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Hyperglycemia as a Risk Factothe Perioperative Patient LINDA RUTAN, MSN, RN, CNS-BC, CNOR, CRNFA; KATHLEEN SOMMERS, EdD, RN

www.aorn.org/CE

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e glucosein patientslycemia iscomes. Anhe body’ssely mon-a through-borativelyioperative

2012. doi:

mellitus.

ABSTRACT

Bodily injury and stress associated with surgical interventions increaslevels not only in individuals diagnosed with diabetes mellitus but alsowithout a preoperative diagnosis of diabetes. Whatever the cause, hypergbecoming an increasingly important indicator of perioperative patient outelevated blood glucose level affects the body’s defense systems and tability to heal after surgical intervention. Perioperative nurses should cloitor the patient’s blood glucose levels and watch for signs of hyperglycemiout the perioperative experience. Perioperative nurses should work collawith other perioperative team members to identify and treat perhyperglycemia. AORN J 95 (March 2012) 352-361. © AORN, Inc,10.1016/j.aorn.2011.06.010

Key words: hyperglycemia, diabetes of injury, stress diabetes, diabetes

prochypergnoslic aptionlt of

s, theintervsruptrglyce

00 mg/dL).2

ses to un-cess thatat hypergly-ic levels,glycemia

rioperativeare practicess and im-.

injury andntions in-iagnosedents withoutperative hy-on for hy-ls have ledpatient.4 The

contac

rn the

wing

leting

ation

hours

Individuals undergoing a surgicalare at risk for complications ofmia even in the absence of a dia

diabetes mellitus.1 Complex metabodocrine changes, including the disruglucose metabolism, occur as a resudividual’s preoperative health statution requiring surgery, the surgicaland postoperative processes. The diglucose metabolism results in hype

indicates that continuing education

hours are available for this activity. Ea

tact hours by reading this article, revie

purpose/goal and objectives, and comp

online Examination and Learner Evalu

http://www.aorn.org/CE. The contact

this article expire March 31, 2015.

352 AORN Journal ● March 2012 Vol 95

edureglyce-is ofnd en-

ofan in-condi-ention,

ion ofmia

(ie, blood sugar level greater than 2It is important for perioperative nurderstand the pathophysiological prodrives hyperglycemia, the effects thcemia has at the cellular and systemresearch correlations between hyperand patient complications in the pesetting, and recommended patient cthat disrupt the pathological procesprove patient healing and outcomes

According to Berkers et al,3 bodilystress associated with surgical intervecrease glucose levels in individuals dwith diabetes mellitus. However, patidiabetes also may experience postoperglycemia. Regardless of the reasperglycemia, increased glucose leveto impaired healing in the surgical

t

con-

the

the

at

for

National Nosocomial Infections Surveillance

doi: 10.1016/j.aorn.2011.06.010

No 3 © AORN, Inc, 2012

emiafectioetes od glu

llnessial adositivoperated unHow

glycemed mhat n

blooyper

eriencrativelatedia in

us.

en dibetests in

nsulin.8

e stress

critical

profound

atients can

hyperglyce-

for perioper-

of many

at result in

ndant endog-

ed glucose

t tissues.9

immune re-

mechanism.3

ted stress

ant increased

ed insulin

ance produce

n of the ad-

tisol, which

muscle pro-

ive hepatic

lly, there is

PERIOPERATIVE HYPERGLYCEMIA www.aornjournal.org

System risk index included hyperglycleading risk factor for surgical site in

In the past, stress diabetes, or diabjury1 (ie, a transitory increase of bloolevel in response to the stress of an ijury), was considered to be a beneficresponse that promotes healing and poperative outcomes.3 Generally, postblood glucose levels were left untrealevels were greater than 200 mg/dL.3

recent research has correlated normothe perioperative patient with decreasand mortality.6 Evidence suggests tshould closely monitor the patient’scose levels and watch for signs of hmia throughout the perioperative expTherefore, it is important for periopeto understand the pathophysiology regical insult and resulting hyperglycemtients with or without diabetes mellit

PATHOPHYSIOLOGYThere are several similarities betwemellitus and diabetes of injury. Diatus is a pancreatic failure that resul

Figure 1. Sympathoadrenergic stimulation in

as ans.5

f in-coseor in-

aptivee post-tiveless theever,ia in

orbidityursesd glu-glyce-e.7

nursesto sur-pa-

abetesmelli-

the

body’s inability to produce or use i

Diabetes of injury is the result of th

imposed by surgical intervention or

illness.1 Both conditions can induce

hyperglycemia. Thus, nondiabetic p

experience significant durations of

mia that present unique challenges

ative nurses.

