Ok I am not a nurse yet. I actually start my nursing program in the fall. I worked this weekend with a nurse that has been working as a nurse for more than 11 years. She went about 5:00 am to get her blood sugars. I think she had ten of them to get. She gets her last one, and before the timer ends she comes to the desk where I was charting and was talking to us. When the test finished she said OMG Mrs. _________ bs is 14. I said are you sure. She practically screams at me I have already done 9 of them and they were all right. So I go down to the residents room (she was on my hall that night and I knew she was ok). Correct me if I am wrong but wouldn't a BS of 14 mean coma or next to death? Any way the nurse gathers up all the supplies (lab supplies). I am in the residents room and when the nurse comes in Mrs. _________and I are talking to each other. I asked the nurse if she might would want to check the BS again just to make sure that it wasn't a faulty strip or something again the nurse says to me "Sue I have done ten of these already and all of them were ok." I said ok that may be true but wouldn't there be other signs and symptoms if her BS was that low. SO she turns to the pt. and says to her while she is pulling out the stuff to draw her blood and says "Honey your BS is 14 and we are going to have to draw blood to send to the lab" and then she says to the resident I am going to have to shoot your veins with sugar water. OMG I about died. Again and this time so the resident could hear me, I say shouldn't you check it again just to be sure. The nurse gets all huffy and says "I will but I will have to send labs out" Now I don't know all there is to the bs thing. But I do know that I would check it again before I drew blood or "shoot her veins" with sugar water of which I have never heard of doing. I don't know if the nurse was just saying that or if it is a new procedure. So she tries first to "milk" more blood out of the first finger stick from at least 10 min ago and she can't get any more blood. So she goes to her other hand gets the blood and now the BS is 207. Still not admitting that the 14 was a wrong read she turns to me and seriously said I have never seen that much of a difference between Left hand and right hand. The resident is very alert and knows what all we are talking about. So when the nurse tells her that her BS is 14 and is preparing to draw blood the residents eyes are as big as saucers and looks to me for I guess an explanation. I don't know what to say or do. I know that if she had of insisted on doing anything before she checked the sugar again I would have called our supervisor or DON or something.
What would have any of you done in the same situation? Would you automatically assume the BS was correct and follow protocol or would you retest to make sure? AND WHAT DOES SHOOT YOUR VEINS WITH SUGAR WATER MEAN?
OMG! you are excellent to stand your ground! many people would not have said anything.
As a woman with type II DM (no meds or insulin), if my bs hits 60 I fell really freaky! I would definitely be in a coma at 14! I'm so glad you finally convinced her to check it again- and the "milking", I can't belive people still do that, especially on an elder. AND saying that they would have to "shoot her veins with sugar water"!!!! Even if you had to resort to something like that-you'd never say it in that manner-to the patient- probably scared that woman enough to raise her BS anyway! OJ works wonders for me.
I hope everything went well after that--and good job! I'd want you by my side if someone wanted to shoot my vein with sugar water :)
Here is the way I feel about how that was handled that night. I am a CNA I have had A & P and I have 16 years experience as a CNA. I by no means think that I know more than any nurse out there but when I see something like that happen I know I can't sit by and let something happen that I may even suspect is wrong. However, I don't want to be stepping on toes and acting like I know better. I have had CNA's come fresh out of certification telling me how things are supposed to be done or just trying to out do me. I don't like it and I don't want to do it to any one else. I very well may be working at this very nursing home and I sure in the heck don't want to be the subject of retialiation once I start out as a nurse. Because I know I will depend upon the nurses to teach me more than I will learn in school. I do respect my nurses and I admire most of them, my lack of admiration towards some of the nurses is well founded. I just can't sit back and let something that I know to be wrong happen. Especially now that I know something about what is going on. Any suggestions on tactfullness and respect, would be greatly appreciated and welcome.
