Primary Nursing Diagnosis

Fluid volume deficit related to excess urinary output

OUTCOMES. Fluid balance; Nutritional status: Food and fluid intake; Circulation status; Hydration; Knowledge: Medication

INTERVENTIONS. Medication management; Hyperglycemia management; Nutrition management; Electrolyte management; Electrolyte monitoring; Fluid resuscitation; Intravenous therapy

Ü PLANNING AND IMPLEMENTATION Collaborative

If the serum glucose level is above 250 mg/dL and the fluid balance is adequate, insulin is usually prescribed either as a subcutaneous (SC) injection or as an intravenous (IV) push injection. Often patients are placed on a "sliding scale" of insulin every 6 hours. If a patient has an elevated serum glucose along with a fluid volume deficit, the fluid volume deficit is corrected first, often with normal saline solution (0.9% sodium chloride), before the glucose excess. If glucose is reduced on a fluid volume-depleted patient before volume resuscitation, the vascular volume decreases and the patient can develop hypovolemic shock.

If the patient has hyperglycemia because of diabetes mellitus or HNKS, management is based on the severity of her or his symptoms. Because HNKS is associated with extraordinarily high levels of glucose (some reports describe levels higher than 1000 mg/dL), the patient usually

442 Hyperglycemia requires volume resuscitation followed by an insulin infusion. Often patients receive intermittent SC or IV doses of insulin as well. This should be done cautiously, however, because if the serum glucose level is reduced too rapidly, fluid shifts into the central nervous system, leading to cerebral edema and death. No matter what the diagnosis, once the glucose level and the patient are stabilized, a full workup to determine the cause and long-term treatment is needed to prevent recurrences of hyperglycemia.

Current thinking with acutely and critically ill patients, in particular surgical patients, is that patient outcomes can be improved with more stringent control of hyperglycemia than in the past. The goal of control during the critical illness is a glucose level in the range of 80 to 125 mg/dL. Frequent, serial glucose monitoring at the bedside as frequently as every 30 minutes with point-of-care technology may be necessary during the administration of insulin through continuous insulin infusions.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Insulin

Varies with severity of disease;

Hormone;

Replaces deficient or absent

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

Get My Free Ebook


Post a comment