Hyperglycemia is the end product

bodily responses and dysfunctions th

two altered metabolic conditions: abu

enous glucose production and impair

uptake in peripheral insulin-dependen

High glucose levels mute the innate

sponse and disrupt the inflammatory

Surgical tissue trauma and associa

activate the endocrine system. Result

hepatic production of glucose, inhibit

secretion or action, and insulin resist

hyperglycemia (Figure 1).6 Stimulatio

renal cortex causes the release of cor

causes hyperglycemia as a result of

teolysis, glycogenolysis, and excess

gluconeogenesis (Figure 2). Norma

response to surgical tissue trauma and stress.

AORN Journal 353

e to hulatioproce

rbated, thed healing is

spon

March 2012 Vol 95 No 3 RUTAN—SOMMERS

a feedback mechanism and responsreduce hyperglycemia, but the stimcatecholamines interferes with this

Figure 2. Hypothalamic-pituitary axis re

Figure 3. Effects of hyperglycemia on the he

354 AORN Journal

elpn ofss. As

hyperglycemia develops or is exaceimmune system is compromised animpaired (Figure 3).10

se to surgical tissue trauma and stress.

aling process.

d randnorma

hospsurgicortalt stu

hat is

pogly

uences,13,16

emia as an

outcomes,

of glucose

1% decreaseinsulin titrate

L versus ainsulin titrate

Lorrelated withindependent

putations inents without

� 180atients whose108 mg/dL

glycemictor foryieldedtraditional

mg/dL withality

reced patient

8(3):506-523.creases in

hemia is poor in

nts. N Engl

after cardiac

ed. 2005;33(7):

):933-944.

PERIOPERATIVE HYPERGLYCEMIA www.aornjournal.org

RESEARCHSeveral quantitative observational ancontrolled studies have associated ab

cose levels with increased lengths ofstay, intensive care unit admissions,infections, neurological events, and m(Table 1).6,11-16 Although some recen

purport that a glucose control range t

low (ie, � 110 mg/dL) can cause hy

TABLE 1. Review of Studies Asso

Authors Research de

Bagry et al (2008)1 � Prospective� Randomized co

trial

Jones et al (2008)2 � Retrospective� Correlational� Descriptive

Malmstedt et al(2008)3

� Cohort study� Correlational� Descriptive

NICE-SUGAR StudyInvestigators,Finfer et al (2009)4

� Randomized costudy

� Correlational� Descriptive

Ouattara et al(2005)5

� Prospective cohstudy

� Correlational� Descriptive

Turnia et al (2005)6 � Retrospective� Correlational� Descriptive

Weiner et al (2008)7 � Meta-analysis

1. Bagry HS, Raghavendran S, Carli F. Metabolic syn2. Jones KW, Cain AS, Mitchell JH, et al. Hyperglycemortality after coronary artery bypass graft surgery. J3. Malmstedt J, Leander K, Wahlberg E, Karlstrom Lpatients with diabetes: a population-based cohort st4. NICE-SUGAR Study Investigators; Finfer S, ChittoJ Med. 2009;360(13):1283-1297.5. Ouattara A, Lecomte P, Le Manach Y, et al. Poorsurgery in diabetic patients. Anesthesiology. 2005;106. Turnia M, Fry DE, Polk HC Jr. Acute hyperglycemi1624-1633.7. Wiener RS, Wiener DC, Larson RJ. Benefits and ri

omizedl glu-

italal siteitydies

too

cemic

events and the accompanying conseq

most studies have emphasized

� the magnified effect of hyperglyc

indicator of patient risk,

� its correlation with negative patient

and

� the positive effects of some level

control with insulin.4,9,14,17,18

ng Hyperglycemia With Patient Outcomes

Sample size Analysis/findings

d1,548 surgical

intensivecare unitpatients

46% reduction in bacteremias and 4in renal failure in patients who hadblood glucose levels � 110 mg/dcontrol group of patients who hadblood glucose levels � 215 mg/d

