hey everyone it's s with register nurse rn.com and in this video I'm going to be going over hyperglycemic hyperosmolar non-ketotic syndrome also called hhns now this video is part of a review for the diabetic patient and I cover all the patho the pharmacology of diabetes metis and diabetic keto acidosis as well so if you want to check out those videos a playlist should be popping up and you can access that so in this video what I'm going to do is I'm going to break down the patho for you about hhns go over the causes the nursing interventions and things you need to specifically know for your inlex exam and for your nursing lecture exam now after you watch this video be sure to go go to my website and take the free quiz that will test your knowledge on hhns and also be sure to check out the next video where I'm going to be comparing dka versus hhns because these two complications are similar and I want to highlight for you the things that you specifically need to know about their differences so let's get started let's begin by defining what hhns is it is a lifethreatening complication of diabetes mtis just like dka except with this you have extreme hypoglycemia in dka you have hypoglycemia but it's not as ex Extreme as it is in hhns these people's blood sugars can run greater than 600 milligram per per deciliter sometimes they can run into the four digits so they have very high glucose and this causes the blood to be really concentrated so they're going to have hyperosmolarity so the name should help you out here so you have hypoglycemia and you're going to have hyper osmolarity now in dka it was just variable osmolarity that wasn't a big factor like how it is in this complication and another key thing is that you don't have the breakdown of fat so you're not going to see ketones so big thing you're going to see is hyperglycemia and dehydration and the dehydration is being caused by this H hyperosmolarity now let's talk about the key players the patho what is going on in this patient okay number one key player is glucose glucose what is glucose it's sugar it's energy for your cell it fuels your cell your cells love glucose and they need it to work here in hhns the body is resistant to using glucose through insulin insulin uses glucose by taking it into the cell and Insulin here is resistant it's not doing its job by taking glucose in so you just have all this glucose hanging out in the body and this glucose becomes very concentrated and um you have hyperosmolarity going on because of this concentration and whenever you have the hyper osmolarity this causes water to be pulled out of those cells so that cell shrivels up and becomes dehydrated and it moves those electrolytes and glucose into the blood which you're going to get even higher glucose levels now insulin insulin like I said takes glucose into the cells and allows your body to use it but here the cells are not receptive to insulin but there is some insulin present and that's why you're not going to see the breakdown of the fats because the body just has just enough where it doesn't have to turn to those fats and break those downs and turn those into ketones and also there could be limited amount of insulin in the body due to illness limiting how much you have of that another thing is the kidneys the kidneys play a role in this as well um kidneys normally reabsorb glucose in the renial tubules but here there is way too much glucose in the blood for the kidneys to be able to reabsorb it so what happens is that it leaks into the urine and when it leaks into the urine it causes osmotic diuresis because the water's like hey according to osmosis water likes to move wherever the most concentrated area is so what's going to happen is you're going to pull all this extra water out so you're going to see polyurea you're also going to see more electrolytes being excreted such as sodium potassium and chloride and this is going to lead to dehydration so let's do a recap with hhns you have no keto ketosis or acidosis because there's just enough insulin in the body to prevent the body from breaking down fats in dka you have that okay also you're going to have heavyduty hypoglycemia a little pneumonic to help you remember that remember hhns remember heavyduty hypoglycemia it's super high it's a lot higher in this condition than in dka and you're going to have dehydration because of that hyperosmolarity causing all that osmotic diuresis to be happening pulling water from the cells just wreaking havoc on the body and this is mainly seen in your type two diabetics dka is mainly seen in type one this is mainly seen in type two however type one diabetics can experience this but it's rare okay let's talk about the causes what causes this complication the absolute main cause of why a patient will enter into this is usually some type of illness or infection especially in your older adults they're really susceptible to this so an inlex question may throw all these options at you and say which one is most susceptible to hhns and look for the patient that is has an infection and is an older adult and hhns typically happens gradually over time on the contrast dka happens