I am a new Nurse, first job in a Nursing home. We just had a meeting about INTERACT and trying to avoid sending patients to ER when not necessary...
last night had a patient who is a diabetic, blood sugar before dinner was 77, gave her 30 grams of Carbs, blood sugar up to 130...she was a little sleepy but not not lethargic. The med nurse held off on her insulin (22 units of NPH) she ate a little of her dinner, started to become more lethargic, I took her vitals, temp did a quick assessment. she was responding to verbal commands but very sleepy and lethargic. I called the MD ( who is always very impatient with me cause I'm new) and reported her condition. He ordered only half of her insuline dose to be given. I mentioned to him that she was becoming lethargic and not herself. He snapped at me that her sugar wasn't low enough to cause these symptoms. Then I mentioned to him that she usually runs around 200-250 so that is low for her. Then he snaps "well then send her out if you want"
later I learned that my DON isn't too happy that I sent her out and that I should have made suggestions to the MD first. Like What? I'm not too confindent yet on making these decisions, I thought best to be safe than sorry.
What other assessments could I have made? or could I have requested what type of lab tests? Any suggestions or comments on this situation would be appreciated.
The worst place for an old person to be is in the hospital. The ambulance ride there is traumatic, the staff doesn't know them as well as you do. If they are a bit confused they become moreso. That's why we should all try to treat them in the facility.That being said, there are times when it is prudent to send someone out. It's important to trust your instintcts. You will learn as you get more experience what you can and can't treat in your facility.A good idea is to read the hospital summary. Did they do anything there that you couldn't have done?
Last edit by CapeCodMermaid on Jan 27, '12
: Reason: Typo