.... I have had CNA's come fresh out of certification telling me how things are supposed to be done or just trying to out do me. I don't like it and I don't want to do it to any one else. I very well may be working at this very nursing home and I sure in the heck don't want to be the subject of retialiation once I start out as a nurse.....
I appreciate your sensitivity to the feelings of others with whom you work, and your concern for retaliation.
But I wonder if, when someone fresh out of school has an idea that might work, or be better than the current method being used, the benefit of the patient might be a priority rather than whether or not someone has years of experience?
When I am the charge nurse, I won't be dictated to, undermined by or countermanded by anyone I supervise when the chips are down and I've made a decision. But my techs and staff nurses, including LVN's and CMA's, had better come to me if they have a good idea. And the fact is, they do, with ease and comfort, and openness.
That's the way a good team works. Share the idea and suggestion, trust that it will be considered in light of the situation, and respect the decision that is made, whether or not you agree with it.
In this case, the diabetic patient that had a very low reading for blood glucose was sitting up, talking, feeling fine. To give a diabetic a load of sugar when it isn't called for can cause a problem called diabetic ketoacidosis. The prudent course is to retest using a different bedside glucometer (to find out PDQ if there really is a problem) and draw a blood sample to have the lab run it to get a more specific, more sensitive test done.
But to consider first whether the person making the prudent observation has enough time in the job to be listened to is a matter of pride, power and control, not responsible patient care. After all, if the patient dies, or experiences a complication, or even is "just" less comfortable than he or she might be, how is that less important than the number of years of experience someone has, whose idea might have prevented it?
For a blood sugar of 14 I would recheck again if not having any hypoglycemic reactions. It may be a false reading. If repeat blood sugar reading is 14 I would give and Injection of Glucagon. Then I would recheck in 15-20 minutes. This happened last Wed. my patient had a blood sugar of 45 I gave a snack peanut butter and crackers and apple juice (she does not like OJ) She drank the apple juice and only 1 peanut butter cracker she also had been nauseated and vomiting before I came on duty. I rechecked her blood sugar in 20 minutes and it had gone done to 35. I then gave her an injection of Glucagon. In 20 minutes blood sugar was up to 91. 45 minutes I rechecked her blood sugar was in the 160.
I would of rechecked it........Under most circumstances, a patient with a 14 fsbs will be in a hypoglycemia coma...No response to tactile stimuli.......SO start an IV and give D50...IM Glucagon if a delay in starting IV.
Also, if you read the studies, giving someone juice with sugar can actually cause a decrease in their blood glucose, worsening the hypoglycemia. Your body has to expend energy to break down the sugar. Its better to use a glucose paste or tabs........
The fact that she didn't want to recheck the BG level before she started treatment is what had me torn up. But all is good now. I don't know what to think of that nurse. The next evening we got a resident back from the hospital that litarally had her thyroid to just quit. Her highest temp of the day was 87.6. We were on break and I just said well that kind of makes since because our last test in a & p was over that. Where the thyroid secretes a hormone that goes to the hypothalamus and the hypothalamus regulates body temp. OK here is what I think is funny. I said that at break just speculating now our last test was taken on the last day of school. The only thing that I know about that test is that I passed it. I don't know actual score I don't know if I got those questions right or not. No one on break corrected me on that but still does not mean I was exactly on about all of it working together. Later that evening I heard the nurse (the same one on the blood sugar issue) telling someone else about that pt with the temp problems exactly what I had said earlier. And she was saying it as if she is the one that come up with it.... I snickered to myself because what if I was wrong. LOL :rotfl:
Always recheck, especially if they have no s/sx of hypoglycemia. 14 is critical!
Also if a BG is too high and the patient seems clear minded. Wash their hands and retest. The monitors are extremely sensitive and will pick up any sugars that might be on their hands, starch from a piece of bread, anything. I am a diabetes educator and had a gestational diabetic in a panic because her BG was 285 (gestationals should be below 120 at all times). She had just made a sandwich for her son. I told her to wash her hands and retest. She called back and her BG was 90.
