[gingersdad]

Hey there folks I need some help on how to handle an issue I had today with a CNA. A resident in my care had a FSBS of 46, was clammy, lethargic, and had that "far away" look we are so familiar with. I immediately gave her 15g of Glutose15 and followed with an Ensure ~10min later. I left the room to attend other duties but a CNA stayed to keep the resident awake and alert. After I left the room ANOTHER CNA came into the room and administered 240cc of OJ loaded w/ 3 packets of sugar. The FSBS came up OK but I have an issue with the CNA giving the OJ+sugar w/o me knowing about it. I informed my manager and the DON about the situation but am wondering how hard I should be about the action of the CNA. I'm a male nurse and I try to tread lightly but keep my license. FYI: The resident did not "yoyo" on her blood sugars.
gingersdad

[Miami NightNurse]

I would want my CNA to give juice and sugar instead of waiting for me. As a diabetic I would want anyone to give me sugar if I was low-it's a horrible feeling I wouldn't want to wait for an RN to approve me having juice. I think you had a good CNA and should appreciate them taking initiative(sp?)

[raykelnickicola]

I would be less concerned with the actions of the CNA than the reason this patient's BG dropped that low in the first place.

I would also want to keep checking her BGs periodically to make sure they didn't drop again. Maybe her meds need to be adjusted. Maybe she could have received someone else's long acting insulin? (Just throwing it out there because I've seen it happen before)

[gingersdad]

I get the message. We think she missed the noon meal, not sure because she has a bit of dementia. The FSBS was 236+4 hours later and the resident was feeling much better. Thank you for the "straight up" answer.
gingersdad

[morte]

did the CNa know that the matter had been addressed, if so, yes I would be upset.....and the juice wth sugar is no longer the usual mode of treatment...a modest amount of sugar and than protein, which is what you did...is the current thinking......i think the big thing here is if the Cna knowingly "went behind your back".....

[BlueRidgeHomeRN]

Originally Posted by morte

did the CNa know that the matter had been addressed, if so, yes I would be upset.....and the juice wth sugar is no longer the usual mode of treatment...a modest amount of sugar and than protein, which is what you did...is the current thinking......i think the big thing here is if the Cna knowingly "went behind your back".....

Yep--I can see how you'd feel as if the CNA had overstepped her bounds--but the big picture question is...is this a CNA who backstabs and oversteps a lot, or a fairly good one doing the best she could with her limited knowlege?

After all, OJ is not a med per se.....

Think it over, and as said, figure out why it happened and how to prevent in the future. IMHO, I'd rather have a BS of 250 than 25!

[PsychRN03]

I'm not an endocrinologist or dietician, but since you gave something that should help give a quick boost to the blood glucose, wouldn't it have been better for the CNA to give something that might help sustain the glucose (e.g., milk, peanut butter) rather than give a quick pop, then possible crash, because, although your resident didn't "'yoyo'", isn't that a valid concern when you load the pt. up with simple carbs?

and like others have said, prevention is the best way to go

[rn/writer]

Was the first CNA still with the resident when the second one came along and gave the OJ/sugar combo? If yes, did CNA#1 tell CNA#2 what you had already done?

How did the second CNA know the blood sugar was low? If she found out from the first CNA, why was your treatment either not conveyed or not considered sufficient? Did she do another blood sugar before giving the juice?

Did the second CNA come tell you what she had done?

Does your facility have a policy and procedure in place to address low blood sugars, and, if so, did the CNA follow it?

I'd be concerned that either there is poor communication and CNA#2 didn't know that the hypoglycemia had already been addressed, or that CNA#2 was informed about the treatment but went ahead anyway with what amounted to a second treatment.

Glutose followed by Ensure 10 min. later should have gotten the blood sugar headed back in the right direction. If CNA#2 had been told about these things and was still concerned, at the very least, she should have done another finger stick before giving anything further. If she didn't know measures had been taken (CNA#1 was still with the patient and didn't tell #2), on what did she base her actions?

There is something amiss in this situation. You are right to be concerned.

[michelle126]

I think RN Writer hit the nail on the head.

[chadash]

I am completely confused!
You dealt with the low blood sugar, left the room, and then the CNA came in and gave somethiing in addition to elevate the blood sugar?
I am a CNA, and if I get a low blood sugar, I go to the nurse and follow their instructions. Even if I know how to respond, I would ask the nurse "would you want me to ....whatever?"
I am very concerned with the actions of this NA.
First, she decided how to treat a problem. Out of scope...
Second, even if she had the permission to treat this type of probem, she should have consulted with the nurse to make sure she was not duplicating his action.
I don't want to diminish the role of nursing assistants, I just feel that ignorance is a dangerous thing. I report and then follow through with actions based on the nurses assessments. I have no education to equip me to determine what actions to take. There are more variables involve than can be seen on the surface sometimes.
so, simply put, if I get a reading that low, I run to the nurses station, arms flailing, oH MY GOSH, whatever should I do?
then the nurse figures it out.
Tell me, would I drive you crazy, or would you rather I just mix OJ and sugar?