Hyperglycemia is a condition where blood glucose levels are higher than normal. It can create an array of medical complications and has the potential to be life-threatening. For this reason, healthcare providers must know how to identify hyperglycemia accurately and what nursing diagnosis they may need to complete for this patient population.
This blog post will provide you with information on three different nursing diagnoses related to hyperglycemia: diabetes, metabolic acidosis, and electrolyte imbalance. Even as you read, keep in mind that our nursing writers are ready to help in case you get stuck with your nursing assignment or can’t complete it due to other reasons. All you have to do is place an order with us!
Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
What is Hyperglycemia?
The term “hyperglycemia” refers to the presence of abnormally high levels of glucose in the blood. Glucose comes from the food we eat, and our body breaks it down into a simple sugar called glucose. Insulin circulates through the bloodstream, helping glucose enter cells for them to be used for energy.
Diabetes is a condition where blood glucose levels are higher than average. In this case, the body’s immune system destroys insulin-producing cells. This results in diabetes mellitus or “diabetes.” There are different forms of diabetes depending upon how the body produces and utilizes insulin.
This is also called insulin-dependent diabetes. It occurs when the pancreas does not produce enough insulin or the body cannot use insulin properly. Type 1 diabetics may need to take daily injections of insulin for glucose to enter cells for energy.
This is called non-insulin-dependent diabetes. It occurs when the body becomes resistant to insulin or doesn’t produce enough of it. This type of diabetes often presents in adults and may not be treated as aggressively as Type 1 diabetes. In both cases, hyperglycemia is present, resulting in complications with the body’s organs and systems.
A hyperglycemic crisis is a medical emergency. It occurs when blood glucose levels are excessively high (more than 600 mg/dl). This can result in dehydration, which may be life-threatening. For this reason, there are specific nursing diagnoses that should be considered for patients with hyperglycemia.
Impaired glucose tolerance (IGT) is defined by a 2-hour postprandial blood sugar level greater than 140 mg/dL (7.8 mmol/L), to about 180 mg/dL (11.1 mmol/L). The prevalence of IGT in adults with DM ranges from 30% to 50%. The normal range for blood sugar is between 70 to 100 mg/dL.
Metabolic acidosis is a condition caused by low levels of bicarbonate in the blood. Blood pH is slightly elevated above 7.4, and carbon dioxide (CO 2) levels are low. It is important to note that metabolic acidosis can occur when there are normal or high CO 2 levels and low CO 2 levels. Acidosis can be caused by several factors, including diabetes mellitus, Kidney failure, and gastrointestinal bleeding.
Electrolyte imbalance is a condition in which the electrolytes are altered. The change in electrolyte levels will affect the cells’ ability to function correctly and lead to mental status changes. It is important to note that there can be normal or high levels of an individual ion within an imbalance, meaning that it is not necessary for all types of ions to be low or high to have an imbalance. Metabolic acidosis is commonly a part of electrolyte imbalances, including all types of fluid and nutrient deficits.
Certain people have an increased risk of developing diabetes mellitus. This includes:
-People with a family history of diabetes, gestational diabetes, or metabolic syndrome
-Individuals over the age of 40 are more likely to develop type 2 diabetes than younger patients. Aging causes a decline in the body’s ability to function properly and produce enough insulin.
-Those who are obese have greater chances of developing type 2 diabetes
-Patients with cancer, as malignancies increase levels of circulating hormones that interfere with insulin use.
Three disorders produce hyperglycemia: 1) impaired fasting (IFG), 2) impaired glucose tolerance (IGT), 3) diabetes mellitus (DM).
Impaired fasting glycemia is a condition in which blood glucose levels are too high but not high enough to be considered diabetes. Diabetes mellitus is an umbrella term for two distinct disorders: type 1 and type 2 diabetes. Both type 1 and type 2 diabetes have hyperglycemia as one of the primary symptoms.
Other conditions can cause diabetes mellitus and are known as hyperglycemic disorders. These include acetonemia, ketoacidosis, reactive, glucosuric, drug-induced, steroid-induced insulin resistance, and autoimmune hemolytic anemia.
Lifestyle changes such as proper nutrition and physical activity can help prevent hyperglycemia. The Center for Disease Control recommends:
-Maintaining a healthy weight -Frequently monitoring the diet for high sugar content foods
-Regular exercise promote blood flow through the muscles, which reduces insulin resistance. Regular exercise also improves metabolism in skeletal muscle and enhances insulin sensitivity.