Always check your patient. If I get a 14 and the patient is lucid I am going to question it and retest. Then get the D50, or if they're awake 4 oz of juice.
the very first lesson I learned from the old ccu nurse handed down to the new ccu nurse "Treat the patient not the monitor" not the same thing as the fsbs but you get the drift. If the patient was awake and alert I would be doing the blood sugar over.
i must say, quite a few times my cna's have caught something that i didn't. they generally (unfortunately) spend more time with the patients during clean up or just in passing than do i. don't get me wrong i would have re-tested a bs of 14, especially with an alert patient. i rarely feel that my cna's are stepping on my toes, they are a true asset. love my girls
here is the way i feel about how that was handled that night. i am a cna i have had a & p and i have 16 years experience as a cna. i by no means think that i know more than any nurse out there but when i see something like that happen i know i can't sit by and let something happen that i may even suspect is wrong. however, i don't want to be stepping on toes and acting like i know better. i have had cna's come fresh out of certification telling me how things are supposed to be done or just trying to out do me. i don't like it and i don't want to do it to any one else. i very well may be working at this very nursing home and i sure in the heck don't want to be the subject of retialiation once i start out as a nurse. because i know i will depend upon the nurses to teach me more than i will learn in school. i do respect my nurses and i admire most of them, my lack of admiration towards some of the nurses is well founded. i just can't sit back and let something that i know to be wrong happen. especially now that i know something about what is going on. any suggestions on tactfullness and respect, would be greatly appreciated and welcome.
What would you do if diabetic pt. has 14 blood sugar.
Run in circles, scream and shout?
Seriously, I agree with our colleagues here--first recheck. I, too, have had a patient with a high BG who only needed to wash her hands, and have had patients with low BGs (but not as low as 14) who acted Really weird.
what would have any of you done in the same situation? would you automatically assume the bs was correct and follow protocol or would you retest to make sure? and what does shoot your veins with sugar water mean?
sue
you said would you automatically assume the bs is correct and follow protocol or would you retest. following protocol would include first rechecking the bs. any bs grossly abnormal requires a recheck, then a venous sample for lab confirmation of bs. however, if the bs was 14, a nurse would not wait for lab result, she would give the 'sugar water' after doing a second bs check confirming the low reading. as for the sugar water it is 50% dextrose and it is given for low blood sugar. i don't know if i would have said it just like that. but if a nurse tells the patient " your capillary glucose was abnormaly low, i am going to give you intravenous d50." the patient would wonder what the heck the nurse was talking about. simplifying terms into everyday language the patient can understand is ok. for example " mrs smith your blood sugar is too low, i am giving you some sugar (glucose) water to get your blood sugar back to normal."
I understand more now that you guys have talked about it. I understand the importance of treatment for a blood sugar that low. I would have never wanted the pt not treated. I talked with a couple of other nurses today about it and they didn't seem to upset (or should I say surprised) at what the said nurse did. They agreed that she could have worded it to the patient in a different way, but they both said they would have rechecked first. That is what I told those two nurses. I wasn't trying to stop the treatment I was trying to make sure the treatment was correct.
Any way had a wonderful night last night. What ever was for supper I got to elvaluate over and over again. :stone
okie2
153 Posts
OMG! you are excellent to stand your ground! many people would not have said anything.
As a woman with type II DM (no meds or insulin), if my bs hits 60 I fell really freaky! I would definitely be in a coma at 14! I'm so glad you finally convinced her to check it again- and the "milking", I can't belive people still do that, especially on an elder. AND saying that they would have to "shoot her veins with sugar water"!!!! Even if you had to resort to something like that-you'd never say it in that manner-to the patient- probably scared that woman enough to raise her BS anyway! OJ works wonders for me.
I hope everything went well after that--and good job! I'd want you by my side if someone wanted to shoot my vein with sugar water :)