hyperglycemia – n. 高血糖症
fasting glucose level – 空腹血糖
indicative – a. 提示的，表示…的
glycosuria – n. 糖尿
polyphagia – n. 多食
polydipsia – n. 多饮
itchy – a. 痒的
ketoacidosis – n. 酮症酸中毒
fruity breath – 水果味口臭
dehydration – n. 脱水
Kussmaul respirations -- 库斯毛尔呼吸
hypoglycemia – n. 低血糖症
starvation – n. 饥饿
parasympathetic – a. 副交感神经的
somatostatin – n. 生长抑素
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Hyperglycemia 高血糖症
Hyperglycemia, or high blood sugar, results when there is an increase in glucose in the blood. Recent guidelines suggest a fasting glucose level of 130 or above is indicative of hyperglycemia. Clinical signs and symptoms include fatigue, lethargy, irritation, glycosuria, polyphagia, polydipsia, and itchy skin (from accumulation of wastes that the liver cannot clear). If the hyperglycemia goes unchecked the patient will experience ketoacidosis and CNS changes that can progress to coma. Signs of impending dangerous complications of hyperglycemia include the following:
l Fruity breath as the ketones build up in the system and are excreted through the lungs
水果味口臭，这是随着酮类在系统中的积聚和经肺呼出所产生的
l Dehydration as fluid and important electrolytes are lost through the kidneys
脱水，因为体液和重要的电解质经肾丢失
l Slow, deep respirations (Kussmaul respirations) as the body tries to rid itself of high acid levels
慢、深呼吸（库斯毛尔呼吸），因为身体想要努力消除本身的高酸水平
l Loss of orientation and coma 定向力丧失、昏迷
Hypoglycemia 低血糖症
Hypoglycemia, or a blood glucose concentration lower than 60 mg/dL, occurs in a number of clinical situations, including starvation, and if treatment of hyperglycemia with insulin or oral agents lowers the blood glucose level too far. The body immediately reacts to lowered blood glucose because the cells require glucose to survive, the neurons being among the cells most sensitive to the lack of glucose. The initial reaction to falling blood glucose level is parasympathetic stimulation—increased GI activity to increase digestion and absorption. Rather rapidly, the SNS responds with a “fight-or-flight” reaction that increases blood glucose levels by initiating the breakdown of fat and glycogen to release glucose for rapid energy. The pancreas releases glucagon, a hormone that counters the effects of insulin and works to increase glucose levels and somatostatin, which help the body to conserve energy. In many cases the response to the hypoglycemic state causes a hyperglycemic state. Balancing the body’s responses to glucose is sometimes difficult when one is trying to treat and control diabetes.
Periodically, the focus of glucose control changes from tight control to less strict control. In 2010, studies were published that showed that patients with very tight control tended to have more CV events and death than patients with less strict control. The incidence of hypoglycemic episodes associated with tight control has been implicated in causing the problems. The new standard, in 2011, is a less rigorous control of blood sugar levels. History shows, however, that this standard may change again in a few years after more studies are conducted.
★Tests ★ 1. A patient who has diabetes is nothing by mouth as prep for surgery. The patient states they feel like their blood sugar is low. You check the glucose and find it to be 52. The next nursing intervention would be to:
A. Administer Dextrose 50% IV per protocol
B. Continue to monitor the glucose
C. Give the patient 4 oz of fruit juice
D. None, this is a normal blood glucose reading
2. A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be:
A. High risk for deficient fluid volume
B. Deficient knowledge: disease process and treatment
C. Imbalanced nutrition: less than body requirements
D. Disabled family coping: compromised.
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答案 Answers 1. A. Administer Dextrose 50% IV per protocol Rationale: This question requires critical thinking because the patient is NPO for surgery and can NOT eat but is experiencing hypoglycemia. Normally, you could give the patient 15 grams of a simple carbohydrate like 4 oz of fruit juice or soda, glucose tablets, gel etc. per hypoglycemia protocol However, the patient can NOT eat due to surgery prep. Therefore the nurse would need to administer Dextrose 50% IV per protocol to help increase the blood glucose and recheck the glucose level. 2. A. High risk for deficient fluid volume Rationale: Increased blood glucose will cause the kidneys to excrete the glucose on the urine. This glucose is accompanied by fluids and electrolytes, causing osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options B, C, and D are not related specifically to the issue of the question.
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