NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

Introduction

Hypoglycemia protocol; and treatment algorithm is developed to provide safe and effective management for the hypoglycemic episode throughout the hospital to achieve blood glucose control under the standards care from the American Diabetic Association,2015. Hypoglycemia occurs when blood glucose (BG ) level drop below 70mg/dl. Most of the patient start developing the symptoms below the blood glucose serum 70, the symptoms include tachycardia, diaphoresis, palpitation, nausea, hunger, irritability, confusion, blurred vision, tiredness, difficulty speaking, and headaches(Service,1995).BG level less than 40 can cause severe, life-threatening complication like seizure and coma. Hypoglycemia is one of the associated cause of death in the critically ill patient.

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Hospital-acquired hypoglycemic coma, hyperglycemic coma, or diabetic ketoacidosis has financial consequence because Medicare plan does not cover expenses related to this. So, most of the hospital have a nurse-driven protocol for treating hypoglycemia. The purpose of initiating nurse-driven hypoglycemia is to manage the hypoglycemia without delay for patient’s experiencing hypoglycemia, with or without symptoms and this protocol is based on evidence-based treatment. NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart.

 Policies and rules

My facility(Unity Point Health) the hypoglycemia protocol we use is an IQ4 Type 2 protocol. IQ4 Type 2 protocols may be initiated by authorized personnel not meeting the definition of a licensed independent practitioner (i.e., an RN) by an order mode that does not require prior licensed independent practitioner (i.e., an MD) authorization.IQ4 protocols will be reviewed annually at the Medical Staff meeting to comply with CMS (Centers for Medicare and Medicaid Services) regulations and guidelines. This protocol is strictly for all non-pregnant Adults.

How, when, why, or where the step is executed for the initation of hypoglycemia protocol

As a nurse we have to keep the following patient populations in mind to evaluate the risk for hypoglycemia.

1. Any patient taking glucose lowering agents including:
   • Injectable: Subcutaneous or IV insulin, or an insulin pump,Non-insulin diabetes injection medications including exenatide or pramlintide
   • Non-Injectable: Orals: A. Insulin Secretagogues: Sulfonylureas such as glimiperide, glyburide, glipizide or Glinides such as Repaglinide or Nateglinide
   • Alpha-Glucosidase Inhibitors such as carobs or miglitol, Inhaled insulin: Afrezza
2. patient with or without diabetes who has:
3. an insulinoma
4. history of gastric bypass surgery
5. changes in nutritional status: emesis, NPO, reduced PO intake, changes in enteral or parenteral nutrition.
6. system (organ) failure and fluctuation in function
7. tapering of corticosteroids
8. changes in other medications that alter blood glucose
9. infection, stress, pain, sepsis

 Information for the execution Hypoglycemia protocol

 Nurses  can initiate adult hypoglycemia treatment protocol if blood glucose is below 70 mg/dL in the following condition:

1. If not already ordered in EPIC, the nurse initiates by: a. Placing a single order for “Initiate Adult Hypoglycemia Treatment Protocol” with order mode of “Hospital policy – Cosign required.”
2. Placing the Order Set for Adult Hypoglycemia Treatment Protocol using the ordering mode “Protocol Orders.” NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

Documentation

The documentation is an integral part of hypoglycemia event as I mentioned earlier all the hypoglycemia is reviewed by the medical staff meeting to comply with Centre of Medicare and Medicaid Services(CMS). RN will document the entire hypoglycemic episode in EPIC in Flowsheets called as Hypoglycemia flowsheet.

1 Once: Initial assessment, treatment

2. Each: 15-minute post-treatment reassessment, treatment (if applicable)
3. Each: provider notification and
4. Once: Hypoglycemia resolution assessment at 1 hr recheck
5. Include probable causes of the hypoglycemic episode

Additional relevant details can be charted as needed in a Significant Event Note. If a rapid response (emergency process) is called, pertinent document details of the Rapid Response Navigator is significant. Not only this we do document hypoglycemia event in the hospital’s incident reporting system

Effectiveness of the Nurse Driven Hypoglycemia protocol

The Nurse-driven protocol is very feasible  It helps in controlling and preventing both mild and severe hypoglycemic episodes. Moreover, nurses particularly appreciated the gain in autonomy and involvement in the management of diabetic patients.

Shortcomes

A common error I personally felt when treating the patient with hypoglycemia is to overtreat hypoglycemia with an excess of carbohydrate. This, in combination with the counterregulatory hormone response to hypoglycemia, facilitates subsequent hyperglycemia. After treatment of any hypoglycemic episode, frequent bedside glucose monitoring should be continued until a stable glucose level is achieved. Depending on the time of day and insulin peak times, a balanced snack with carbohydrate, protein, and fat (i.e., peanut butter and crackers, or milk) can prolong treatment effectiveness (Tomky,2015) NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

Conclusion

There is an evidence-based research shows that simple nurse-managed hypoglycemia protocol measures significantly reduced hypoglycemia in diabetic hospitalized patients. NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart. We cannot deny the fact that hypoglycemic events are frequent in the hospital setting and have adverse prognostic implications.Close attention and monitoring are needed to ensure patients have intravenous glucose infused during prolonged fasting; Patient dietary intake also should be monitored This should become an in-hospital routine preventive strategy with insulin treatment(Tomky,2015).

References

American Diabetes Association Workgroup on Hypoglycemia 2005. Diabetes Care.2005;28(5):1245-1249.

American Diabetes Association. 2015 Standards of Medical Care in Diabetes. DiabetesCare. 2015;38(Suppl. 1):S38-40, S80-85.

1. (2015, April 16). Effectiveness of a Nurse-Managed Protocol to Prevent Hypoglycemia in Hospitalized Patients with Diabetes. Retrieved October 23, 2017, from https://www.hindawi.com/journals/jdr/2015/173956/cta/ NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

http://care.diabetesjournals.org/content/38/Supplement

Service, F. J. (1995). Hypoglycemic Disorders. Handbook of Diagnostic Endocrinology, 193-212. doi:10.1385/1-59259-293-7:193

Tomky, D. (2005, January 01). Detection, Prevention, and Treatment of Hypoglycemia in the Hospital. Retrieved October 23, 2017, from http://spectrum.diabetesjournals.org/content/18/1/39

UnityPoint Health Trinity’s Hypoglycemia Protocol NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart