[Sue7573]

Ok I am not a nurse yet. I actually start my nursing program in the fall. I worked this weekend with a nurse that has been working as a nurse for more than 11 years. She went about 5:00 am to get her blood sugars. I think she had ten of them to get. She gets her last one, and before the timer ends she comes to the desk where I was charting and was talking to us. When the test finished she said OMG Mrs. _________ bs is 14. I said are you sure. She practically screams at me I have already done 9 of them and they were all right. So I go down to the residents room (she was on my hall that night and I knew she was ok). Correct me if I am wrong but wouldn't a BS of 14 mean coma or next to death? Any way the nurse gathers up all the supplies (lab supplies). I am in the residents room and when the nurse comes in Mrs. _________and I are talking to each other. I asked the nurse if she might would want to check the BS again just to make sure that it wasn't a faulty strip or something again the nurse says to me "Sue I have done ten of these already and all of them were ok." I said ok that may be true but wouldn't there be other signs and symptoms if her BS was that low. SO she turns to the pt. and says to her while she is pulling out the stuff to draw her blood and says "Honey your BS is 14 and we are going to have to draw blood to send to the lab" and then she says to the resident I am going to have to shoot your veins with sugar water. OMG I about died. Again and this time so the resident could hear me, I say shouldn't you check it again just to be sure. The nurse gets all huffy and says "I will but I will have to send labs out" Now I don't know all there is to the bs thing. But I do know that I would check it again before I drew blood or "shoot her veins" with sugar water of which I have never heard of doing. I don't know if the nurse was just saying that or if it is a new procedure. So she tries first to "milk" more blood out of the first finger stick from at least 10 min ago and she can't get any more blood. So she goes to her other hand gets the blood and now the BS is 207. Still not admitting that the 14 was a wrong read she turns to me and seriously said I have never seen that much of a difference between Left hand and right hand. The resident is very alert and knows what all we are talking about. So when the nurse tells her that her BS is 14 and is preparing to draw blood the residents eyes are as big as saucers and looks to me for I guess an explanation. I don't know what to say or do. I know that if she had of insisted on doing anything before she checked the sugar again I would have called our supervisor or DON or something.

What would have any of you done in the same situation? Would you automatically assume the BS was correct and follow protocol or would you retest to make sure? AND WHAT DOES SHOOT YOUR VEINS WITH SUGAR WATER MEAN?

Sue

[Mulan]

I would have rechecked it under the circumstances.

Our protocol is to give an amp of D50 IV for a blood sugar less than 50.

[RNlove2fly]

Originally Posted by Sue7573

What would have any of you done in the same situation? Would you automatically assume the BS was correct and follow protocol or would you retest to make sure? AND WHAT DOES SHOOT YOUR VEINS WITH SUGAR WATER MEAN?

Sue

Sounds like you're off to a good start. Yes, when ever you have a number that is way out of whack look at how the patient is presenting first. I have seen a few patients out in the field with BG's in the 30's that are still not too bad off, but generally acting at least a little loopy. Usually, however, a BG<30 means the pt is unconscious or close to it. Personally, I would have rechecked it if the patient didn't act like someone with a BG of 14.

Sugar water is basically the cure for low blood sugar...as the post before said, it's D50W (50% dextrose in water). A large bore IV must be started, preferably nothing smaller than an 18 gauge (because it is very thick and syrupy), and as long as it's a good IV (not leaking out of the vein into the tissues) D50W won't hurt anyone even if they don't need it...it'll just make their blood glucose a little higher. So, if she had gone ahead and given it, the patient probably just would have needed a little more insulin the next time around.

Your good critical thinking skills will be an asset for you when you start your nursing career.

[FROGGYLEGS]

[

I work in LTC.
Our policy is IM glucagon if BG is less than 60 and symptomatic
OJ and sugar if less than 60 and asymptomatic
Recheck BG within the hour and notify MD.

We check the glucometers on nights to make sure they are working okay.
I've still had some strange readouts, but you recheck and assess.

I always recheck any BG that is too high or too low. I recheck if it doesn't appear normal for the resident whether it is extremely high or low or not.

If I got a 14 from someone who was coherant I would definitely think something was off. The lowest I've had was probably high 20's and the patient most definitely had sx.

I'm not sure what all the stat lab work would be for unless she called the MD and they requested it, but surely they'd want to work on the hypoglycemia first.

I've never heard the phrase "shoot you veins with sugar water". My guess is that would be IV dextrose.

[Bird2]

The last time I saw a glucoscan of 14 the resident was unconscious and having a seizure.