2,297 coronaryartery bypasspatients

Early postoperative hyperglycemia cincreased morbidity and mortalityof diabetes mellitus

1,840 coronaryartery bypasspatients

Significant increase in ipsilateral ampatients with diabetes versus patidiabetes

d 6,104 intensivecare unitpatients

Patients whose glucose control wasmg/dL had lower mortality than pglucose control was 81 mg/dL to

200 patientswith diabetesundergoingheart surgery

Multivariate analysis identified poorcontrol as an independent risk facmorbidity; tight control of glucosesignificantly better outcomes thancontrol

516 traumapatients

Correlated glucose levels of � 200higher rates of infection and mort

8,432 criticallyill patients

Tight glucose control resulted in mohypoglycemic episodes than redumortality

and insulin resistance: perioperative considerations. Anesthesiology. 2008;10dicts mortality after CABG: postoperative hyperglycemia predicts dramatic ins Complications. 2008;22(6):1-6.

son L, Swendenborg J. Outcome after leg bypass surgery for critical limb iscbetes Care. 2008;31(5):887-892.u SY, et al. Intensive versus conventional glucose control in critically ill patie

rative blood glucose control is associated with a worsened hospital outcome-694.

e innate immune system: clinical, cellular, and molecular aspects. Crit Care M

ht glycemic control in critically ill adults: a meta-analysis. JAMA. 2008;300(8

ciati

sign

ntrolle

ntrolle

ort

dromemia preDiabete

, Alfredsudy. Diack DR, S

intraope3(4):687a and th

sks of tig

AORN Journal 355

ptimaycemiks.4 Rwith(ie,

olonglucos

plicais recbloodthouthat shsk of

hypemnon.19

issioose ldiseaand

creenng onenz2

emicrativituted

r recom-

1c test that

; if the result

ician is con-

ostponing a

levels im-

ommends

120 mg/dL

d glucose

er the pa-

ications. If

, peak, and

the nurse

od glucose

und stress

f nursing

ive care.

abolic

ase blood

s who have

ly prone to

ose tissue

ocrine organ

l cellular

rglycemia.23

surgical

ed within the

ol is obtainedervention if

erativeccessed

March 2012 Vol 95 No 3 RUTAN—SOMMERS

Study results conflict regarding the ocose control range to prevent hypoglas well as to avoid hyperglycemic rissearch has yet to correlate outcomesglycated hemoglobin (HbA1c) resultsplasma glucose concentration over prods) or hospital stay average blood g

IMPLICATIONSResearch results have a number of imfor perioperative nurses (Table 2). Itmended that nurses obtain a baselinecose level for the patient. Patients widiabetes can demonstrate symptoms talert the perioperative nurse to the riglycemia or developing perioperativemia. These symptoms may include sofruity breath, itchy skin, and confusio

Some hospitals have instituted adming that includes an initial blood glucall patients, regardless of preexistingThe Agency for Healthcare Researchrecommends preoperative glycemic ssubsequent control measures dependifindings.20 A study by Gurkan and Wported maintaining preoperative glyc� 200 mg/dL. A protocol for periopecose management developed and inst

TABLE 2. Glycemic Control: Rec

Admission bloodglucose level

� 100 mg/dL � N100 mg/dL � 220 mg/dL � R

p� M� C

� 220 mg/dL � C� P

s

1. Committee on Perioperative Evaluation (CAPO), Bevaluation. Arq Bras Cardiol. 2007;89(6):e197-208. hOctober 16, 2011.

356 AORN Journal

l glu-c crisise-

eitheraverageed peri-e levels.

tionsom-

glu-knownould

hyper-rglyce-lence,

n test-evel forses.Qualitying and

the1 sup-levelse glu-

by the

Ohio State University Medical Cente

mends reviewing a preoperative HbA

was obtained within the past 30 days

is greater than 9%, the referring phys

tacted and consideration is given to p

nonemergent procedure until glucose

prove.22 In addition, the protocol rec

maintaining a target glucose level of

to 150 mg/dL intraoperatively.

