Kayla Villegas
Professor Aretha Morgan Med Surg Clinical Make Up April 11, 2020
Severe Hypoglycemia
1. What do you think is going on with
... [Show More] T.R.?
2. What is the first action you would take?
3. Which assessment findings would support that T.R. is experiencing a hypoglycemic reaction?
4. If no glucose meter were available, would you treat T.R. on the assumption he is hyperglycemic or hypoglycemic? Explain your rationale.
5. It is 1025. T.R.’s glucose reading is 50 mg/dL. What should your next action be?
6. When you enter the room to administer the juice, T.R> is not responsive enough to drink the juice safely. What should you do? (
7. T.R. is breathing at 16 breaths/min and has a pulse of 112 beats/min and regular.
Because outpatient resources vary, describe your actions if (1) your clinic is well equipped for emergencies or (2) your clinic has no emergency supplies.
- (1) If the clinic is well equipped for emergencies, have T.R. eat a simple carbohydrate. In a case where T.R. might be placed on NPO, other alternatives would be giving intravenous (IV) bolus 50% dextrose or giving intramuscular IV.
8. What questions would you ask to find out what precipitated this event?
Did you skip a meal? Did you administer the correct dose of your insulin or sulfonylureas? Did you eat less than usual the day of the hypoglycemic event or the days before? Have you been following a regular eating schedule? Did you engage in physical activity or moderate exercise? Did you consume any alcohol? Did you consume any drugs? What medicines or herbal supplements have you been taking? Have you gained or lost weight lately?
9. What further action do you need to take at this time?
I would take the patient’s vital signs to check if he is stable, I would also recheck his blood sugar levels and assess if the client is able to eat and drink. I would also assess his ability to stand up, if he has any pain, and most importantly, I would provide food for him if his blood sugar level is low. I would also gather more information about the patient’s medicines list and provide that to the physician so he/she could order them.
10. At 1045, you recheck T.R.’s glucose and the reading are 64 mg/dL. His vital signs are 120/72, 18, 92. Has his status improved or not? Defend your response
T.R. 's status has improved seeing as how his heart rate has decreased towards normal standards, his respiratory rate is still within a normal range and his blood pressure is normal. In terms of his blood glucose levels, they have increased which is a good thing since the normal blood glucose when fasting is less than 100mg/dL before a meal and takes an hour to peak after a meal. This shows that his condition is improving.
11. What would your next action be?
Since his status is more stable, I would assess his vital signs every 2 hours, and in about 40 minutes, monitor his blood glucose once more to see if they have risen closer to safer levels.
12. At 1110, you recheck T.R.’s glucose and the reading are 104 mg/dL. What should you do now?
I would continue to monitor his levels to make sure his BGLs continue to be stable. I would also reassess his vital signs.
13. Based on this information, why did T.R. experience this episode of hypoglycemia?
T.R. experienced the episode of hypoglycemia because breakfast wasn’t consumed. The insulin that T.R. is on requires breakfast to be consumed; T.R is on an insulin that is fast acting, this means that he needs to restore his body after a long night. The snack he had wasn’t sufficient enough for his diet.
14. Based on your knowledge of the types of insulin T.R. is receiving, when would you expect T.R. to experience a hypoglycemic reaction?
If you are administering too much insulin, or if you administer insulin without eating.
Humalog is a fast-acting and T.R might experience redness, swelling, or itching at the site of the injection.
15. He says he had two similar low-blood sugar episodes recently. He treated them by eating a candy bar. He says he is on a 2000 calorie, carbohydrate-controlled diet but has been checking his blood glucose levels every “couple of days” only. What common mistake in previously treated episodes of hypoglycemia did T.R. make?
T.R is treating hypoglycemia with sweet carbohydrates that contain fat like cookies or candy bars should be avoided because lipid/fat slows down the absorption of the sugar and delays the response to treatment.
16. List at least four important points that you would stress in a teaching plan with T.R.
- Check your blood sugar every day
- Carry a glucose tablet, some candy or juice with him to take whenever he feels his blood pressure is low then check blood sugar 15 mins after
- Don’t skip or delay meals
- Carry around some type of diabetic identification so in case of an emergency that info is known
17. You instruct him to check his blood glucose at 1230 then eat lunch at the normal time.
He is to follow up with you in 1 week to discuss how he is managing. You will determine that T.R. understands your teaching regarding hypoglycemia if he states:
a. “I need to eat within 30 minutes of taking the regular insulin”
b. “If I am too sick to eat, I will not take any insulin until I feel better”
c. “Only certain kinds of alcoholic drinks will affect my blood glucose levels”
d. “I will exercise just before eating and taking insulin, so I do not get cramps
18. S: 22 yr old male presents to the clinic with diaphoresis, pale skin,
O: Upon arrival: Respiratory 16, Heart Rate 112 beats/min, 10:45 Respiratory 18, Heart Rate 92, Blood Pressure 120/72, Glucose 64mg/dL,11:10 Glucose Level 104 mg/dL
A: Pt vitals were taken, administered 2 mg of glucagon, glucose rechecked,
P: Plan is to keep patients glucose level within normal range; pt education on ensuring he eats adequately throughout the day and when administering insulin [Show Less]