Differentiate Between Hypo- and Hyperglycemia

Case Summary

The school RN sees an 8-year-old male coming into the nursing office by his Phys Ed teaching with complaints of profuse sweating and confusion. The patient is currently afebrile.

 

Objectives. (More or less are possible)

1.       Recognizing signs of hypoglycemia 2.       Differentiate between hypo- and hyperglycemia 3.       Initiates treatment plan for abnormal blood sugars 4.       Evaluating effectiveness of treatment plan

 

Description of Client

Age:	8 years	Gender	male
Medical diagnosis or chief concern		Abnormal blood sugars

 

Care Setting (More than one are possible)

Emergency Department Medical-Surgical Unit Pediatric Unit Maternity Unit Behavioral Health Unit Intensive care unit

Post-anesthesia Care Unit Skilled-care Facility Home Outpatient Clinic Other setting: school Others present:

 

History of chief concern/current condition/problem

Symptom: sweating and confusion Onset: 30 minutes ago Treatments tried (if applicable): drank water and sat down

 

Other history as indicated

Allergies: NKA Weight/BMI (If applicable): 23 kg Medical diagnosis/surgeries/psychosocial: Type I DM diagnosed 1 year ago, no further past medical history, no surgical history Medications: Novolog Diagnostic tests: blood glucose POC, vital signs

 

Assessments

Important, abnormal, or relevant assessments	Normal or irrelevant assessments
Confusion Sweating Recent illness with “up and down” sugars PMHx DM Type I	Afebrile

 

Solutions

Priority to address	Desired outcome
Confusion Sweating DM I history	Alert and oriented x3 Normal blood sugars
Actions/order indicated	Actions/order not indicated/contraindicated
Obtain blood sugar Obtain full set of vital signs	Send back to gym class immediately Increase insulin dose

 

Information Sources

Phase Sheet Nurses’ Notes History and Physical Admission Notes Vital Signs Medications Orders

Intake and Output Laboratory Report Flowsheet Progress Notes Diagnostic Report Other:

 

• What is most concerning finding? (10 points)
• What factors best explain client’s symptoms? Use specific pathophysiology. (15 points)
• What condition would most likely be expected? (10 points)
• What will happen if this condition is not treated? (10 points)
• What actions should the nurse take? (15 points)
• Which actions are contraindicated? (10 points)
• How should the nurse provide the glucose and why? (10 points)
• When should the RN re-check the blood glucose? (10 points)
• ? (5 points)
• Who should the nurse notify? (5 points)

1. The most concerning finding is the patient’s confusion, as it suggests potential neurological impairment, which can be serious.
2. The client’s symptoms are best explained by hypoglycemia. In diabetes mellitus type 1, the body is unable to produce insulin, leading to high blood sugar levels. However, excessive insulin administration or inadequate carbohydrate intake can result in hypoglycemia. Profuse sweating and confusion are classic signs of hypoglycemia, as the brain is deprived of glucose, its primary energy source.
3. The most likely condition expected is hypoglycemia, given the symptoms presented and the history of type 1 diabetes.
4. If hypoglycemia is not treated promptly, it can progress to severe neuroglycopenia, causing seizures, loss of consciousness, coma, and even death.
5. The nurse should take the following actions: a. Obtain a blood sugar reading to confirm hypoglycemia. b. Administer glucose orally or intravenously to raise blood sugar levels. c. Monitor vital signs regularly. d. Reassess the patient’s mental status and symptoms.
6. Contraindicated actions include sending the patient back to gym class immediately without addressing the hypoglycemia and increasing the insulin dose, which would exacerbate the condition.
7. The nurse should provide glucose orally if the patient is conscious and able to swallow safely. If the patient is unconscious or unable to swallow, intravenous glucose administration may be necessary for rapid correction of hypoglycemia.
8. The RN should re-check the blood glucose within 15-30 minutes after administering glucose to ensure that it has normalized and to monitor for rebound hypoglycemia.
9. EMS should be activated if the patient’s condition does not improve despite glucose administration or if there are signs of severe hypoglycemia such as seizures, loss of consciousness, or inability to swallow.
10. The nurse should notify the school administration, the child’s parents or guardians, and the child’s primary care physician or endocrinologist about the episode of hypoglycemia and the treatment provided.