Transcript
CHAPTER 32
Clinical Reasoning Checkpoint Answers
Marcel M., 32 years old, is brought into the emergency department by his wife. She informs the nurse that her husband has been not been feeling well over the past few days with a gastrointestinal problem and his mental state has slowly shifted from being anxious and “foggy headed” to drowsy. About one hour before arrival at the ED, Marcel reportedly experienced a seizure. His wife relates that her husband is a type 1 diabetic who has been on insulin most of his life. Over the past three days, he has been trying to eat but has been vomiting up his food. He has continued to administer his usual dosage of insulin until today. The nurses suspects that Marcel may be experiencing hypoglycemic crisis.
1. Assuming that Marcel has developed hypoglycemic crisis, what common symptoms would you anticipate finding during your assessment?
Answer: The nurse would likely find cold and clammy skin, tachycardia, hyperventilation, and diaphoresis. If Marcel was sufficiently awake, he might also complain of a headache, nervousness, tingling of his extremities, nausea and vomiting, and continuous hunger. There would also be changes in mentation and coordination, thickened speech, and other signs of brain function deterioration.
2. Briefly explain the pathophysiologic basis for the classic signs and symptoms of hypoglycemia.
Answer: The manifestations of hypoglycemia result from a combination of CNS effects and catecholamine effects. The CNS effects are related to the brain cell’s rapid consumption of glucose for energy. When hypoglycemia develops, brain cells rapidly deplete their oxygen source and symptoms result. The catecholamine effects result from stimulation of stress hormones, particularly epinephrine, which then causes activation of the sympathetic nervous system response.
3. Marcel is now unconscious. What interventions are appropriate at this time?
Answer: A STAT blood glucose should be obtained to establish that hypoglycemia is the problem. The nurse can anticipate that, typically, a 50 mL bolus of 50 percent glucose is administered intravenously. In the absence of available glucose, he also could be treated with 1–2 mg of glucagon. Following administration of one or the other drug, the nurse would closely monitor the patient for reversal of the hypoglycemic manifestations.
4. A STAT bedside glucometer reading cannot be obtained at this time. Should Marcel’s drug therapy of either glucose or glucagon be held until his blood sugar level is confirmed? Why or why not?
Answer: No, the nurse should not wait. Therapy should not wait on obtaining a blood sugar level if the test cannot be done immediately. It is recommended that treatment move forward to prevent possible complications of severe hypoglycemia.
