A resident with hypoglycemia and I did all the right things!
This is for the other new nurses out there who are worried they won't respond appropriately to an emergency. Because even when you think you're "just an LTC nurse", you really do remember what they taught you in school. :)
So this is no major story, because my days in LTC are generally not all that exciting. lol. But this particular situation was a first for me.
My resident, a 93 year old woman with type 2 diabetes, has a FSBS of 90. In the MAR, it says to give her no sliding scale coverage for a FSBS between 61 and 149, but to give a preprandial (before meals) dose of 4 units fast acting insulin. I felt a slight discomfort giving the insulin, because she normal runs a bit high, but the order said to give it and dinner was only an 30 minutes away, so I did.
Dinner came a little late, which is not unusual. When the trays were finally served, one of my assistants comes to me and tells me that she is not eating and is really sweaty. Immediately, I know whats wrong. I went in and asked the CNA to go get her a glass of OJ and I checked her blood sugar again. It was 40. I didn't panic, like I thought I would. I was calm and collected and just thought about what to do next.
When the OJ came, she was able to drink some of it, so I left it with my assistant and asked her to stay with her and make sure she keeps drinking it. I went to the nurses station and looked in the MAR for parameters, do I call the doc? Should I give her a glucose tablet? It didn't say. I went to the standing orders for hypoglycemia, that didn't say either.. So I looked in the cart for a glucose tab, couldn't find one anywhere. Of course there wouldn't be any when I need them.. I went back and she had drank all of the juice. Phew, this is a good sign!
I checked her sugar again, it was 44. Still low, but it IS rising. I got her another drink with sugar in it and encouraged her to keep drinking it. I checked her sugar 30 minutes later, again 30 minutes later and it was slowly going up. by 2 hours after the start of the event, she was up to 75. That's when I felt like she would be fine and I had done the right thing. A very good feeling! :)
I called my DON and informed the MD and they both said to continue with what I was doing, checking it often and to let the next shift know to hold preprandial doses until she is eating well again and continue only with the sliding scale.
