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.
It seems like a cost issue to me. My director would absolutely blow a gasket if you used an injectable,when you could have used food or p.o. glucose paste . But as another poster pointed out, just because someone is conscious doesn't mean you will be able to get food into them. If I wasn't able to get someone to drink/eat I would have without a doubt given the Glucagon.
I am just wondering why this residents blood sugars were so low all day and no intervention was done prior to you coming on?
It seems like a cost issue to me. My director would absolutely blow a gasket if you used an injectable,when you could have used food or p.o. glucose paste . But as another poster pointed out, just because someone is conscious doesn't mean you will be able to get food into them. If I wasn't able to get someone to drink/eat I would have without a doubt given the Glucagon.
I am just wondering why this residents blood sugars were so low all day and no intervention was done prior to you coming on?
I questioned that too. I really want to know why something wasn't done about it when it was in the 50s.
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First of all I would have been ballistic if I found out my patients blood sugar was so low...Why??, did they not eat, were they stressed out during the day? Is something else physically happening to them, was insulin given if if it shouldnt have been? Did a prior nurse misread the meter? Did SHE misread the last reading?.....(I personally dont trust any glucose meter, but you have no choice) You go by how they are feeling, objective and subjective cues, and what happened furing the day. Well. If my patient were crashing like that but they were still conscious and answering my simple questions ok and able to swallow small sips of juice or give them the paste. I would have continued that until the BS came up. I did that once when a patient was crashing but was still conscious. It took awhile. A hour or two. They could swallow and hear me. I always keep these Cardinal rules in my head. My ABCs, then awakenness, alertness and orientation, are they in pain or discomfort, can they still swallow sips of fluid,? I would take vitals. make my complete assessment and make my decision based on that assessment. Call the MD if I felt unsure or needed meds ordered. If there is ANY chance I can handle that situation myself and get the person back on their feet, I wouldnt hesitate. Its a darn shame that people, families, friends and whatnot think you are intentionally trying to harm your loved one. I always hated that......its the loonie nurses out there too that give us a bad rap when all you are trying to do is a good job and help people:yeah:
If you give glucagon you are releasing the liver's sugar stores into the bloodstream. Once you've done that it takes time for a decent amount of stores to build up again...I've heard as long as a week. So by giving the glucagon you have used that emergency measure for the week, and the patient doesn't have a reserve for illness/stress.
I would have given the glucagon too, if the patient couldn't take po, and damn the DON. But knowing you can only do it once with good effect can make you push the patient a little harder to swallow something.
how ridiculous. you got an order from the MD. doesn't sound like the patient was alert enough for oral measures. Do you have standing orders for Low BS? I would have tried to get the patient to eat a snack earlier.
You did the right thing. Yes she was conscious but she was dangerously low. Giving her OJ may not have been the trick then you would've needed to dial 911. Ridiculous that you get chewed out for that.
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Schmoo1022
520 Posts
It seems like a cost issue to me. My director would absolutely blow a gasket if you used an injectable,when you could have used food or p.o. glucose paste . But as another poster pointed out, just because someone is conscious doesn't mean you will be able to get food into them. If I wasn't able to get someone to drink/eat I would have without a doubt given the Glucagon.
I am just wondering why this residents blood sugars were so low all day and no intervention was done prior to you coming on?