Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome: Nursing Care Plan (Nursing)

00:01 Now, how do we care for somebody with HHS or DKA? What things of the same? What things are different? We're going to look at the priorities and there are three of them.

00:10 Whoa, that first box has a lot of words.

00:13 Let me speak it to you.

00:15 Correct osmotic diuresis induced dehydration to sustain blood pressure.

00:19 What are we going to do? Oh, well, we remember.

00:21 Wow, they've got those high levels of glucose.

00:24 So that kicks in to osmotic diuresis.

00:26 So they pee out a lot of volume and now there hypovolemic.

00:31 So we got to fix that osmotic diuresis.

00:34 So there are no longer hypovolemic because we want to keep their blood pressure up within a normal range to perfuse all of their body.

00:43 Second one, we gotta fix that high blood sugar, right, the hyperglycemia.

00:49 Third one fixed those electrolyte imbalances and there are the potential for several of them.

00:55 So let's go back to number one.

00:57 Now that we know that it is we know the patient is at risk for significant osmotic diuresis and so they're going to be low volume.

01:04 When you have low volume in your intravascular space your blood vessels.

01:09 Your blood pressure is, Low.

01:12 What happens to your heart rate? It's high.

01:15 Because your body says, oh my goodness.

01:17 We've only got this much volume.

01:19 We've got to move it around faster faster faster faster.

01:21 So that's why blood pressure is low, heart rate is high.

01:26 When the patient has low volume in their blood vessels.

01:31 Now, what do we do? Well, we got to replace the fluid volume.

01:34 Now, there's a protocol and you adjust the type of fluid based on the patient's assessment.

01:38 So we're not going into detail here but trust me when you've got somebody in this state, they're are very specific protocols in the hospital setting of what type of fluid you use when based on the patient assessments.

01:53 Now, I'm going to be watching vital signs and lab work, like a hawk.

01:57 Okay.

01:58 So vital signs and lab work watch like a hawk, those very closely because you know, when we have electrolyte imbalances, we have low volume.

02:08 We start putting things into the intravascular space you've got watch them very closely to make sure they're not overloaded and that we replace that volume safely.

02:18 Now the hyperglycemia, we're going to give controlled insulin Administration.

02:22 So we don't want to do this too quickly.

02:25 We don't want to we don't want to tank that blood sugar too quickly because you can end up with cerebral edema and a whole other set of problems.

02:35 So when we say controlled insulin administration, we're going to bring that high blood sugar back to normal rather slowly.

02:45 So we're going to monitor serum glucose.

02:47 Multiple times.

02:49 We're going to keep watching that serum glucose over and over and over again.

02:54 And because we know there's a risk for cerebral edema when blood sugar is that high, we're going to do consistent neuro status checks, if anything changes in the patient, we're going to notify the healthcare provider and work with them to decide, what's the next best step because remember what we did in number one.

03:12 We've also got some electrolytes off. So you need to be in constant communication with the health care provider as necessary.

03:19 So we're going to fix that osmotic diuresis by replacing fluid volume safely.

03:25 Keep an eye on their vital signs watch their lab work.

03:27 We're going to try and bring that high blood sugar down slowly and with control and intention.

03:34 Keeping an eye on that glucose and watching their neuro status because I want to make sure I catch it early if there's any problems with cerebral edema.

03:42 Now I'm going to correct that electrolyte imbalance and this depends on what their lab work says.

03:46 Not every patient pushes through this exactly the same.

03:49 So we're watching lab work for priority number one.

03:53 We're watching lab work for priority number two.

03:55 We're watching lab work for priority number three.

03:58 You'll work with the health care provider or a set protocol that tells you how to address the electrolyte imbalances.

04:05 So you're watching that lab work and you're watching for signs of depleted electrolytes.

04:10 You guys know what these are so you should be able to recognize the signs and symptoms of high and low sodium, magnesium, calcium.

04:17 Those are all things that are in our nursing bag of tricks and tools for assessment.