A nurse is caring for a patient who has type 2 diabetes mellitus and their glucose levels are rising. Which of the following would indicate the patient is in a hyperosmolar hyperglycemic state (HHS)?

Choice A reason: Redness of the anus is a local response to irritation from frequent diarrhea in gastroenteritis, not a systemic response. Systemic responses involve the whole body, like fever, driven by cytokine release. Anal redness is a localized tissue reaction, not reflective of the broader inflammatory process in this infection.

Choice B reason: Stomatitis, or mouth inflammation, is not a systemic response to gastroenteritis. It may occur in specific infections (e.g., herpes) but is not typical in gastroenteritis, which primarily affects the intestines, causing diarrhea and dehydration. Systemic responses involve fever or leukocytosis, not localized oral inflammation, making this choice incorrect.

Choice C reason: Intestinal inflammation is a local response in gastroenteritis, causing diarrhea and abdominal pain. Systemic responses, like fever, result from cytokines (e.g., IL-1, IL-6) released during infection, affecting the entire body. Intestinal inflammation is the primary pathology, not a systemic effect, so this does not fit the question’s focus.

Choice D reason: Increased body temperature (fever) is a systemic response to gastroenteritis, triggered by cytokines (e.g., IL-1, TNF) released during infection. These signal the hypothalamus to raise body temperature, enhancing immune response. The patient’s feeling of warmth aligns with fever, a common systemic manifestation of inflammatory infections like gastroenteritis.

Choice A reason: Administering pain medication may mask symptoms of appendicitis progression, such as perforation, which vomiting and distension suggest. Pain relief does not address the underlying issue or potential complications like peritonitis. Notifying the provider is prioritized to reassess the patient’s worsening condition, which may require urgent surgical intervention.

Choice B reason: Applying a heating pad to the abdomen is contraindicated in appendicitis, as heat can increase inflammation, potentially causing appendix rupture. Repositioning does not address vomiting or distension. These symptoms indicate possible complications, requiring medical evaluation, not comfort measures that could worsen the patient’s condition.

Choice C reason: Notifying the primary health care provider is critical, as vomiting, abdominal distension, and diminished bowel sounds suggest appendicitis progression or complications like perforation or peritonitis. These findings warrant urgent reassessment, possibly advancing surgery or ordering imaging, to prevent life-threatening complications like sepsis or abscess formation in this acute condition.

Choice D reason: Calling the operating room to expedite surgery bypasses the primary provider’s assessment, which is needed to confirm the patient’s status. Vomiting and distension may indicate perforation, requiring imaging or immediate evaluation. Direct communication with the provider ensures appropriate decision-making, as surgery timing depends on clinical reassessment, not nurse-initiated scheduling.