A patient with Type 2 Diabetes has been diagnosed with Hyperglycemic Hyperosmolar Syndrome (HHS). The patient's spouse asks the RN which symptoms characterize this disorder. Which are the most appropriate responses by the RN? Select all that apply.

A. Slow heart rate: HHS usually triggers a compensatory tachycardia as the body attempts to maintain cardiac output in the face of severe dehydration and hyperosmolarity. A slow heart rate is not consistent with the physiological response seen in this disorder and could indicate another underlying issue. B. Elevated blood glucose: Marked hyperglycemia, often exceeding 600 mg/dL, is a hallmark of HHS caused by insufficient insulin action and increased hepatic glucose production. This severe elevation in blood glucose contributes to the osmotic diuresis and fluid loss characteristic of the syndrome. C. Taut, dry skin: Dehydration due to excessive osmotic diuresis results in decreased skin turgor, making the skin appear taut and dry. These changes reflect significant fluid volume deficits that require prompt correction to prevent complications such as shock. D. Decreased osmolality: Osmolality in HHS is elevated due to high serum glucose pulling water from cells into the extracellular space, increasing plasma concentration. A decreased osmolality would suggest overhydration or other metabolic disturbances, which do not align with the pathophysiology of HHS. E. Elevated BUN and creatinine: The dehydration and hypovolemia in HHS reduce renal perfusion, leading to prerenal azotemia characterized by elevated BUN and creatinine levels. These markers indicate impaired kidney function secondary to volume depletion and must be closely monitored.