Assessment

HISTORY. Ascertain if the patient has any disorders that are risk factors for hyperglycemia. Elicit a complete medication history, focusing on whether the patient has ever taken insulin or oral antidiabetic medications. Ask about polyuria (excessive urination) and polydypsia (excessive thirst). Because it is common to have large amounts of dilute urine, ask if the patient has noted a larger urinary output than usual and if the color was light yellow or clear.

PHYSICAL EXAMINATION. The patient may not have any symptoms unless the blood glucose level has increased high enough to cause fluid volume deficit and dehydration. Perform a complete head-to-toe assessment, including a neurological examination. Patients with severe hyperglycemia also have an increased serum osmolarity (higher concentration of particles than water in the blood); when it goes above 300 mOsm/L, osmolarity causes decreased mental status. Assess the patient's level of consciousness and the cough and gag reflexes.

Inspect for signs of dehydration: dry mucous membranes, poor skin turgor, and dry scaly skin. Press gently on the patient's eyeballs; they may feel soft rather than firm. The patient's vital signs may reveal hypotension from fluid loss and tachycardia. If the dehydration has occurred for several days, the patient may have warm skin and an elevated temperature. In spite of the state of dehydration, the urine may not appear concentrated.

PSYCHOSOCIAL ASSESSMENT. Ask about the home environment, occupation, knowledge level, financial situation, and support systems, which may provide information that can be used to prevent future episodes. Determine the patient's and significant other's social, economic, and interpersonal resources to help manage a potentially chronic condition such as diabetes mellitus.

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Serum glucose

70-110 mg/dL

>110 mg/dL

Elevation of glucose resulting from

level (fasting)

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