Had a patient today who is a "frequent flyer" in our hospital. She is 27 years old and have MANY health problems. She is a very brittle type 1 diabetic and her glucose can go from 490 to 33 within an hour.She is on a continuous Dilaudid drip and last night was given an ambien for sleep.Most of the morning she was very drowsy, and non-verbal. She was NPO for a test (CT scan of abdomen i think), and right after she was given the barium she started to seize. They brought her back upstairs and as she was seizing she turned completely gray and her resps were labored. We checked her glucose and it was a critical low... meaning the lab had to come and confirm. At that point we were just about to give D50 when the charge nurse said "wait we want the Lab to draw first for an acurrate reading."
Why would you wait when the pt was NPO,and was having very obvious s/s of hypoglycemia? We did end up giving it first, and then the pt aroused a bit. Later that day she seized again, and this time her FSBS was WNL. We ended up calling a code, stabilizing her and then sending her to the unit.
I guess I just feel things werent done quickly enough. When she was unresponsive this morning something should of been done, and then after the seizure activity the doc should of ordered something... Any insights?
i'm thinking a reaction to the barium/contrast media...
which i thought was contraindicated (or used very cautiously) for those with dm, specifically diabetic nephropathy or renal impairment.
that would be my guess.
leslie
We don't give it if their serum Cr. is elevated. If it's WNL and they're on oral meds (glucophage in particular), they are instructed not to take their glucophage for several hours, b/c combined with the contrast it does have the potential to damage the kidneys.
And I'd be going over that nurses head and reporting that. It's not good decision making, and shows poor critical thinking skills.
OP, you were right about giving the D50 right away. I would have done the same thing.
Your question about something being done when the pt was unresponsive in the morning is a bit harder to answer.
First you said she was drowsy, then later you said she was unresponsive in the morning. A couple of questions come to mind.
How old is she and why is she in the hospital?
Why the dilaudid drip?
What's her baseline level of consciousness and mental status?
Was she on routine fingersticks and what was it that morning?
So which was it: drowsy or unresponsive?
What were the other assessment findings?
Any co-existing medical issues that could be in play here?
Depending on the answers to these, I could do anything from watch and wait to a full-tilt-boogie rapid response call.
I agree that after the first seizure episode, there should have been orders for at least some ativan to control active seizures while they figured out why she seized in the first place.
Very interesting situation ... thank you.
this admission diagnosis was DKA. She has ESRD and has dialysis three times weekly.Her baseline mental status is completely coherent. A/Ox3. At first she was very groggy, but would answer yes and no. Which then advanced to no response except eye rolling, and then to seizure activity. Earlier in the morning the FSBS was WNL. When she continued to be groggy it was tested again with a reading of critical low. The odd thing to me is that when her s/s were the worst (during the grand mal seizure, and when her resps were so poor) her FSBS was 109. I guess that is what I really dont understand. She wasnt my pt. but i was helping out on the floor doing admissions, and when she went bad I stepped in. I really dont know why she wasnt sent to the unit. Especially since the last time this happened she did CODE. IN the MD notes today he stated it was a Hypoglycemic attack. Today she was transferred back to the floor. Stable of course.
And for the dilaudid drip she has a chronic bowel disorder (NOT crohns, or IBS.. some mal absorption issue causing chronic diarrhea.) She is on the drip at home and also gives herself phenergan IV. I just dont think giving the ambien with all that narc on board already. But what do I know!
Its one thing for the patient to be barely alert and hypoglycemic and another thing when the meter reads low and the patient is alert. Just use this as reference if you happen upon this situation again. If the meter reads critically low and the patient is not alert and you've checked two glucose checks on a meter that both are low, go ahead and give the D50. You're hospital should have some sort of protocol in regards to hypoglycemia. Remember, it's your license, not that charge nurse's who I'm sure wouldn't back you up if say the patient died as a result of hypoglycemia.
I have had other nurses tell me to wait to give OJ on a diabetic patient who is clammy and cool. Wait to see what the BS is. I don't care what it is. I know she isn't looking at me and she is not speaking. I also know when this happened to the same patient last week we gave the juice and by the time lab got up her she was still at 50. SO I am giving the frigging juice!
Aneroo, LPN
1,518 Posts
We don't give it if their serum Cr. is elevated. If it's WNL and they're on oral meds (glucophage in particular), they are instructed not to take their glucophage for several hours, b/c combined with the contrast it does have the potential to damage the kidneys.
And I'd be going over that nurses head and reporting that. It's not good decision making, and shows poor critical thinking skills.