Hyperglycemia, a condition that is often associated with diabetes, means high blood glucose. This condition occurs when the body is not able to use insulin properly.
A blood glucose level over 125 mg/dL may be considered hyperglycemic while fasting, and over 180 mg/dL after eating.
Hyperglycemia may be caused by various conditions including type 1 and 2 diabetes, endocrine disorders, pancreatic disorders, a sedentary lifestyle, stress, and medication side effects.
Hyperglycemia is found through blood and urine tests. Symptoms of hyperglycemia include:
- Increased thirst (polydipsia)
- Frequent urination (polyuria)
- Increased hunger (polyphagia)
- Headache
- Fatigue
- Blurry vision
Uncontrolled hyperglycemia damages nerves and blood vessels and can cause complications such as cardiovascular disease, peripheral neuropathy, retinopathy, and nephropathy, as well as an increase in infections and decreased ability to heal.
The Nursing Process
The primary goal for the management of hyperglycemia is to lower the blood glucose to the acceptable range and to promote patient education in the prevention of complications. The nurse plays an important role in health promotion and supportive care for patients with hyperglycemia.
Nursing Care Plans Related to Hyperglycemia
Ineffective Health Maintenance Behaviors Care Plan
Hyperglycemia can occur due to unhealthy practices like a diet high in carbohydrates, a sedentary lifestyle, and failure to take insulin medications correctly.
Nursing Diagnosis: Ineffective Health Maintenance
Related to:
- Competing demands
- Insufficient resources
- Conflict between cultural beliefs and health practices
- Conflict between health behaviors and social norms
- Difficulty with decision-making
- Inadequate social support
- Ineffective coping strategies
As evidenced by:
- Failure to take action that prevents health problems
- Inability to take responsibility for health actions
- Inadequate commitment to a plan of action
- Inadequate interest in improving health
- Inadequate knowledge of basic health practices
- History of poor decision-making
- A pattern of lack of health-seeking behavior
Expected Outcomes:
- The patient will demonstrate lifestyle changes that promote effective health maintenance
- The patient will verbalize factors that contribute to hyperglycemia
Ineffective Health Maintenance Behaviors Assessment
1. Assess the patient’s beliefs about proper health management.
Personal and cultural beliefs along with decision control preferences, values, and perceptions can affect the patient’s decision-making regarding health management behaviors.
2. Note desire and ability to meet needs.
Assess the patient’s motivation to change behaviors as well as their ability to make decisions and perform/participate in health maintenance.
3. Assess resource barriers.
Assess for possible financial, transportation, and equipment barriers as well as the patient’s living arrangements and need for physical support.
Ineffective Health Maintenance Behaviors Interventions
1. Develop realistic goals.
Patients may be unwilling to change their lifestyles but developing small goals that can be met such as cutting back on desserts or walking twice a week can be a compromise.
2. Teach the patient ways to manage complex medication schedules.
If the patient displays difficulty adhering to their medication schedule, help them develop reminders such as alarms, pill boxes, signage, etc., that supports adherence.
3. Refer to community support programs.
The patient may require home health support, social worker assistance, or even skilled nursing services in order to meet their health and safety requirements.
4. Teach the patient ways to manage stress.
Stress can be a major factor in managing health maintenance behaviors. If the patient is burdened by other roles such as caregiving, parenting, or career responsibilities, their health may not be a priority.
5. Assist the patient to develop confidence in managing the health condition.
Self-management education improves physiological outcomes, effective healthcare use, and enhanced coping techniques.
Risk for Unstable Blood Glucose Care Plan
Patients who experience hyperglycemia are known to be susceptible to variations in serum levels of glucose. If left untreated, this condition could compromise the patient’s health and result in further complications.
Nursing Diagnosis: Risk for Unstable Blood Glucose
Related to:
- Diabetes mellitus
- Medication side effects
- Infections
- Pancreatic diseases
- Ineffective health management behaviors
- Ineffective medication management
- Ineffective weight management
- Inadequate glucose monitoring
- Dietary intake
- Pregnancy
- Stress
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet and nursing interventions are directed at the prevention of symptoms.
