I graduated in March and took a month off. I've been working in a LTC center. I worked with an RN the other night and was very unsure on how she responded to a situation would like others opinions.... a residents blood sugar dropped to 46 she was unresponsive with mucous and phlegm coming out her nose and mouth. You could hear her gurgling to get air in. The RN tried to pour juice and sugar packets into her mouth, then left to call doctor never checking her stats. I put the pulse ox on her and her SpO2 was 78 and her pulse was 46. The nurse never told doctor this. She was upset that I put oxygen on her till she decided what she was doing. Needless to say a day later she has pneumonia. I guess I know you need to stabalize her sugar but why wouldn't you suction her first to ensure that the juice and sugar are going to her and not in the mucous. She didn't attempt to swallow the juice at all. And do you think I should have not put the oxygen on without her telling me too. I am a new grad and an LPN but it concerns me cause I would of done things much different and I'm not sure if my thinking is correct or not????
barefootlady, ADN, RN 2,174 Posts Jun 12, 2005 This RN did not follow through by taking vitals prior to calling MD. We should always attempt to paint a complete picture for the doctor when we call him, so having all the information we can gather is important and necessary. I think if the suction was available, and the patient was in need of suction then do it, NEVER pour liquid down the throat of an unresponsive patient, that is what they make glucose paste for, it disolves quickly, easily, and does not choke a patient. I am guessing but this nurse was not experienced enough to do her job. You sound like a competent, caring nurse, new grad or not. Keep up the good work.
cursenurse 391 Posts Specializes in LTC, ER. Has 11 years experience. Jun 12, 2005 in a situation like that, you don't put anything in the pt's mouth. it sounds like she needed to be suctioned. i have actually been in situations like that in ltc, if it is not possible to obtain iv access and give an amp of d50, then there should be im glycogen (i think that's what it's called) available. i would have suctioned her, put o2 on her and gotten some sugar into her iv or im stat before even calling the dr. all the places i've ever worked you don't leave the bedside to phone a dr about hypoglycemia, you take immediate action to bring that sugar up and you tell the dr about it later. most facilities have protocols for hypoglycemia.
crjnursewarrior 131 Posts Specializes in Correctional Nursing, Geriatrics. Jun 13, 2005 I agree with the other posters. This RN you are speaking of needs to go back to school...HELLO!!!! Can you say ABCs???? It sounds like this patient did not have a patent airway, which means this is your #1 priority...NOT pouring fluids into her and giving her aspiration pneumonia. It could have been worse. She could have killed the poor woman. Airway must always be given #1 priority..."let's see...she can't breathe but by golly we got her sugar back up!"....DUH!! Good for you for STAYING with your patient and LOOKING and SEEING what was going on and what she needed and following through with that. Putting O2 on someone who is clearly in resp. distress is WAY within your scope of practice, you do not have to wait for her to tell you to do so. And leaving the pt. to call the dr. is ridiculous. Treatment of hypoglycemia is a NURSING MEASURE...if you have to get dr's orders to actually give the treatment then you do it later after you have adequately taken care of your pt. Stay away from that RN! Keep up the good work you learned in nursing school. It sounds like you are already on your way to becoming a very competent nurse. :)
