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Management Of Hospitalized Patient With Diabetes Mellitus

2806 words - 11 pages

Mr. Brown is a 45 year old male who has been diagnosed with type 2 diabetes mellitus (T2DM), peripheral arterial disease,(PAD), and hypertension (HTN). Mr. Brown requires immediate intra venous therapy of normal saline to re-hydrate and correct his electrolyte imbalance. Mr. Brown was admitted to the ward following a revascularization procedure on his anterior lower right leg, and has a history of Hyperosmolar Hyperglycaemic Nonketotic Syndrome (HHNS) which is a combination of hyperosmolality of extracellular fluid, resulting in dehydration of intracellular fluid, combined with hyperglycaemia, which is defined by a blood glucose level (BGL) over 11mmol/L (Berman, 2012). Andrew (2004, p57.) states that dehydration is a main contributing factor that leads to HHNS which is recognized as a serious endocrine emergency. Mr. Brown’s current blood glucose level (BGL) of 21mmol/L, and his reporting of feeling weak and nauseated, vomiting for two days, and thirsty are signs of dehydration, which means John is at risk of suffering from HHNS.
Mr. Brown is observed to have dry mouth, warm and dry skin, with increased turgor, and a decreased level of consciousness which signify dehydration. If Mr. Brown’s dehydration is not addressed promptly his BGL will continue to escalate, he could experience seizures, coma and eventually death, which are body reactions to high levels of glucose, and are symptoms of late stage HHNS Katsilambros (2011, p.62).

The combination of suffering from T2DM and being dehydrated, has devastating effects on the microvasculature, which can cause potential retinopathy, nephropathy and forms of neuropathy (Andrew 2004). This can lead to coronary artery disease (CAD), Renal Disease and worsen his current PAD which is common with diabetic patients Lepäntalo (2012). Due to the severity of the complications it is imperative that he is rehydrated by intravenous fluids as it would help increase the intravascular, interstitial and intracellular fluid volume, which would therefore reduce the risk of circulatory collapse (Katsilambros 2011, p.64). Subsequently, the nurse would expect to see improvements in Mr. Brown’s clinical signs of dehydration, glomerular perfusion, reversal of the hyperglycaemic state (21mmol/L) Katsilambros (2011,p.64).

Mr. Brown did not follow the diabetes “sick day” rule which states that during illness or stressful events the body will require additional insulin to combat the release of hormones during stressful events to the body (Katsilambros, 2011 ,p.178). Mr. Brown’s recent Femoral popliteal revascularization would have put stress on the body and due to vomiting and nausea he isn’t able to tolerate fluids, which fuels his dehydration (Katsilambros 2011).

Kohan (2013) states that renal insufficiency and damage to the kidney is due to T2DM, and can lead to Chronic Kidney Disease which would decrease the medication clearance and cause electrolyte disturbances. Severe hyperkalemia is defined in patients as...

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