Need help with prioritization

Published

Who would you see first?

1.) Pt with a blood sugar of less than 50

2.) Pt with a blood sugar of more than 350

3.) Diabetic pt who just got out of surgery (got his toe amputated)

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Specializes in Medical and general practice now LTC.

which one do you think

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Always patient number one.

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The signs and symptoms of hypoglycemia are: diaphoresis, cold and clammy skin, weakness, nausea, mental confusion, personality changes, altered level of consciousness, headache, anxiety, tremor, and slurred speech.

Greater than 350 means diabetic ketoacidosis. The signs and symptoms of DKA are: kussmauls respiration, flushed appearance, thirst, polyuria, drowsiness, anorexia, vomiting, may lead to shock and coma.

Ok, based on those findings, i think pt number 2 because the worst thing that could happen with a pt with DKA is shock and coma.

Can someone confirm this with their own rationale?

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Greater than 600 means hyperosmolar hyperglycemic state which is highly fatal but this is not the case.

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I'm pretty sure it is patient number 1. Hypoglycemia is always the biggest concern with people, and a lot of people can handle higher levels of blood sugar much better than lower. They always tell us that if we see a diabetic patient passed out or not responding, always assume it's hypoglycemia.

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Would it help you to know that if someone is found down in the field, the protocol most paramedics use includes giving glucose?

This is because if your glucose is 350 and it gets bumped to 450, not great, but not so bad, and easy and fast to fix. If your glucose is 50 and it gets bumped to 120, you don't die while people are wondering what to do.

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Yeah I knew the reasoning why, but that same reasoning is also why I believe 1 is the answer. As you stated, going from 350-450 won't be as bad since a lot of diabetics, especially type II's, can adjust to a point. I've always learned that hypoglycemia was more worrisome.

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Specializes in Emergency.

Remember it this way:

Hyperglycemia can kill eventually.

Hypoglycemia can kill now.

The analogy is that your brain is an engine and glucose is the gas. What happens to an engine when you run out of gas?

For the nclex, always think safety, abc's. What is going to kill the patient 1st?

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Def #1 Severe symptoms with really low blood sugar.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Think which is going to kill you first and the fastest....the surgical patient probably has the OR with them...they can wait. 350? not the best but it won't kill them in the next 20 min. A glucose of 50that is continuing to drop unless intervention ....they WILL seize and suffer brain damage...glucose of 50 number one.

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Pt 1--hypoglycemia is the killer answer so it makes nclex lady happy lol hurst is the best! Too much sugar kills slowly not enough kills fast

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