suddenly and you will have some warning signs with this the patient if they're monitoring their blood sugar a lot of times they're not but if they are they will notice that their blood sugars are probably not even reading on the monitor the monitor can't even read them or they're greater than 600 they also will have frequent urination polyuria and they'll be drinking a lot poly dipsia so what are the signs of hhns well how is this patient going to look to you as the nurse what do you need to know they're going to have that heavy duty hypoglycemia you're going to go and check their blood sugar maybe running four digits I have seen that or it may not even read on the glucometer and you have to get a blood draw so that's a red flag um they'll have polyura again this is because of such the high concentration of glucose in the blood whenever the kidneys go to reabsorb they can't reabsorb all that so you have osmotic diuresis that leaks glucose into the urine along with all those other electrolytes so they're just putting out lots of fluid because of that um polydipsia they will try because they're frequently urinating they're going to be trying to drink to help combat that but it just doesn't work they're going to be majorly dehydrated and you're going to see dry dry mucous membranes fever fatigue and a big thing that you normally see that you can see in this compared to dka are those mental status changes that you can have confusion it can progress to a coma and seizures now let's look at the nursing interventions okay what is the goal what are you going to be doing for this patient with hhns remember they have high blood sugars and they are super dehy hyd so our goal is to hydrate them which is just as important because actually hydrating them with IV fluids is actually going to shift and make those flu make that blood sugar come down and we're going to be decreasing that blood sugar through insulin so um you're going to be giving IV fluids whatever the doctor orders this treatment is usually similar to dka um so typically what's started out is an isotonic solution 0.9% saline that'll go in replenish that vascular system which is depleted a fluid because they've been urinating it out they may be progressed to half normal saline which is a hypotonic solution because remember in this the cells are just shriveled up and dehydrated and hypotonic Solutions go in and hydrate that cell but when you give hypotonic Solutions you have to watch out for cerebral edema because you can overhydrate the cell so watch out for that also 5% dextrose half normal saline may be started when those sugars are running between 250 to 300 and this is just the help because you don't want to drop that sugar too fast because normally you're giving these fluids along with insulin drip an insulin drip and if you drop the sugar too fast the brain can't cope you're going to have that shifting um of water into the spinal fluid which is going to cause um cerebral edema and increase intracranial pressure so that's one of the reasons for that now with insulin um you'll be starting an insulin drip normally you'll be giving a ballis and then starting a drip and the only insulin you can get intravenously remember this this is very important is regular insulin and Insulin insulin causes potassium to move back into the cell so you want to make sure before you start this insulin drip the potassium level is greater than 3.3 because if you are moving all this pottassium back into the cell you're going to drop the potassium levels in the blood and you're going to have hypokalemia so um with insulin you'll be giving a unit Bolis whatever the doctor orders then you'll be starting an insulin drip and you'll titrate this drip based on glucose checks and you will be in this room a lot checking glucose levels continuously and titrating to the drip and messing with the drip until you get a good glucose level and then they'll be started back on um subq insulin or the oral medications things like that another solutions they may be on is a potassium solution which will again help just keep that PO iium level nice and normal while you're giving insulin since insulin will be moving the potassium back into the cell but with potassium you got to watch out with fitis which is irritation on the veins potassium is really hard on the veins EKG changes and make sure that the renal function is good because patients who have renal failure do not clear potassium and it can they can enter into hyperemia and one thing you want to keep in mind when administering insulin through um IV with tubing whenever you go to Prime the tubing insulin absorbs into the plastic IC lining so you'll probably want to waste 50 cc's to 100 cc's whatever institution um recommends before after you prime that tubing just to prevent the patient um from losing that insulin that absorbed into the lining so that is about hhns syndrome now go take that quiz and see how well you grasp this material and be sure to check out out my other video on dka and then the other video about me comparing dka and hhns together thank you so much for watching and please consider subscribing to this YouTube channel