After a postoperative admission, a client with type 2 diabetes mellitus has a blood glucose level of 750 mg/dL. Which assessment should be the priority?

• A. Assess for signs of fluid volume deficit
• B. Monitor for signs of congestive heart failure
• C. Check for insulin administration errors
• D. Assess for active infection

Answer: (A)

The main concept is that severe hyperglycemia often causes osmotic diuresis, leading to fluid volume deficit. In a postoperative patient, this dehydration can quickly compromise perfusion, electrolyte balance, and wound healing, making fluid status the most immediate concern.

A blood glucose of 750 mg/dL signals a dangerous level where the body is losing fluids through the kidneys. The priority assessment is to evaluate signs of fluid volume deficit—check vital signs for tachycardia or hypotension, assess mucous membranes and skin turgor, look at capillary refill, monitor intake and output, and note any decreased urine output. These findings guide urgent fluid management and stabilization.

While other issues like infection, potential insulin administration errors, or congestive heart failure are important in diabetes care, they do not take precedence over confirming and addressing dehydration in this acute scenario.