When evaluating a patient’s bloo

level, it is important to know wheth

tient is taking any antidiabetic med

so, knowledge of the last dose, onset

duration of that medication can give

insight into the direction that the blo

level is likely to follow.

Identifying factors that can compo

hyperglycemia is an important part o

assessment, judgment, and perioperat

Corticosteroids, catecholamines, an

agents, and other medications incre

glucose levels. Furthermore, patient

central visceral obesity are particular

insulin resistance. The excessive adip

around the abdomen works as an end

and is an indication of dysfunctiona

metabolism that contributes to hype

Acute pain, blood loss, and lengthy

endations for the Perioperative Period1

Perioperative recommendations

cific preoperative measurescreatinine test results and a baseline electrocardiogram obtains 12 monthsr blood pressure closelyer referring the patient to an endocrinologist after surgeryer postponing nonemergent surgery until better glycemic contr

a blood glucose test at induction and consider insulin drip intlasts longer than 1 hour

ociety of Cardiology. Steps to reduce surgical risk. In: I guidelines for periopideline.gov/content.aspx?id�12237&search�perioperative�patient�care. A

omm

o speeviewreviouonitoonsidonsiderformurgery

razilian Sttp://gu

statement

t’s endocrineaintained atd fromvels.

PERIOPERATIVE HYPERGLYCEMIA www.aornjournal.org

TABLE 3. Nursing Care Plan for Preventing Perioperative Hyperglycemia

Diagnosis Nursing interventionsInterim outcome

statement Outcome

Risk of electrolyteimbalance

� Identifies baseline endocrine status byinterviewing the patient and reviewingthe medical record for a history ofendocrine disorders (eg, diabetes).

� Performs a diabetic assessment toinclude

� identifying types of diabetes (ie,type I, type II, gestational, diabetesof injury) and

� identifying means of diabetescontrol, such as

� diet,� exercise,� use of oral glycemic agents,

and� type of insulin taken if

applicable (ie, name, dose,route, date of last dose).

� Identifies physiological status.� Verifies presence of prosthetics or

corrective devices (eg, insulin pump).� Assesses baseline skin condition.� Reports deviation in diagnostic study

results (eg, blood glucose level,glycated hemoglobin).

� Communicates physiological healthstatus (eg, verbal reports, patientrecord) to appropriate team members.

� Collaborates with other health careproviders regarding diagnostic studyresults or assessment findings.

� Administers prescribed medications by� reviewing the medication

reconciliation sheet for currentmedications, medication allergyinteractions, contraindications, andmedication-medication or herbalsupplement-medicationinteractions;

� validating order as prescribed;� verifying the medication label;� anticipating the need for and

availability of equipment andsupplies based on the patient’sneeds (eg, insulin drip pump);

� selecting equipment and suppliesin an organized and timely manner;

� Laboratory values (eg, bloodglucose levels) are withinexpected ranges immediatelyafter surgery.

� The patienstatus is mor improvebaseline le

AORN Journal 357

sistan

sixthe comis tosion t). If tmg/dLff meese re

aboraol foith aod g

mic tergen

ry tw

ative blood

lin drip if

ose checksnts in the

g protocolse level of �

hing abouthyperglyce-hat would

n endocrinol-

and re-sk factor for4 However,

statement

March 2012 Vol 95 No 3 RUTAN—SOMMERS

procedures also can induce insulin rewell as decrease glucose disposal.6

RECOMMENDATIONSGlucose level is often considered thesign.24 The first step in preventing thtions of perioperative hyperglycemiaprove clinical assessment with admisof glucose level and HbA1c (Table 3tient’s blood glucose level is � 180nurse should consult with medical staPerioperative nurses should follow thmendations:

� Initiate and become part of a colleffort to develop a hospital protoccose control in surgical patients wwithout diabetes to maintain a blolevel of � 140 mg/dL.

