HHS Flashcards
(22 cards)
Who does HHS occur most often in?
Patients between 50-70 yrs old with type 2 DM
List 3 causes of HHS
1) Precipitating event (i.e. infection)
2) Acute or chronic illness (i.e. pneumonia, stroke, UTI)
3) Meds or procedures that exacerbate hyperglycemia
What may the patient experience for days to weeks?
Polyuria & polydipsia
What two things do NOT occur in HHS but are seen in DKA?
1) Ketosis
2) Acidosis
What occurs in both DKA & HHS but is worse in HHS?
Dehydration
Pathophysiology of HHS Hint: 2
1) Insulin levels too low/ resistant to prevent hyperglycemia & osmotic diuresis but is high enough to prevent fat breakdown
2) the more resistant the insulin the more at risk a patient is for HHS
List 4 clinical manifestations of HHS
1) Hypotension/ orthostasis
2) Profound dehydration
3) Tachycardia
4) Neuro signs
List 2 examples of signs we see with profound dehydration
1) Dry mucous membranes
2) Poor skin turgor
List 3 neuro signs seen in HHS
1) Alteration of sensorium
2) Seizures
3) Hemiparesis
What are mental status changes & neuro deficits common secondary to in HHS?
Cerebral dehydration that results from extreme hyperosmolarity → often > than DKA
What is the difference in glucose levels between DKA & HHS?
Glucose levels are often higher in HHS
What are the mortality rates in elderly with HHS? What are they related to?
1) Mortality rates 10-40%
2) Usually r/t underlying illness → coexisting cardiac & renal disease
List 3 ways to Dx HHS
1) Blood glucose → 600-1200 mg/dL
2) High serum osmolality → often exceeds 350 mOsm/kg
3) Electrolytes & BUN consistent w profound dehyration
List the order of Tx for HHS
Similar to that of DKA
1) Fluid replacement
2) Insulin administration
3) Correction of electrolyte imbalances
What must the nurse watch for when Tx HHS?
Heart failure Sx → esp in those at risk
How is fluid initially given to Tx HHS?
Start w 0.9% or 0.45% NS → dependent on sodium level & level of volume depletion
What is fluid replacement guided by when Tx HHS?
Central venous or hemodynamic pressure monitoring
When do we add K+ to IV fluids when Tx HHS? What is it guided by?
K+ is added when urinary output is adequate → guided by continuous ECG monitoring & frequent lab K+ determination
Why is insulin not as important when Tx HHS as it is in DKA?
Rehydration will affect the BG level & there is no acidosis to Tx
What IV solution do we use when glucose levels fall to 250-300 mg/dL?
Dextrose IV solution
How long do neuro Sx take to resolve after Tx HHS?
3-5 days
Patient teaching after Tx of HHS Hint: 3
1) Most people can go back to diet
2) Most can go back to oral med management
3) Frequent self BG monitoring to prevent recurrence of HHS when high risk events occur
