Kim, a RN who works in a long-term care facility, receives an emergency call at 9:30 am. A staff member in the dining room noticed that Bob, one of the residents, was not acting like himself.
“He’s unresponsive,” the dining room attendant shouts excitedly into the phone.
“Is he breathing?” Kim asks.
“Yes, he seems to be breathing but he’s staring right at me and won’t answer my questions.” the attendant clarifies.
Kim grabs the emergency bag and runs down the hall to the dining room. Kim is already starting her nursing assessment in her head. A few years ago, Bob lost a leg to uncontrolled diabetes. Kim suspects Bob received his morning insulin and delayed eating breakfast. He was probably experiencing a hypoglycemic attack (low blood sugar).
When Kim arrives, Bob is sitting in his wheelchair with his eyes closed. His untouched breakfast sits in front of him. He opens his eyes briefly when Kim addresses him, but then quickly closes them. He appears lethargic. Kim wheels him out of the dining room to a nearby hallway, pulls out a glucometer and pricks Bob’s finger to obtain a blood sugar.
The result reveals what Kim suspected. Bob’s blood sugar is only 48. Kim tries to give Bob a little orange juice, but he isn’t alert enough. It dribbles out of his mouth. Kim grabs a tube of Insta-glucose and squeezes the entire tube into Bob’s mouth. By now, Bob’s head is beginning to sag. Afraid he might fall out of his wheelchair, Kim asks a certified nursing assistant (CNA) and another nurse to hoyer lift Bob into bed. Kim rechecks Bob’s blood sugar: 56. It had not come up much in the last 10 minutes.
Kim knew Bob’s blood sugar needed to go up or he could go into a diabetic coma and die. Injectable Glucagon was available in the emergency box, but Kim had no order to administer it. The facility did not have the capability to give intravenous dextrose (sugar into the vein). Kim had to think clearly and act quickly.
What does Kim decide to do next? Give IM Glucagon even without an order? Hope Bob’s doctor can be reached in time to save Bob? What action would you take? Read Nursing Assessment of Hypoglycemic Crisis Part 2 to find out what happens.