Management of Hospitalized Patient With Diabetes Mellitus

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Mr. Brown is a 45 year old male who has been diagnosed with type 2 diabetes mellitus (T2DM), peripheral arterial disease,(PAD), and hypertension (HTN). Mr. Brown requires immediate intra venous therapy of normal saline to re-hydrate and correct his electrolyte imbalance. Mr. Brown was admitted to the ward following a revascularization procedure on his anterior lower right leg, and has a history of Hyperosmolar Hyperglycaemic Nonketotic Syndrome (HHNS) which is a combination of hyperosmolality of extracellular fluid, resulting in dehydration of intracellular fluid, combined with hyperglycaemia, which is defined by a blood glucose level (BGL) over 11mmol/L (Berman, 2012). Andrew (2004, p57.) states that dehydration is a main contributing factor that leads to HHNS which is recognized as a serious endocrine emergency. Mr. Brown’s current blood glucose level (BGL) of 21mmol/L, and his reporting of feeling weak and nauseated, vomiting for two days, and thirsty are signs of dehydration, which means John is at risk of suffering from HHNS.

Mr. Brown is observed to have dry mouth, warm and dry skin, with increased turgor, and a decreased level of consciousness which signify dehydration. If Mr. Brown’s dehydration is not addressed promptly his BGL will continue to escalate, he could experience seizures, coma and eventually death, which are body reactions to high levels of glucose, and are symptoms of late stage HHNS Katsilambros (2011, p.62).

The combination of suffering from T2DM and being dehydrated, has devastating effects on the microvasculature, which can cause potential retinopathy, nephropathy and forms of neuropathy (Andrew 2004). This can lead to coronary artery disease (CAD), Renal Disease and worsen his current PAD which ...

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Thompson h.j. & Kagan s.h. (2011) Clinical management of fever by nurses: doing what works. Journal of Advanced Nursing 67(2), 359–370. DOI: 10.1111/j.1365-2648.2010.05506.x

Tollefson, Joanne. (2012). 5th edition. Clinical Psychomotor Skills: Assessment skills for nurses. Cengage Learning, Australia.

Wolf, Gunter (2012). Diabetes and Kidney Disease. Wiley and Sons, Holdenbrook NJ. Retrieved from http://www.eblib.com. EISBN: 9781118494103

Ziyadeh, Fuad. Hoffman,Brenda. Cheol Han, Dong. Iglesias-de la Cruz, Carmen. Soon Won Hong. Long-term prevention of renal insufficiency, excess matrix gene expression, and glomerular mesangial matrix expansion by treatment with monoclonal antitransforming growth factor-β antibody in db/db diabetic mice. PNAS 2000 97 (14) 8015-8020; published ahead of print June 20, 2000, doi:10.1073/pnas.120055097

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