Seriously I don't understand it. I work 12 hr. nights in LTC. so about 2am i went to check on my resident b/c it was reported from days that her bs was running in the low 50's. also she was asymptomatic of hypoglycemia. she was fine when i came on talking laughing just her usual self. i've been checking her bs and it was pretty much the same 53. i goes in and she was disoriented shaking etc. i took her bs and it was 23. i immediatly ran to call the md. there was no order for glucagon but we got it in the ekit and that's what i was going to give her. told the md what was going on and see if i can give the glucagon he said yes. i give her 1ml of glucagon IM. immediatly she started to come around. bs slowly was coming up and in about an hour she was 119.
of course i charted and reported to the next shift finished up my work and went home. i got a call later from the DON chewing my butt out for giving glucagon and she wasn't unconscious. i told her there was nothing else i could give her and i had the permission of her doctor to do so.
That is ridiculous that your DON reprimanded you for following orders. I would go to her supervisor and report her treatment of you after the fact. DON's and management who are bullies can cause staff to make mistakes that can harm patients. Any staff who is afraid to act on behalf of the patient should not be practicing. You did the right thing, you are a Patient Advocate - never, ever back down!
your DON is ridiculous...had u killed the patient you would have been in bigger trouble. Wait for the patient to be unconscious? ummm no, i would have done the exact same thing you did, bs of 23 is scary
That's absolutely ridiculous. You did the right thing.
It's odd to me that the MD didn't want to address blood sugars in the 50's, even if she was asymptomatic. That does not leave much wiggle room before she is in serious trouble, as you encountered. Baseline in the 50's is not a good thing...
But seriously, you did the right thing. To NOT give glucagon in that scenario would be negligent, in my opinion. I would not have thought twice to even check for an order...I would just give it with a sugar in the 20's, and worry about the order later!
Thank you so much i completly agree. what got me in report no one thought of calling the doc. she has a poor appetite and ate very little for lunch and dinner. i got her chart and there was no order for glucagon. they gave her oj and something else can't remember and her bs was still low.
It doesn't sound like this patient was stable enough to take oral ANYTHING. Glucagon was on hand and to call 911 would have just delay treatment of the low bs. I woulda done the same thing.
I'm not disagreeing with the OPs actions, I probably would have done the same thing as well. I was merely spectulating to why nurse manager was upset.
However, even though 23 is a low number.. but you do have to look at the patient. If she is only disoriented and shaking.. she has a gag reflex and would probably be able to take something. But again, I agree with the OP.
You spoke to a dcotor and got an order for glucagon. No problem.
However, does your facility have standing orders for hypoglycemia? Giving some orange juice or oral glucose? Or calling 911?
I can understand if you went against standing policy but you got an order, so it shouldn't be a huge issue.
We do give oj, milk if we are lucky to have dietary leave some for us. i just thought it was odd that my DON would even say anything negative about what i done. she said you're not supposed to give glucagon unless they're unconscious. i've seen orders that stated give glucagon IM for bs
Dosen't your facility have a policy on hypoglycemia management? I work in a hospital and we treat if 70 mg/dl or less without MD approval. Someone needs to be sure there is a policy to protect you from stupid people.
You are so lucky to work in a hospital. i absolutely hate working in ltc, at least the one i'm at. these people scare me with all the you can't do this, or you should've done that, crap.
Specializes in Gerontology, Med surg, Home Health.
Not to be fresh and I'll probably be flamed, but I'd reprimand you for your bad grammar!
If the resident is able to swallow, we would have given oral glucose. If that hadn't worked or she couldn't swallow, we'd give glucagon. The nurses sometimes forget to include a glucagon order on an insulin dependent diabetic, but that really wouldn't stop any of us from giving it.
One of the hardest things to learn/master in nursing is:
Knowing when to listen to admin./management and when to pretend you are listening.
I'd have explained myself, and if the DON didn't get it at that point...........just let'em do their thing. Certainly don't sign any write ups though. Truth is, you said the pt. was talking silly so they may not have been able to take PO at that time very well.
Here is the flip side of your situation: Lets say next time you don't bother with the glucogon cause, well, they are not unconcious. Then something happens to the patient. You think that DON will stand by you and say "Yes, my nurse did the right thing, we don't give glucogon until the pt. is unconcious"? NOPE. They'll pull out the ole "Our nurses are expected to use their judgement and make the best decision........blah blah blah".
In short, its your license, so do whats right for the pt.
If this patient hadn't been eating all day, they knew this was coming! Your DON's just ticked off because you handled things correctly without consulting her first. She doesn't want you as an LPN to think for yourself. Makes her look well, sort of dumb.
Isabelle49
849 Posts
That is ridiculous that your DON reprimanded you for following orders. I would go to her supervisor and report her treatment of you after the fact. DON's and management who are bullies can cause staff to make mistakes that can harm patients. Any staff who is afraid to act on behalf of the patient should not be practicing. You did the right thing, you are a Patient Advocate - never, ever back down!