� Collaborate to set a specific glyce� 80 mg/dL for scheduled nonemcal interventions.

� Perform blood glucose checks eve

TABLE 3. (continued) Nursing Ca

Diagnosis Nursing inte

� determining that afunctioning before

� performing patienusing at least two

� ensuring the seveadministration aremedication admin

� right patient,� right medicatio� right dose,� right route,� right time,� right reason, a� right documen

� Monitors physiologic� Evaluates endocrine� Reviews pertinent la

results (eg, serum gl

during surgery if surgery lasts longer t

358 AORN Journal

ce as

vitalplica-

im-estinghe pa-, thembers.com-

tiver glu-ndlucose

arget oft surgi-

o hours

hours and if the patient’s preoperglucose level was � 110 mg/dL.

� Be prepared to implement an insuneeded.

� Perform postoperative blood glucwith initial vital signs on all patiepostanesthesia care unit.

� Develop postoperative monitorinfor patients with a blood glucos180 mg/dL.

� At discharge, provide patient teacsigns and symptoms of increasedmia and infection or nonhealing trequire medical attention.

� Consider obtaining a referral to aogist if necessary.19

CONCLUSIONThere is a consensus among expertssearchers that hyperglycemia is a rinegative surgical outcomes.2,3,6,11,1

an for Preventing Perioperative Hyperglycemia

ionsInterim outcome

statement Outcome

ment is

ficationers;of solution

ed duringn:

meters..ry testlevels).

re Pl

rvent

ll equipuse;

t identiidentifin rightsfollow

istratio

n,

ndtation.al parastatus

boratoucose

han two experts disagree on target blood glucose levels

s of high blood

levels, if

edicine, if

igh bloodery?

.ay experience, and heart; in-r circulation;be prevented

0 days. Thenume-free soapor powder di-pletely healed.lood sugar.structed by your

by your doctor.

xperience any

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tp://www168/TAB�

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PERIOPERATIVE HYPERGLYCEMIA www.aornjournal.org

PATIENT EDUCATION

Perioperative HyperglycemiaOverviewHyperglycemia means the amount of glucose (sugar) inyour blood is too high. This may happen if your pancreasdoes not make enough insulin, which controls blood sugar.However, hyperglycemia can also happen if your body isstressed by illness, injury, or undergoing surgery. Hyper-glycemia can cause problems during surgery and can inter-fere with wound healing after surgery.

What are signs and symptoms of hyperglycemia?If you have hyperglycemia, you may have increased thirst,dry mouth, decreased appetite, fatigue, blurred vision, fruitybreath, itchy skin, nausea or vomiting, abdominal pain, fre-quent urination, or confusion.

How is hyperglycemia diagnosed?Your health care provider will test your blood.

What are my treatment options?Sometimes hyperglycemia can be treated by controlling theamount and type of food you eat, or you may need medi-cine to control your blood sugar. This medicine may betaken by mouth or may be given as a shot or through an IVdirectly into your blood.

What will the preoperative care include?

� Health care providers may ask you questions about signsand symptoms of hyperglycemia and any treatment youare currently using, such as eating a diabetic diet or tak-ing medicine for high blood sugar.

� A health care provider may draw blood to test your bloodsugar level or test your urine for ketones. Ketones are aby-product of the body using fat for energy instead of glu-cose when insulin is not present in sufficient quantities.

� You may need hyperglycemia medicine before surgery.

What happens during surgery?Health care providers will watch you closely for any symp-toms of hyperglycemia during surgery. They may drawyour blood and may give you hyperglycemia medicine ifyour blood sugar level gets too high.

What will postoperative care include?

� After surgery, you will be admitted to the recovery areaand monitored closely.

� A nurse may draw your blood to test your blood sugarlevel and may give you hyperglycemia medicine, ifneeded.

