Would you have given the meds??

Lol....Cant win for losing here. I see his point as to why hes mad he wasn't notified for the critical sugar. He should have been the one to make the decision to hold the meds or not before the next morning. But.....The previous nurse should be getting crap for that not you.

That blood sugar of 39 should've been addressed STAT and with D50. I'd be afraid she would be passing out as I give her the OJ/crackers to drink.

At the same time I'm giving D50--my resource is calling that doctor stat.

Edit to Add: You should look into your hospital policy for hypoglycemia (emergency one). You need to have that at all times on you.

[quote=kanzi monkey;3903885]I would have talked to the MD about the previous FS of 39 in case s/he wanted to adjust the meds or investigate why the pt got so low.

This is what I would do next. I would hold everything because you can always fix the increasing blood sugar with the "giving" of meds (IV insulin works quick) rather than taking back something P.O. that stays in the system for the whole day.

I would've start working backwards as to why the patient's blood sugar dropped and go from there. As for the other nurse, I would've asked all of these already because the doctor is going to ask the same thing. And when I get the call from the doctor, I would want to make sure he does his rounds with this patient first. (or send his NP).

Next, I'd be writing an incident report to investigate the process as to what occurred and why. NOT as punitive for the nurses, but to check the processes that led to this incident.

One more thing, if you know something is a critical lab value and you ASSUME that it needs to be called (prudent nurse) you should follow up with a phone call to the M.D.--regardless of whether or not the previous nurse has contacted him already. If this were to ever go to trial, a lawyer could ask you specifically, "what would a prudent nurse have done?" CALL THE DOCTOR.

Never, never, never, never, never, never ASSUME something can be given until the ENTIRE situation has been assessed and re-assessed. DO NOT give any drugs until another perspective (especially the physician who probably knows this patient well) has been notified and you both banter over the next avenue.

Those are actions of a prudent nurse.

I think it's fair to assume that the previous nurse acted as a prudent nurse and notified the MD of the low CBG. ***HOWEVER***What I learned in my days as a floor nurse was to NEVER assume that the previous nurse notified the MD of anything. If I did not see any mention of MD notification of a critical lab value in the previous nurse's charting, then I would notify them myself. I have come onto shift at 1500 one too many times to find a K+ of 3 from 0600 that was never followed up on by the previous nurse to just assume anything. Next time, specifically ask the nurse if the MD was notified. If not, then do it, and write an incident report.

Oh, and yes, I would have given the meds. You are being thrown under the bus.

I'd have given the PO meds. The 70/30, not sure on. I so rarely give 70/30 (our population mostly gets lantus and humalog), that I'm really not sure what I would have done. Humalog works so quick and lantus is so "long" that it's a much easier decision than 70/30. Either way, you keep an eye on them so whichever way that blood sugar decides to go, you can fix it. Sounds like that was done, and monitoring is the most important part.
Blood sugars are always a rock and a hard place, and of course, whatever it does is the nurse's fault, because it couldn't possibly be that the patient's sugars are out of control for whatever reason they're in the hospital!

If the patient is a Type 1 diabetic, then insulin should never be held. If they're Type 2, they may have some ability to make their own insulin. Actually, in the OPs pt, if they are at a stage that they are requiring insulin, it's not likely that the PO meds are having much effect anymore.

So...you probably learned something from this experience....I know I did...specifically this - that doc is a jerk and you don't have to deal with him anymore....YAY!
You got the crappy end of this stick, were likely embarrassed in front of peers, and you deserve better. I would write this incident up and make sure that my superiors are aware of the inappropriate behavior of the MD. You, after all, are not his hand maiden, not his anger management therapist, and not his employee. Seems to me as if the entire situation would have been avoided had that doc actually addressed the anticipated glucose instability of an acutely ill, hospitalized diabetic in his orders....oh my gosh...did I actually just suggest that maybe the doc was to blame for the entire scenario???? There are arrogant and inappropriate docs in all specialties (nurses too), stay in nursing long enough and you will meet quite a number of them.

I have yet to see a diabetic labeled as Type I or Type II. I was wondering that recently about one of my patients and was unable to find the answer, even the patient didnt know and couldn't tell me when they were diagnosed. Histories only report NIDDM or IDDM which still doesnt identify the types. Still think the OP did the right thing.