Management of Hospitalized Patient With Diabetes Mellitus Essay

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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 …show more content…
Subsequently, the nurse would expect to see improvements in Mr. Brown’s clinical signs of dehydration, glomerular perfusion, reversal of the hyperglycaemic state (21mmol/L) Katsilambros (2011,p.64).

Mr. Brown did not follow the diabetes “sick day” rule which states that during illness or stressful events the body will require additional insulin to combat the release of hormones during stressful events to the body (Katsilambros, 2011 ,p.178). Mr. Brown’s recent Femoral popliteal revascularization would have put stress on the body and due to vomiting and nausea he isn’t able to tolerate fluids, which fuels his dehydration (Katsilambros 2011).

Kohan (2013) states that renal insufficiency and damage to the kidney is due to T2DM, and can lead to Chronic Kidney Disease which would decrease the medication clearance and cause electrolyte disturbances. Severe hyperkalemia is defined in patients as over 7mmol/L and the high potassium in the blood can be reduced by urine production which is stimulated by fluid intake (Wolf 2012). Mr. Brown’s decreased renal perfusion and altered electrolyte levels, along with decreased oxygen perfusion which is due to less volume of fluids in circulation, again signifies Mr. Brown’s current condition of dehydration