� Before you go home, a nurse will teach you and your

� about watching for signs and symptomsugar levels;

� how to test your blood for high sugarneeded; and

� how to give yourself hyperglycemia mneeded.

What are possible complications of hsugar levels during and after my surg

� Your wound may not heal well.� You may get an infection in your wound� If hyperglycemia is left untreated, you m

problems with your eyes, kidneys, nervesfections in your mouth, skin, or feet; poodiabetic coma; or even death. These mayby controlling your blood sugar level.

What happens after I go home?

� Eat healthy and stay active.� Keep the incisions dry for the first 7 to 1

wash your incisions daily with mild, perfand gently pat dry; do not put any lotionrectly on the incisions until they are com

� Watch for signs and symptoms of high b� Monitor your blood sugar and urine as in

doctor.� Take hyperglycemia medicine if ordered

Call your doctor immediately if you eof the following:

� shortness of breath or sudden dizziness o� increased redness, swelling, or drainage a

sites;� fever greater than 101° F (38.3° C) or ch� nausea or vomiting that is not relieved w� ongoing diarrhea;� blood glucose levels that are persistently

mg/dL with ketones in your urine;� trouble keeping your blood glucose withi

range.

ResourcesHyperglycemia in diabetes. Mayo Clinic. ht.mayoclinic.com/health/hyperglycemia/DS01indepth. Accessed October 19, 2011.

Hyperglycemia (high blood sugar). ProHhttp://www.prohealthcare.org/pdf/patient_edHyperglycemia%20-%20High%20Blood%2

designated support person 20R2009-09.pdf. Accessed October 19, 2011.

AORN Journal 359

entionealin

contric evatiention wa reincr

italstocoltrolical

moni

al. Tye to su

HC. Sstudy

06;24

n dene orga2008;

l on pn cardnce Nu

illanceuary 1. http:.pdf. A

etaboliive co-523.ernikessiveardiactudy..

sociati�WW

_comp

Berghe a rol

iaz JJ.Nutr C

Hyperglycemiarative hypergly-rtality after cor-betes Complica-

arlstrom L,after leg by-

s poor in pa-cohort study.

fer S, Chittockentional glucoseJ Med. 2009;

, et al. Poorassociated

r cardiac sur-gy. 2005;

hyperglycemial, cellular, and

05;33(7):1624-

nefits and risksadults: a meta-

DR, et al. Hy-bral aneurysmross neurologicClin Proc.

You X, Thalerdependentts with undiag-

b. 2002;87(3):

ve management/emedicine#showall. Ac-

(CAPO), Bra-duce surgical

valuation. Arq://guideline

erioperative�1.ion control: anurgery. Ortho-

videnced-based’s Guide toManagement.University

et al. Increasedue productionsurgery

nsulin resis-1(11):

h vital sign.

March 2012 Vol 95 No 3 RUTAN—SOMMERS

and duration and methods of intervachieve optimal patient safety and hvious trends toward tight glycemicbeen shown to produce hypoglycemthat generate unintended negative pcomes.13 Consequently, in combinaevidence that hyperglycemia can bedictor of surgical site infections andmorbidity and mortality, many hospproducing glucose management progeared toward a more moderate conRegardless, hyperglycemia is a surgthat demands attention and carefulby perioperative nurses.

References1. Schricker T, Gougeon R, Eberhart L, et

betes mellitus and the catabolic responsAnesthesiology. 2005;102(2):320-326.

2. Turina M, Miller FN, Tucker CF, Polkhyperglycemia in surgical patients and alated cellular mechanisms. Ann Surg. 20851.

3. Berkers J, Gunst J, Vanhorebeek I, VaG. Glycaemic control and perioperativtion. Best Pract Res Clin Anesthesiol.135-149.

4. Patel KL. Impact of tight glucose controtive infection rates and wound healing igery patients. J Wound Ostomy Contine35(4):397-404.

5. National Nosocomial Inspections SurveSystem Report, Data Summary from Janthrough June 2004, issued October 2004.cdc.gov/nhsn/PDFs/datastat/NNIS_2004December 2, 2011.

