Final answer:
A nurse assessing a patient with hyperglycemic hyperosmolar state should expect to find severe dehydration and an extremely high blood glucose level, often exceeding 600 mg/dL. These signs are due to osmotic diuresis caused by high glucose levels and are hallmarks of this condition typically seen in type 2 diabetes.
Step-by-step explanation:
A client presenting with hyperglycemic hyperosmolar state (HHS), often associated with type 2 diabetes, generally exhibits certain characteristic clinical findings. Among these signs, a nurse can expect to find indications of severe dehydration due to the osmotic diuresis caused by high blood glucose levels leading to excessive urination and loss of fluids. The dehydration is evidenced by symptoms such as dry mucous membranes, poor skin turgor, and increased thirst.
Another key finding in HHS is an extremely high blood glucose level, often exceeding 600 mg/dL. This significantly elevated glucose concentration stems from insulin resistance and inadequate insulin secretion, which results in reduced glucose uptake by tissues and subsequent hyperglycemia. Because the kidneys cannot reabsorb glucose efficiently at such high levels, glucose spills into the urine, causing glucosuria. The renal threshold for glucose is typically around 180 mg/100 mL, and when blood glucose levels exceed this threshold, the kidneys begin to excrete glucose, contributing to osmotic diuresis and further dehydration.
It's important to remember that while conducting a glucose tolerance test or estimating blood glucose for diagnosing diabetes mellitus, hyperglycemia observed during such tests is a vital diagnostic criterion. Additionally, in emergency scenarios, patients with severe hyperglycemia may present with low blood pressure and confusion, symptoms that also contribute to the diagnosis of severe hyperglycemic states.