A new nurse feeling confident :)

Published

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.

Today was a job well done. I AM a nurse. :D

Up Vote Up Vote ×
Specializes in LTC, Medical, Telemetry.

Great job! It is an awesome feeling when everything falls into place, especially the very first time you act as a nurse and solve a problem. Or even just identifying a problem (and being right) is an awesome feeling!

Believe me, it only gets better :D

Up Vote Up Vote ×

Great job! It seems that you really are born to be a nurse!

Up Vote Up Vote ×

After reading so many "I hate being a nurse" threads, this made my morning!

Up Vote Up Vote ×
Specializes in geriatrics.

Great! Milk also works if you don't have juice on hand (provided they aren't lactose intolerant).

Up Vote Up Vote ×
Specializes in 1st year Critical Care RN, not CCRN cert.

Excellent post! On our floor we wait until the trays hit the floor then give coverage. You just never know when the crazy kitchen will get the trays to us. Still can't make the people eat but I sure do encourage if I'm giving novalog or other quick acting insulin. I too am a brand new nurse and it's a great job! Working in the pcu allows for a higher level of autonomy that is really great! If a pt has low K+, order the K+ protocol and run with it, same with other protocols.

Up Vote Up Vote ×
Specializes in Operating Room, LTAC.

Great job Nurse! :-)

Up Vote Up Vote ×

Good for you!! I am happy to hear you are confident as a new RN :)

Up Vote Up Vote ×
Specializes in Med Surg.

Isn't that a great feeling! I had something similar a couple of weeks ago (including the hypoglycemia). I just did everything I needed to do automatically. It felt like I had arrived as a nurse. :) Congrats!!

Up Vote Up Vote ×
Specializes in Psych, LTC/SNF, Rehab, Corrections.

Why was I reading the story at the edge of my seat? I was in suspense....

"...and THEN?" LOL

I'm glad that you worked calmly through the situation. That training sure kicked in.

Our meals are always comes late for some reason, too. Can't explain the trend.

I've a little lady with no 'awareness'. Her B/S could be haywire and she'll be walking about perfectly normal. When I learned of her condition? That night, I went home and reviewed my DM chapter.

LOL

Up Vote Up Vote ×

Congrats!!! While im reading this i felt like watching a suspense movie:) lol Thanks for sharing your experience:) im hoping to start a job in an ltc facility soon. How have you been with a preceptor? Any advise you can share with me?

Up Vote Up Vote ×
Specializes in Ambulatory Surgery, Ophthalmology, Tele.

Great job. :) And good for you for celebrating your accomplishments. As new nurses I think we tend to notice our short comings but not our positives. A seasoned nurse showed me a trick of mixing a few sugar packets in the juice too. ;) Also offering the patient a protein and carb is good (string cheese, peanut butter and graham crackers) as the juice will give a quick rise but blood sugar can drop quickly again. The protein will help it stay up longer. Again, good job. :up:

Up Vote Up Vote ×
+ Join the Discussion