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CNOR,d RN firstarmel Sts Rutan

d be per-of interest

an assis-at Mountbus, OH.

iation thattentialon of this

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e accu-ng sur-

oxida-ons ofSurg Res.

Linda Rutan, MSN, RN, CNS-BC,CRNFA, is a clinical level 5 certifieassistant and staff nurse at Mount CAnne’s Hospital, Westerville, OH. Mhas no declared affiliation that coulceived as posing a potential conflictin the publication of this article.

Kathleen Sommers, EdD, RN, istant professor of graduate studiesCarmel College of Nursing, ColumDr Sommers has no declared affilcould be perceived as posing a poconflict of interest in the publicati

article.

AORN Journal 361

.1.aorn.org/CE

EXAMINATION

CONTINUING EDUCATION PROGRAM

2wwwHyperglycemia as a Risk Factor in

the Perioperative Patient

ioperative

ve

ur conve-e Exami-

PURPOSE/GOAL

To educate perioperative nurses about the risks of complication from perhyperglycemia in patients with and without a diagnosis of diabetes.

OBJECTIVES

1. Explain the causes of hyperglycemia.2. Discuss the effects of hyperglycemia.3. Identify symptoms of hyperglycemia.4. Describe interventions that nurses should consider to treat perioperati

hyperglycemia.

The Examination and Learner Evaluation are printed here for yonience. To receive continuing education credit, you must complete thnation and Learner Evaluation online at http://www.aorn.org/CE.

roceduemia etes me

y, wasadaptositive

cose

eral insulin-

ly responsestered meta-

se.

2, and 32, 3, 4, and 5

uses release ofas a result of

is.

nd 4

QUESTIONS

1. Individuals undergoing a surgical prisk for complications of hyperglycthe absence of a diagnosis of diabea. true b. false

2. Stress diabetes, or diabetes of injurmerly considered to be a beneficialsponse that promotes healing and perative outcomes.a. true b. false

3. Hyperglycemia1. causes abundant endogenous glu

production.

2. disrupts the inflammatory mechanism.

362 AORN Journal ● March 2012 Vol 95

re are atven inllitus.

for-ive re-

postop-

3. impairs glucose uptake in periphdependent tissues.

4. is the end product of many bodiand dysfunctions that result in albolic conditions.

5. mutes the innate immune respon

a. 4 and 5 b. 1,c. 1, 2, 3, and 4 d. 1,

4. Stimulation of the adrenal cortex cacortisol, which causes hyperglycemia

1. muscle proteolysis.2. glycogenolysis.3. excessive hepatic gluconeogenes4. enzymatic glycosylation.

a. 1 and 3 b. 2 a

c. 1, 2, and 3 d. 1, 2, 3, and 4

No 3 © AORN, Inc, 2012

feres wthat isa.

lucose

.ission

3, and2, 3, 4

operae dev

nd 42, 3, a

abdo

cellul

reas.

nd 42, 3, and 4

ioperative

ers if the pa-e level is

ery two hours’s preoperative

g/dL.ulin drip if

ose checksents in the

gns and symp-and infectionmedical

n endocrinolo-

4, and 6, 3, 4, 5, and 6

me to a con-emia is a risks.

linical editor,

have no de-

CE EXAMINATION www.aornjournal.org

5. Stimulation of catecholamines interfeedback mechanism and responsetended to help reduce hyperglycemia. true b. false

6. Studies have associated abnormal gwith1. increased lengths of hospital stay2. increased intensive care unit adm3. surgical site infections.4. neurological events.5. mortality.

a. 1 and 3 b. 2,c. 1, 2, 4, and 5 d. 1,

7. Symptoms that should alert the perinurse that the patient may have or bperioperative hyperglycemia include1. confusion.2. fruity breath.3. itchy skin.4. somnolence.

a. 1 and 3 b. 2 ac. 1, 2, and 4 d. 1,

8. Excessive adipose tissue around the1. contributes to hyperglycemia.2. is an indication of dysfunctional

metabolism.3. diverts blood flow from the panc

The behavioral objectives and examination fo

with consultation from Susan Bakewell, MS,

clared affiliations that could be perceived as posing

ith ain-

levels

s.

