Endocrine System Disorders Q 34

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Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer:

  

    A. I.M. or subcutaneous glucagon.

    B. I.V. bolus of dextrose 50%.

    C. 15 to 20 g of a fast-acting carbohydrate such as orange juice.

    D. 10 U of fast-acting insulin.

    

    

Correct Answer: C. 15 to 20 g of a fast-acting carbohydrate such as orange juice.

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This client is having a hypoglycemic episode. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. For conscious patients able to take oral (PO) medications, readily absorbable carbohydrate sources (such as fruit juice) should be given. If the client has lost consciousness, the nurse should administer either I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%.

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Option A: For patients unable to take oral agents, a 1-mg intramuscular (IM) injection of glucagon can be administered. Once the patient is more awake, a complex carbohydrate food source should be given to the patient to achieve sustained euglycemia. More frequent blood glucose monitoring should occur to rule out further drops in blood sugar.

Option B: Identification of a hypoglycemic patient is critical due to potential adverse effects, including coma and/or death. Severe hypoglycemia can be treated with intravenous (IV) dextrose followed by infusion of glucose. Patients should be advised to wear a medical alert bracelet and to carry a glucose source like gel, candy, or tablets on their person in case symptoms arise.

Option D: The nurse shouldn’t administer insulin to a client who’s hypoglycemic; this action will further compromise the client’s condition. Nonpharmacological management of recurrent hypoglycemia involves patient education and lifestyle changes. Some patients are unaware of the serious ramifications of persistent hypoglycemia. As such, patients should be educated on the importance of routine blood glucose monitoring as well as on the identification of the individual’s symptoms of hypoglycemia.

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