose causes a complete reprocessing in order to determine the long-term treatment of relapse, it is necessary to prevent hyperglycemia.

Current thinking carefully and critically ill patients, especially surgical patients, the patient results can be improved with tighter control of hyperglycemia than in the past. The goal of management during critical illness is a blood glucose range of 80-125 mg / dL. Regular monitoring of sugar in the night series as often as every 30 minutes pointof care technology that may be necessary for the administration of insulin by continuous infusion of insulin.

The first priority is adequate water balance. Actions of glucose as an osmotic diuretic place patients at risk of severe fluid volume deficit. If he or she is awake, encourage the patient water and sugar-free drinks with caffeine drink. Because patients are usually tachycardic caffeinated beverages is contraindicated. As a result of severe hyperglycemia is associated with increased serum osmolarity and reduced mental condition is achieved by IV fluid replacement, in most cases. Rapid fluid resuscitation if necessary, use a large gauge peripheral IV site with a brief to allow for rapid fluid replacement. Keep the hose as soon as the infusion bag or bottle, and avoid long strings of pipe in the heart of the patient. Follow the signs under hydration (mental status remains depressed, dry mucous membranes, eyes soft) and an excessive intake of fluid (pulmonary congestion, swollen neck veins, shortness of breath, frothy sputum, cough).

Patients with the most serious cases of hyperglycemia a risk of ineffective airway due to decreased mental status and respiratory tract with the language. Breathing apparatus in the vicinity of the bed of the patient at all times, including oral and nasal airways, endotracheal tubes and laryngoscope. If a patient develops a snoring, apnea, or breathing slowly, maintaining the airway and breathing bag, manual resuscitator and consult your doctor.

If the patient has diabetes or hyperglycemia because HNKS adequate patient education. Discuss the management of insulin, a consistent and appropriate method of administration of insulin is essential for optimal management of blood sugar. If possible, the patient manage their own insulin. Encourage exercise. Instruct the patient self-monitoring signs and symptoms of hypoglycemia hyperglycemiaand recognition. To teach the patient and significant others, both the skin and lower grade infections, ulcers, and problems with healing.

Nursing guidelines for discharge planning and home care
To teach the patient strategies for managing the disease. A written list of all medications, including dose, route, time and side effects. If necessary, the patient's phone number if he or she has a number of problems with self-administration of insulin or self-monitoring of blood glucose. Providing the patient with a list of recommendations in the outpatient diabetes clinic or community health center for follow-up contacts and information. Provide a list of equipment and materials needed for home care. Does the patient have any brochures and written materials for the management of hyperglycemia.