4, and 5

tiveeloping

nd 4

men

ar

4. works as an endocrine organ.a. 1 and 3 b. 2 ac. 1, 2, and 4 d. 1,

9. To prevent the complications of perhyperglycemia, nurses should1. consult with medical staff memb

tient’s preoperative blood glucos� 180 mg/dL.

2. perform blood glucose checks evduring surgery and if the patientblood glucose level was � 110 m

3. be prepared to implement an insneeded.

4. perform postoperative blood glucwith initial vital signs on all patipostanesthesia care unit.

5. provide patient teaching about sitoms of increased hyperglycemiaor nonhealing that would requireattention.

6. consider obtaining a referral to agist if necessary.a. 1, 3, and 5 b. 2,c. 2, 3, 5, and 6 d. 1, 2

10. Experts and researchers have not cosensus regarding whether hyperglycfactor for negative surgical outcomea. true b. false

program were prepared by Rebecca Holm, MSN, RN, CNOR, c

, director, Perioperative Education. Ms Holm and Ms Bakewell

r this

RN-BC

potential conflicts of interest in the publication of this article.

AORN Journal 363

.1.aorn.org/CE

LEARNER EVALUATION

CONTINUING EDUCATION PROGRAM

2wwwHyperglycemia as a Risk Factor in

the Perioperative Patiente therograms as d

tives o

.

.

.

ould.

ase yo

l objec

tion fr

result ofr question

e? (Select all

team regard-

to change/ure.

eeting withand acceptance

valuate theintervals untilest practice.

e as a resultt all that

t relevant to

teach othersd change.port to make

we verifyhe 2.1 con-6-minute)

This evaluation is used to determinwhich this continuing education pyour learning needs. Rate the item

below.

OBJECTIVES

To what extent were the following objeccontinuing education program achieved?

1. Explain the causes of hyperglycemiaLow 1. 2. 3. 4. 5. High

2. Discuss the effects of hyperglycemiaLow 1. 2. 3. 4. 5. High

3. Identify symptoms of hyperglycemiaLow 1. 2. 3. 4. 5. High

4. Describe interventions that nurses shto treat perioperative hyperglycemiaLow 1. 2. 3. 4. 5. High

CONTENT

5. To what extent did this article increknowledge of the subject matter?Low 1. 2. 3. 4. 5. High

6. To what extent were your individuamet? Low 1. 2. 3. 4. 5. High

7. Will you be able to use the informaarticle in your work setting?

applicant who successfully completes this program

364 AORN Journal ● March 2012 Vol 95

extent tomet

escribed

f this

consider

ur

tives

om this

8. Will you change your practice as areading this article? (If yes, answe#8A. If no, answer question #8B.)

8A. How will you change your practicthat apply)1. I will provide education to my

ing why change is needed.2. I will work with management

implement a policy and proced3. I will plan an informational m

physicians to seek their inputof the need for change.

4. I will implement change and eeffect of the change at regularthe change is incorporated as b

5. Other:8B. If you will not change your practic

of reading this article, why? (Selecapply)1. The content of the article is no

my practice.2. I do not have enough time to

about the purpose of the neede3. I do not have management sup

a change.4. Other:

9. Our accrediting body requires thatthe time you needed to complete ttinuing education contact hour (12

dentialing Center

eptance of this

ers. Each

1. Yes 2. No program:

This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.

AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

AORN recognizes these activities as continuing education for registered nurses. This recognition does not imply that AORN or the American Nurses Creapproves or endorses products mentioned in the activity.

AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check with your state board of nursing for accactivity for relicensure.

Event: #12509 Session: #0001; Fee: Members $10.50, Nonmembers $21

The deadline for this program is March 31, 2015.

A score of 70% correct on the examination is required for credit. Participants receive feedback on incorrect answ

can immediately print a certificate of completion.

No 3 © AORN, Inc, 2012