A patient with Type 2 Diabetes has been diagnosed with Hyperglycemic Hyperosmolar Syndrome (HHS). The patient's spouse asks the RN which symptoms characterize this disorder. Which are the most appropriate responses by the RN? Select all that apply.

Slow heart rate

Elevated blood glucose

Taut, dry skin

Decreased Osmolality

Elevated BUN and creatinine

Answer and Explanation

Correct Answer : B,C,E

A. Slow heart rate: HHS usually triggers a compensatory tachycardia as the body attempts to maintain cardiac output in the face of severe dehydration and hyperosmolarity. A slow heart rate is not consistent with the physiological response seen in this disorder and could indicate another underlying issue.

B. Elevated blood glucose: Marked hyperglycemia, often exceeding 600 mg/dL, is a hallmark of HHS caused by insufficient insulin action and increased hepatic glucose production. This severe elevation in blood glucose contributes to the osmotic diuresis and fluid loss characteristic of the syndrome.

C. Taut, dry skin: Dehydration due to excessive osmotic diuresis results in decreased skin turgor, making the skin appear taut and dry. These changes reflect significant fluid volume deficits that require prompt correction to prevent complications such as shock.

D. Decreased osmolality: Osmolality in HHS is elevated due to high serum glucose pulling water from cells into the extracellular space, increasing plasma concentration. A decreased osmolality would suggest overhydration or other metabolic disturbances, which do not align with the pathophysiology of HHS.

E. Elevated BUN and creatinine: The dehydration and hypovolemia in HHS reduce renal perfusion, leading to prerenal azotemia characterized by elevated BUN and creatinine levels. These markers indicate impaired kidney function secondary to volume depletion and must be closely monitored.

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Correct Answer is ["A","B","C","D","E","F","G"]

Explanation

A. Assess bowel sounds: The patient’s abdomen is soft with hypoactive bowel sounds, which may indicate gastrointestinal hypomotility or early ileus secondary to metabolic derangement or infection. Monitoring bowel sounds is critical for detecting potential complications and guiding treatment.
B. Obtain blood glucose from the lab: Laboratory glucose measurement confirms bedside findings and helps evaluate trends, ensuring accurate assessment of glycemic status in a critically hypoglycemic patient.
C. Obtain temperature: Elevated white blood cell count and history of recent illness raise concern for infection, which can precipitate metabolic instability in diabetes. Monitoring temperature aids in identifying infectious processes requiring intervention.
D. Obtain pulse oximeter: The patient has diminished lung sounds despite oxygen therapy at 2 L/min, suggesting possible respiratory compromise. Continuous pulse oximetry is essential for monitoring oxygenation status.
E. Stop insulin drip: The patient’s blood glucose of 40 mg/dL indicates severe hypoglycemia; continuing insulin at this point risks worsening neuroglycopenia and potentially fatal outcomes. Immediate cessation of insulin is necessary.
F. Administer dextrose: IV dextrose administration is the primary treatment for severe hypoglycemia, especially in a lethargic patient unable to take oral carbohydrates. This intervention rapidly restores serum glucose and prevents neurological damage.
G. Assess neurological status: Lethargy reflects central nervous system impairment from hypoglycemia. Ongoing neurological assessment is crucial to monitor progression and response to treatment.

A. Periorbital edema B. Recent tooth extraction C. Hypoventilation D. Diarrhea last 4 days E. Heart rate 140 bpm

Correct Answer is ["B","D","E"]

Explanation

A. Periorbital edema: Periorbital edema is more commonly associated with hypothyroidism or thyroid eye disease (Graves’ orbitopathy), not thyroid storm. It does not typically present as an acute sign of thyroid storm.

B. Recent tooth extraction: Recent invasive procedures such as tooth extraction can act as a precipitating stressor for thyroid storm by triggering an acute release of thyroid hormones. Identifying such triggers is important for prompt intervention.

C. Hypoventilation: Thyroid storm typically causes increased metabolism leading to tachypnea (rapid breathing), not hypoventilation. Respiratory rate is generally elevated to meet increased oxygen demands.

D. Diarrhea last 4 days: Gastrointestinal symptoms like diarrhea are common in thyroid storm due to increased gastrointestinal motility from excess thyroid hormone. Persistent diarrhea reflects systemic hypermetabolism.

E. Heart rate 140 bpm: A significantly elevated heart rate (tachycardia) is a hallmark feature of thyroid storm and reflects excessive thyroid hormone stimulation on the cardiovascular system, increasing risk for cardiac complications.

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A patient with Type 2 Diabetes has been diagnosed with Hyperglycemic Hyperosmolar Syndrome (HHS). The patient's spouse asks the RN which symptoms characterize this disorder. Which are the most appropriate responses by the RN? Select all that apply.

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