Assignment
T.R. is a 55-year-old Hispanic female who was brought in by ambulance when her husband and granddaughter could hardly arouse her in the morning. For the last 2 to 3 days, T.R., her husband, and her granddaughter have had vomiting and diarrhea that they thought was caused by a virus. Before that, T.R. was so weak she could barely stand by herself.
History includes: Type 2 diabetes mellitus, hypertension for more than 20 years, and a mild myocardial infarction 3 years ago. She usually takes glyburide (Micronase) for her diabetes and metoprolol (Lopressor) for her blood pressure and heart disease. But she has not taken her medication since she has been vomiting because she has not been eating. Her skin is hot and dry with poor turgor, and she is stuporous. Her vital signs are blood pressure (BP) 92/50, heart rate 112, respiratory rate 28, and temperature 38.2° C. Weight is 141 lbs. Her blood glucose is 632 mg/dL. Her urine is negative for ketones. HHS is the diagnosis.
ICU Admission orders for Hyperosmolar Hyperglycemic Syndrome (HHS):
1. Regular Insulin bolus 0.1 unit/kg
2. 1000 mL NSS with 40 mEq KCL to infuse at 150 ml/hour continuously
3. 1000 mL NSS with 500 units regular insulin to infuse at 8 units/hour
4. Insert urinary catheter
5. Chemsticks every hour; titrate insulin drip per protocol
6. Cardiac monitoring
7. Serum electrolytes, osmolality, CK, CK-MB, troponin q 6 hours
8. ECG
9. ABGs
10. CBC
11. Lovenox 1 mg/kg subcutaneously every 12 hours
Use the 10th edition IGGY textbook to answer these questions and cite your reference correctly.
A. Which of the physician orders will you perform first and why?
B. Discuss five priority interventions that you would expect to implement during the initial treatment of T.R.
C. Detail priority assessment points most appropriate for T.R. at this point?
D. How much regular insulin (units) will you administer for the IV bolus? Round to the nearest whole number.
E. Diabetic patients need teaching about self-management. What are the sick day rules you will teach patients with diabetes?