Because he received his morning insulin 45 minutes before breakfast, Bob was experiencing a hypoglycemic episode. He was too lethargic to drink orange juice. The high sugar Insta-glucose had failed to bring his blood sugar up. After 20 minutes, his blood sugar was still only 56. There were no orders for IM Glucagon and the facility did not insert IVs. So what did Kim do?
Kim debated calling 911 or calling Bob’s physician. Luckily, within five minutes Kim reached Bob’s physician who ordered Glucagon intramuscularly. Kim had the injection ready and instead of taking the time to roll Bob’s long shirt sleeves up, pulled Bob’s pant legs up and inserted the needle deep into his anterior thigh muscle.
As Kim stood at Bob’s bedside gently shaking his shoulder and stimulating him with conversation, Bob opened his eyes and mumbled at times. He still was not responding well. Fifteen minutes later his blood sugar read only 77. Kim called the physician again who ordered another Glucagon injection. Kim gave the shot in Bob’s other thigh.
Over the next few minutes Bob started to respond. His eyes opened. He knew who he was and where he was. He drank the glass of orange juice Kim poured into him. His blood sugar in 15 minutes was 80. Kim called his physician to discuss the situation. Even if Bob remained alert enough to eat breakfast, Kim was uncertain that Bob’s blood sugar would rise quickly enough or stay up. Kim suggested that the safest plan was to call 911. Bob’s physician agreed. The EMTs could give Bob intravenous glucose to bring his blood sugar up quickly.
While waiting for the ambulance to arrive, Kim checked Bob’s sugar twice more: 101 and a few minutes later 136. Bob drank his second glass of orange juice.
“He’s out of the woods,” Kim thought.
Kim checked his blood sugar as the EMTs walked into the room: 75. His insulin was continuing to cause his blood sugar to drop. After inserting an intravenous line, the EMTs transported Bob to the local emergency room. After an intense hour, Kim could relax. Bob was in good hands now.
Without Kim’s thorough nursing assessment and quick action Bob’s blood sugar would have continued to drop, and he might have died. Kim used specialized knowledge and skill to save Bob’s life. This is what nursing is all about.