-Routinely monitoring the levels of glucose in one’s blood
The signs vary depending on the cause.
The most common symptom is excessive thirst, but some people may develop frequent urination, fatigue, nausea, or vomiting.
Other possible signs include blurred vision, tingling hands or feet, numbness, or weakness in arms and legs.
In patients with ketoacidosis and hyperglycemic crises, signs and symptoms may have:
-Abdominal pain, nausea, or vomiting
-Dry skin, rapid breathing, and heart rate
Definition: A disorder of carbohydrate, fat, and protein metabolism is usually characterized by elevated blood glucose level due to low insulin production or utilization. It can lead to severe complications if left untreated.
-Functional Oral Intake (NANDA I – 2012)
Applicable for patients who are unable to tolerate their usual diet due to vomiting or nausea
– Nutrition, Less Than Body Requirements (NANDA I – 2012)
Applicable for patients who are unable to eat because of symptoms such as nausea and vomiting or have difficulty chewing or swallowing
– Disturbed Body Image (NANDA I – 2012)
Applicable for a patient who is unable to perceive their body shape due to excess weight
-Chronic pain (NANDA I – 2012)
Applicable for patients with diabetes-related problems such as neuropathy, eye problems, foot ulcers that cause chronic pain
-Thermal Incompetence (NANDA I – 2012)
Applied for patients with diabetes mellitus or hyperthermia
– Acute Pain (NANDA I – 2012)
Applicable for patients experiencing acute illness related to complications from diabetes
-Constipation (NANDA I – 2012)
Applicable for patients with neuropathy and other body issues that cause constipation
-Impaired Skin Integrity, Risk for (NANDA I – 2012)
Applied to diabetic foot ulcer patient who is at risk of skin breakdown
-Altered Nutrition, Less Than Body Requirements (NANDA I – 2012)
Applicable for a patient with nausea and vomiting who are unable to tolerate oral intake
-Chronic Sorrow (NANDA I – 2012)
Applicable for patient grieving a loss of skin integrity or limb related to diabetes 1
-Fluid Volume Deficit (NANDA I – 2012)
Applicable for a patient who presents with dehydration due to vomiting or diarrhea
-Deficient Knowledge (NANDA I – 2012)
Applied to a patient who makes errors in medication dosage or timing
– Alteration in Consciousness, Unilateral (NANDA I – 2012)
Applicable for a patient with unilateral stroke due to hypertension
– Altered Nutrition: Less Than Body Requirements (NANDA I – 2012)
Applicable for a patient with malnutrition due to metabolic disorders 1
–Fluid Volume Deficit (NANDA I – 2012)
Applicable for a patient with diabetes mellitus who are unable to maintain their fluid balance
-Deficient Knowledge (NANDA I – 2012)
Applicable for the patient who is unable to manage their treatment because of lack of education or support
– Sensory-Perceptual Alterations (NANDA I – 2012)
Applied for the patient with blurred vision due to severe hyperglycemia
Other Nursing Diagnosis:
-A medical history and physical examination
-A blood test to measure glucose levels such as:
- Hemoglobin A1c
- Fasting glucose test
-A test measuring the amount of sugar in a sample of urine
Nursing diagnosis of diabetes can be challenging if it is undiagnosed. Failure to diagnose and treat hyperglycemia can lead to severe complications such as:
The nursing care plan should be prepared by a registered nurse and include the following;
-Educate diabetic patients on the following:
-How to monitor their blood glucose level
-When and how many times per day they should check their glucose levels (usually before meals, at bedtime, and any time they feel like they need to)
-What the average blood sugar range is for a healthy individual (70-110)
-Signs of hyperglycemic episodes
-How diabetes mellitus can be treated using medication, insulin, or other means.
-Ways to decrease the risk of hyperglycemia (eating a healthy diet, exercise)
-Encourage the patient with diabetes to check their blood glucose level throughout the day and be aware of the symptoms of hyperglycemia.
-Teach the patient with type 2 diabetes how to monitor their hemoglobin A1C levels for evidence of lacking control over hyperglycemia.
-Encourage diabetic patients to participate in activities they enjoy, such as walking or swimming, even if they have an illness.
-Teach a patient how to recognize and treat diabetes mellitus or hyperglycemia episodes using the evidence-based steps from previous studies.
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Educate the patient on the importance of monitoring blood glucose levels throughout each day and report any changes to a health care provider.
