Is this request unreasonable? Diabetic question.

[SilleLu]

I really do want honest opinion here, I swear!

Receiving a diabetic patient (insulin dependent) from ER, serum glucose was approx 220 five hours earlier, pt has been NPO for at least same 5 hours. No capillary glucose check done at any time since arrival. No insulin or hypoglycemia management orders entered.

Request ER nurse to check capillary glucose before sending patient up. Was told that was a ridiculous request since there was "nothing I can do about it anyway" since no orders. I said I was only concerned about a possible low, that I would deal with getting insulin orders on the floor if it was high. Got more resistance and a "whatever, fine" and basically got hung up on.

I don't get the resistance to checking it before transport...insight anyone?

[emtb2rn, BSN, RN, EMT-B]

Did they get fluids in the ED? My ED docs wouldn't do more than that for 220 glucose.

Did you expect the pt bottomed out after 5 hours npo? And 220 is simply not an emergent lab value.

[SilleLu]

I wasn't worried about the 220, like I said, I even told her if it was high I'd get the insulin orders. Only fluids were abx and NS bolus.

Yes, my concern was that she could be low, nurse did not know what if any insulin she had taken before coming in. So it would have been ok then in your opinion not to push for the check? Have had a few brittle diabetics recently, so maybe I was being overly cautious?

Thank you

[emtb2rn, BSN, RN, EMT-B]

Was she symptomatic? If no, then i don't see the concern.

If she was truly brittle, she probably would've gotten sporty in the ed. And brittle diabetics usually (but not always) seem to start out hypo in the ed, not hyper.

[Here.I.Stand, BSN, RN]

I would have just gotten the glucometer and checked w/ admission VS/assessment.

[Pangea Reunited, ASN, RN]

220 wouldn't have concerned me, at all. In fact, I'd be mildly annoyed that the transferring nurse took up my valuable time rattling that number off.

[Devon Rex, ADN, BSN]

I wouldn't have asked for a new glucose reading under those circumstances, just done one myself upon receiving the patient along with vitals. Now... if it had been the SBP @ 220... THEN it would've been a different story.

[Horseshoe, BSN, RN]

I would have just done one myself after I admitted the patient. At that point, absent any symptoms, it really wouldn't have been a high priority for the reporting nurse. She didn't need to be rude, but I don't get why you would ask her to stop and do a blood glucose check when she's handing over the care of the patient to you and there has been no mention of any symptoms of hypoglycemia. As the receiving nurse, I would have automatically done a baseline blood glucose check as part of my initial assessment.

[SilleLu]

Ok, thanks for the input, sounds like I was just overly nervous because of another recent brittle and let that skew my judgement, I appreciate your feedback!

[KatieMI, BSN, MSN, RN]

It takes two minutes, and it gives you (and maybe somebody else) a benchmark to start working from. Unless you are from one of these ridiculous places where nurses need a Holy Order to do CBG, I see no issue.

[ComeTogether, LPN]

I'd rather do it myself, since I'd have to call the MD to get orders that I would have to administer.

[TheCommuter, BSN, RN]

If the patient had entered the ED with a FSBS of 500+ (or less than 50) and was symptomatic, perhaps a recheck from the ER nurse would have been warranted.

However, I simply would have obtained a FSBS as part of the admission assessment if the nonemergent number of 220mg/dL was thrown out there.