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Table 6-28

	Hypoglycemia	Ketoacidosis
Pathophysiology	Major metabolic complication when too little food or too-large dose of insulin or hypoglycemic agents administered; interferes with oxygen consumption of nervous tissue	Major metabolic complication in which there is insufficient insulin for metabolism of carbohydrates, fats, and proteins; seen most frequently with clients who are insulin dependent; precipitated in the person with known diabetes by stressors (such as infection, trauma, major illness) that increase insulin needs
Risk factors	Too little food Emotional or added stress Vomiting or diarrhea Added exercise	Insufficient insulin or oral hypoglycemics Noncompliance with dietary instructions Major illness/infections Therapy with steroid administration Trauma, surgery Elevated blood sugar: >200 mg/dL
Assessment	Behavioral change: Subjective data—nervous, irritable, anxious, confused, disoriented Objective data—abrupt mood changes, psychosis Visual: Subjective data—blurred vision, diplopia Objective data—dilated pupils Skin: Objective data—diaphoresis, pale, cool, clammy, goosebumps (piloerection), tenting Vitals: Subjective data—palpitations Gastrointestinal: Subjective data—hunger, nausea Objective data—diarrhea, vomiting Neurological: Subjective data—headache; lips/tongue: tingling, numbness Objective data—fainting, yawning; speech: incoherent; convulsions; coma Musculoskeletal: Subjective data—weak, fatigue Objective data—trembling Blood sugar: <80 mg/dL	Behavioral change: Subjective data—irritable, confused Objective data—drowsy Visual: Objective data—eyeballs: soft, sunken Skin: Objective data—loss of turgor, flushed face, pruritus vulvae Vitals: Objective data—tachycardia; thready; respirations: Kussmaul’s; BP: hypovolemic shock Gastrointestinal: Subjective data—increased thirst and hunger, abdominal pain, nausea Objective data—vomiting, diarrhea, dry mucous membrane; lips, tongue: red, parched; breath: fruity Neurological: Subjective data—headache; irritability; confusion; lethargy, weakness Musculoskeletal Subjective data—fatigue; general malaise Renal: Objective data—polyuria Blood sugar: >130 mg/dL
Analysis/nursing diagnosis	Risk for injury related to deficit of needed glucose Knowledge deficit (learning need) related to proper dietary intake or proper insulin dosage Altered nutrition, less than body requirements, related to glucose deficiency	Risk for injury related to glucose imbalance Knowledge deficit (learning need) related to proper balance of diet and insulin dosage
Nursing care plan/implementation	Goal: provide adequate glucose to reverse hypoglycemia: administer simple sugar STAT, PO or IV, glucose paste absorbed in mucous membrane; monitor blood sugar levels; identify events leading to complication Goal: health teaching: how to prevent further episodes (see I. DIABETES, Health Teaching, Physiological Integrity); importance of careful monitoring of balance between glucose levels and insulin dosage	Goal: promote normal balance of food and insulin: regular insulin as ordered; IV saline, as ordered; bicarbonate and electrolyte replacements, as ordered; potassium replacements once therapy begins and urine output is adequate Goal: health teaching: diet instructions, desired effects and side effects of prescribed insulin or hypoglycemic agent (onset, peak, and duration of action); importance of recognizing signs of imbalance
Evaluation/outcome criteria	Adheres to diet and correct insulin dosage Adjusts dosage when activity is increased Glucose level: 80–120 mg/dL	Accepts prescribed diet Takes medication (correct dose and time) Serious complications avoided Glucose level: 80–120 mg/dL