Provide mental health interventions as appropriate:
Ensure a patient with diabetes follow a healthy diet and exercises regularly to prevent diabetes mellitus or hyperglycemia episodes.
Provide counseling when a diabetic patient is unable to maintain adequate blood glucose levels on their own.
Teach the patient about how to manage their blood glucose level.
Insulin injection and monitoring of blood glucose levels should be taught to diabetic patients who are not self-managing their disease with diet or oral medications.
Teaching diabetes management requires sound knowledge of each component that contributes to the overall metabolism in the human body.
Insulin injection is the primary means of managing type 1 diabetes in today’s society. The timing and amount of insulin administered depend on several factors:
- Physical activity level,
- Blood glucose level and any other medications that may be used (Wittels 1996).
Teaching diabetic patients to administer their insulin injections is of utmost importance because this allows them to become self-reliant in the long run. This reduces the number of doctor appointments and reduces health care costs in the long run.
Incidentally, administering insulin injections requires proper knowledge and understanding of how it works. Insulin acts as a key that unlocks cells from burning glucose for fuel because of a lack of insulin in the body. Hence, glucose is stored as glycogen and fat.
The cells are now locked away from burning glucose for fuel and instead start to burn the now available energy source: fat and protein (Wittels 1996). Thus, when the body has enough insulin, all excess glucose that does not get used in the body receives transferred into fat and then stored. This is how insulin works in a nutshell.
The goal of diabetes management is to maintain blood glucose level within the normal range (70-110mg/dl) as much as possible. However, this may not always be possible, and a therapeutic range must be set for each individual.
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Treatment focuses on lowering the high blood glucose level by administering insulin in various forms. These include the following:
Rapid-acting insulin that starts working within 15 minutes and lasts for three to six hours (NovoLog)
Long-lasting insulin that is generally administered once or twice a day. It works slowly, but it usually lasts for three to six days.
Basal-bolus insulin usually involves a combination of short-acting and long-acting insulins.
It is essential to educate the patient on all these aspects because, without the knowledge, they would run the risk of mismanaging their diabetes inadvertently due to a lack of information.
A patient with type 1 diabetes to have a well-balanced and healthy diet. This helps in maintaining weight which reduces complications caused by obesity (Wittels 1996). Thus, the diet should consist of the following:
- Alkaline forming foods such as vegetables and fruits
- Protein from high protein food. Protein helps to build muscle mass which in turn helps to burn fat (Wittels 1996). These can include meats, fish, eggs and dairy products, etc.
- Carbs- complex carbs should be preferred over simple sugars because they release energy faster than simple sugars. They also have a low glycemic index (GI). Foods with a high GI cause a sharp spike of blood glucose after eating, and then there is a sudden crash when the liver releases insulin to bring it back down. This causes unstable blood glucose level that can lead to hyperglycemia in people with diabetes who are not careful (Wittels 1996).
- Sweets- these should be eaten in moderation only. The sweet taste of foods releases insulin which can destabilize blood glucose levels, causing diabetes mellitus. Sugary drinks and sugary snacks such as donuts etc. are not very good for people with diabetes because they can cause rapid spikes in blood sugar levels and lead to hyperglycemia.
Diet and exercise are the first line of defense in managing type 2 diabetes (Wittels 1996). Exercise is very beneficial for people with diabetes because it helps maintain muscle mass, which helps burn fat.
Persons with diabetes need to wear clothes that they can easily take off in case of an emergency. People with diabetes must keep a spare change of clothes in the car, the office, and any other place that they spend a lot of time in to prepare for any situation (Wittels 1996). It is also essential to keep a glucose monitor handy at all times.
Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels that result from defects in insulin secretion, or its action, or both. Diabetes mellitus, commonly referred to as diabetes, was first identified as a disease associated with “sweet urine” and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of sugar into the urine, hence the term sweet urine.
Diabetes is now known to be caused by hereditary and environmental factors interacting with genetic susceptibility. The most common form of diabetes is Type 2 diabetes which accounts for 90-95% of all cases. Insulin resistance, a condition in which cells fail to respond properly to insulin, is commonly linked to obesity and accounts for most diabetes cases in many countries.
The main treatment for diabetes is exercise, proper nutrition, weight control, and insulin therapy in people with type 2 diabetes. Although research is ongoing, a cure for the disease has not been discovered, and the goal of treatment is to reduce symptoms and maintain long-term health.
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