[Tweety]

People with capillary blood glucoses of 14 are symptomatic one way or another. Usually they are loosing consciousness or at least they begin to have a change in consciousness, or at the very least diaphoretic, shakey, etc. I have seen people with very low bood glucoses be alert, but the are symptomatic in another way. The lack of symptoms should have been clue #1 to this profressional.

I always recheck glucose sticks if the reading is way out of wack, and requires intervention. I do the same with blood pressures, and any threatment that requires giving a med, because once you give it, you can't take it back.


"Shoot your veins with sugar water" is cute.

[Spidey's mom]

"Shoot your veins with sugar water" makes me think of all the elderly people who come in and say "I have sugar diabetes".

I'd check my patient first for syptoms and then recheck my blood sugar.

steph

[chris_at_lucas_RN]

1) When the lab value and the patient's obvious condition are inconsistent, always redo the test.

2) "Milking" more blood from a stick means breaking capillaries and cell walls, which releases more glucose into the blood and will give a false reading. The drop of blood should be obtained as gently as possible. Better to use a little gravity and a warm moist towel to get the periphery relaxed and dilated.

3) Your critical thinking is excellent--and you are just a student. You are in the right field. We're always glad to see students like you.

4) The nurse you observed behaved unprofessionally in several areas. This was no call for panic. She should have realized there was something wrong with the lab value if the patient was asymptomatic. Using a phrase like "shoot your veins with sugar water" is condescending and, frankly, makes the nurse sound stupid. The patient probably could have managed an appropriate explanation, along with a rationale. We often call this "patient education."

5) Sometimes we learn how not to be by watching those meant to teach us how to be.

<sheesh!>

Originally Posted by Sue7573

Ok I am not a nurse yet. I actually start my nursing program in the fall. I worked this weekend with a nurse that has been working as a nurse for more than 11 years. She went about 5:00 am to get her blood sugars. I think she had ten of them to get. She gets her last one, and before the timer ends she comes to the desk where I was charting and was talking to us. When the test finished she said OMG Mrs. _________ bs is 14. I said are you sure. She practically screams at me I have already done 9 of them and they were all right. So I go down to the residents room (she was on my hall that night and I knew she was ok). Correct me if I am wrong but wouldn't a BS of 14 mean coma or next to death? Any way the nurse gathers up all the supplies (lab supplies). I am in the residents room and when the nurse comes in Mrs. _________and I are talking to each other. I asked the nurse if she might would want to check the BS again just to make sure that it wasn't a faulty strip or something again the nurse says to me "Sue I have done ten of these already and all of them were ok." I said ok that may be true but wouldn't there be other signs and symptoms if her BS was that low. SO she turns to the pt. and says to her while she is pulling out the stuff to draw her blood and says "Honey your BS is 14 and we are going to have to draw blood to send to the lab" and then she says to the resident I am going to have to shoot your veins with sugar water. OMG I about died. Again and this time so the resident could hear me, I say shouldn't you check it again just to be sure. The nurse gets all huffy and says "I will but I will have to send labs out" Now I don't know all there is to the bs thing. But I do know that I would check it again before I drew blood or "shoot her veins" with sugar water of which I have never heard of doing. I don't know if the nurse was just saying that or if it is a new procedure. So she tries first to "milk" more blood out of the first finger stick from at least 10 min ago and she can't get any more blood. So she goes to her other hand gets the blood and now the BS is 207. Still not admitting that the 14 was a wrong read she turns to me and seriously said I have never seen that much of a difference between Left hand and right hand. The resident is very alert and knows what all we are talking about. So when the nurse tells her that her BS is 14 and is preparing to draw blood the residents eyes are as big as saucers and looks to me for I guess an explanation. I don't know what to say or do. I know that if she had of insisted on doing anything before she checked the sugar again I would have called our supervisor or DON or something.

What would have any of you done in the same situation? Would you automatically assume the BS was correct and follow protocol or would you retest to make sure? AND WHAT DOES SHOOT YOUR VEINS WITH SUGAR WATER MEAN?

Sue

[meownsmile]

Absolutely recheck. A patient with 14 would have to have some symptoms, diaphoresis, confusion. Stat amp of dextrose would be in order along with the call to the dr.
Although we were taught that giving milk is better than giving OJ and sugar for raising blood sugar. It raises more evenly and sustains levels longer than OJ and sugar.

[stidget99]

My guess is that the nurse probably did the accu check wrong giving her a false low. Often times, if you don't get a good enough blood sample on the strip (i.e. not filling the strip fully w/ blood) you can get a false low reading.

I concur w/ the others...if the pt is asymptomatic, definitely recheck before pushing an amp of D50.