Expected Outcomes:
- The patient will demonstrate behaviors that improve hyperglycemia and maintain blood glucose levels within normal range
- The patient will verbalize two strategies to prevent hyperglycemia
Risk for Unstable Blood Glucose Assessment
1. Assess laboratory values.
Blood glucose levels are monitored through laboratory tests like HbA1C and fingerstick glucose tests. Alterations in these laboratory values can indicate an underlying condition like diabetes. Urinalysis can check for high ketone levels which indicates ketoacidosis and requires immediate medical attention.
2. Assess the patient’s understanding of glucose.
Ensure the patient understands their disease process and how glucose is affected by insulin.
Risk for Unstable Blood Glucose Interventions
1. Administer medications as indicated.
Insulin and other antidiabetic agents may be administered to help lower blood glucose levels.
2. Instruct on the use of glucometers or other equipment.
To properly assess and manage hyperglycemia, the patient must understand how to check their glucose levels. Observe them using their glucometer for accuracy. Some patients may benefit from a Dexcom which is a wearable continuous glucose monitoring device.
3. Monitor for any signs of hypoglycemia.
Blood glucose levels can fluctuate and hypoglycemia may occur if hyperglycemia is overcorrected. Signs and symptoms of hypoglycemia include dizziness, shakiness, sweating, headache, pallor, confusion, seizures, and mental status changes.
4. Encourage the patient to maintain a blood glucose log.
A blood glucose log can help track the patient’s responses to the treatment regimen and determine if those treatments are effective or need alteration.
5. Encourage lifestyle modifications.
Lifestyle modifications including healthy eating habits and exercise can maintain normal glucose levels and prevent hyperglycemia.
Deficient Knowledge Care Plan
A lack of knowledge or understanding of an underlying health condition, medication regimen, diet, and more can result in hyperglycemia.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Misinformation
- Inadequate access to resources
- Inadequate awareness of resources
- Inadequate information
- Inadequate interest in learning
- Inadequate participation in care planning
- Inadequate trust in healthcare professionals
- Misinterpretation of information
As evidenced by:
- Inaccurate follow-through of instructions
- Uncontrolled glucose levels
- Inaccurate statements about hyperglycemia
- Development of preventable complications
Expected Outcomes:
- The patient will verbalize the relationship between glucose and insulin
- The patient will verbalize how and when to administer insulin
Deficient Knowledge Assessment
1. Assess the patient’s learning abilities and motivation to learn.
Learning is only effective when the patient is ready and willing to learn. The patient’s ability to learn may be an obstacle but the learning process can be adjusted and use appropriate learning techniques to meet the patient’s learning style.
2. Assess current understanding.
A patient’s lack of follow-through may be mistaken for deficient knowledge. Before providing education, discuss what the patient currently understands about hyperglycemia so as not to patronize or offend them.
Deficient Knowledge Interventions
1. Encourage the patient and family members to take part in the learning process.
A combination of teaching methods adapted to the patient’s learning styles shows efficient outcomes. Involving family members in the learning process encourages support and allows both the patient and family members to better understand the health condition.
2. Reinforce patient education through frequent repetition.
Repeated and continuous education sessions about glucose management and treatment support follow-through.
3. Begin with the most vital information.
Managing diseases such as diabetes requires a life-long commitment. Determine what is most critical and remind the patient that change doesn’t happen overnight, but with consistent behavior change.
4. Refer the patient to a dietician.
A dietician can provide the patient with appropriate carbohydrate counting instructions. Monitoring carbohydrate intake is a key strategy in effectively achieving glycemic control.
References and Sources
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- High blood sugar (hyperglycemia). NHS. Reviewed May 26, 2022. From: https://www.nhs.uk/conditions/high-blood-sugar-hyperglycaemia/
- Hyperglycemia (High Blood Sugar). Cleveland Clinic. Updated Feb 11, 2020. From: https://my.clevelandclinic.org/health/diseases/9815-hyperglycemia-high-blood-sugar
- Hyperglycemia in diabetes. Mayo Clinic. Updated Aug 20, 2022. From: https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631
- Hyperglycemia. Mouri MI, Badireddy M. [Updated 2022 Apr 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430900/
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
