Tremblay_CS_Hypoglycemia

Case Study- Hypoglycemia 1. What do you think is going on with T.R.? - TR is disoriented - Decreased LOC could be due to high/low sugar levels of electrolyte imbalance 2. What is the first action you would take? - Assess A&O - VS - BG levels 3. Which assessment findings would support the premise that TR is experiencing a hypoglycemic reaction? a. Extreme thirst and nausea b. Nervousness and tachycardia c. Hypertension with bounding pulses d. Fruity breath with deep rapid respirations 4. If no glucose meter were available, would you treat TR on the assumption he is hyperglycemic or hypoglycemic? Explain your rationale - If there were no glucose meter available, I would ask questions about what he has eaten that day, medications he’s on, activity of the day, any preexisting medical conditions. I would treat him as if he were hypoglycemic based off the symptoms hes exhibiting such as pallor, diaphoresis, and confusion. 5. It is 1025. TR’s glucose is reading is 50mg/dL. What should your next action be? - Assess ability to eat and drink by mouth - Bring him juice or a snack to raise his blood sugar 6. When you enter the room to administer the juice, TR is not responsive enough to drink the juice safely. What should you do? - Check to see if clinic has emergency glucagon, administer it and monitor response 7. TR is breathing at 16 breaths/min and has a pulse of 112 bpm and regular. Because outpatient resources vary, describe your next actions if (1) your clinic is well equipped for emergencies or (2) your clinic has no emergency supplies. - Clinic well equipped o Administer glucagon o Monitor HR., RR, and LOC o Call 911 if TR continues to be unresponsive o No glucagon  Insert IV and administer emergency dose of glucose - Clinic not equipped o Call 911 o Continue to monitor VS o Use AED or perform CPR if necessary

A few mins after administering 2mg glucagon, TS begins to awaken. He becomes alert and asks where he is and what happened to him. You orient him and then explained what transpired. 8. What questions would you ask to find out what precipitated this event? - What have you had to eat and drink today? - Have you exercised today? - What was the last thing you remember? - Has this happened before? When was the last time? - How do you manage your diabetes? Do you take medication? 9. What further action do you need to take at this time? - Monitor blood glucose levels - Monitor VS and LOC - Provide snack and drink if able 10. At 1045, you recheck TRs glucose and the reading is 64mg/dL. His VS are 120/72, 18, 92. Has his status improved or not? Defend your response. - His status has improved - BG levels are low but his VS are stable 11. What would your next action be? - Monitor BG levels until they are at least 80 but preferable between 100-180 - Discuss medications and regularly checking his blood sugar - Express the importance of eating and drinking enough to prevent this from happening again 12. At 1110, you recheck TRs glucose and the reading is 104mg/dL. What should you do now? - Start discharge preparations - Review medications and reinforce diabetes teaching TR tells you he took 35 units glargine insulin and 12 units of regular insulin at 0745. He says he was late to class, so he grabbed an apple on the way. 13. Based on this information, why did TR experience this episode of hypoglycemia? - TR experienced this hypoglycemic attack because he overmedicated and underate - He should have eaten a proper meal to account for the medication 14. Based on the types of insulin TR is receiving, when would you expect TR to have a hypoglycemic reaction? - Glargine- long acting - Regular- short acting - TR should eat within 30 mins of insulin administration and if he hasn’t then he should expect a drop in BG levels