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hypergycaemic hyperosmolar nonketotic syndrome(HHNKS) (assessment and…
hypergycaemic hyperosmolar nonketotic syndrome(HHNKS)
definition
it is the life threatening complication of type two diabete characterised by hypergycaemia and hyperosmolarity, resulting in alterations of the sensorium.
it often occurs in elderly patients who have had no previous history of DM.
diagnosis
high blood glucose of greater 35mmol/l
urea and electrolytes which may reveal elevated sodium levels, decreased levels of potasium, chloride, phosphorus and magnesium.
signs of severe dehydration
surum osmolarity of 343mosmoo/l
assessment and common fundings
dysrhythimias
CVA result from decreased cerebral blood flow or thromboemboli
polyuria and polydipsia
a dteriorating mental status from confusion to coma
seizures
hypovolaemic shock and signs of eletrolyte imbalances
possible complication into renal failure and myocardial infarction due to decreased renal blood flow and incresed cardiac workload
multiple organ failure and thrombosis
management
normal saline is administered rapidly on IV at a rate of 200-300ml/hr until the blood glucose drops to less than 15mmol/l
fluids given to correct hypovolaemia and hypertension for first two hours of infusion, and dextrose solutions given when the blood glucose reaches less than 15mmol/l
monitoring of BP and CVP to assess patient responce to rapid infusion of fluid
addition of potassium to replace fluid when patient's urinary output is adequate
placement of the patient on continous cardiac monitor for regular monitoring of electrolyte levels
rapid-acting insulin may be administered for continous infusion to treat hypergycaemia
nursing management
maintainance of fluid administration as prescribed
strictly monitoring of intack and output
monitoring blood pressure and central venous pressure continously and report dysrhythmias
nursing care of patient in a coma
nursing a patient in a cot bed and with the side rails up at all times to prevent risk falling
carrying out an endotracheal intubation to ensure maintain adequate airway.
inserting an indwelling catheter for accurate measurement of urinary output
care for the patient's back and pressure points
manage seizures
causes
infection
therapeutic procedures such as dialysis increase the demand for insulin and may precipitate the acute development of HHNKS.
the ingestions of medications that provokes insulin insuficiency cause HHNKS e.g thiazide diuretics.