Teaching a patient who has hyperosmolar hyperglycemic syndrome (HHS). Which of the following topics should be prioritized?
The nurse is caring for a patient with type 2 diabetes mellitus who has been prescribed doses of insulin.

Choice A reason: Decreased Body Temperature

Decreased body temperature is not typically associated with hyperthyroidism. In fact, hyperthyroidism often causes an increase in body temperature due to the accelerated metabolic rate. Patients with hyperthyroidism may experience heat intolerance and excessive sweating, but not a decrease in body temperature.

Choice B reason: Tachycardia

Tachycardia, or an abnormally fast heart rate, is a common symptom of hyperthyroidism. The elevated levels of thyroid hormones (T4 and T3) increase the body’s metabolism, leading to an increased heart rate. This can result in palpitations and a feeling of a racing heart, which are characteristic signs of hyperthyroidism. Therefore, tachycardia is the most likely vital sign abnormality in this scenario.

Choice C reason: Hypotension

Hypotension, or low blood pressure, is not typically associated with hyperthyroidism. Instead, hyperthyroidism can sometimes cause an increase in blood pressure due to the heightened metabolic activity and increased cardiac output4. Therefore, hypotension is not a characteristic finding in patients with elevated thyroid hormone levels.

Choice D reason: Slow Respiratory Rate

A slow respiratory rate is not commonly seen in hyperthyroidism. The condition usually leads to an increased respiratory rate due to the body’s heightened metabolic demands. Patients with hyperthyroidism may experience shortness of breath and rapid breathing, but not a slow respiratory rate.

Choice A Reason:

Monitoring blood glucose levels is crucial for managing diabetes, but in the context of hyperosmolar hyperglycemic syndrome (HHS), recognizing the signs and symptoms is more critical. HHS is a serious condition characterized by extremely high blood sugar levels without significant ketoacidosis. Early recognition of symptoms such as extreme thirst, frequent urination, confusion, and weakness can prevent complications and prompt timely medical intervention.

Choice B Reason:

Recognizing signs and symptoms of HHS is the most important topic to prioritize. HHS can develop gradually and may be life-threatening if not identified and treated promptly. Patients and caregivers need to be aware of the warning signs to seek immediate medical attention. Symptoms include severe dehydration, altered mental status, and very high blood glucose levels. Educating patients on these signs ensures they can act quickly to prevent severe outcomes.

Choice C Reason:

Administering insulin correctly is essential for managing diabetes, but it is not the top priority in the context of HHS education. While proper insulin administration helps control blood glucose levels, the immediate concern in HHS is recognizing the condition’s onset. Once HHS is identified, insulin administration becomes part of the treatment plan, but early detection is key to preventing severe complications.

Choice D Reason:

Understanding the importance of hydration is important because dehydration is a significant component of HHS. Patients with HHS often experience severe dehydration due to high blood glucose levels leading to osmotic diuresis. Educating patients on maintaining adequate hydration can help manage their condition and prevent the onset of HHS. However, recognizing the symptoms of HHS remains the top priority.

Choice E Reason:

Managing diet and nutrition is a fundamental aspect of diabetes care, but it is not the primary focus when dealing with HHS. While a balanced diet helps maintain stable blood glucose levels, the immediate concern in HHS is identifying and responding to the condition’s symptoms. Once HHS is recognized and treated, dietary management becomes part of the long-term care plan.