Hypoglycemia for Progressive Care Certified Nurse (PCCN)
Included In This Lesson
Outline
Hypoglycemia
Definition/Etiology:
- Definition
- Blood sugar < 60 mg/dL and is a common endocrine emergency.
- Think of an airplane.
- Fly too high will give you altitude sickness. (Make you sick)
- Fly to low = you crash and die
- Etiology
- Diabetic
- Excessive insulin or oral agent
- ETOH – Liver stores glycogen
- Procedures – VGS
- “Dumping syndrome”
- Diseases
- Pancreatic Disease
- Cancer
- Diabetic
Pathophysiology:
- Glucose is the primary fuel for Brain and CNS
- The brain cannot make or store glucose, so it relies on circulating blood sugar
- ↓ 60 or Rapid BS decline = SNS Activation AKA EARLY WARNING SYSTEM
- BETA BLOCKERS HIDE THESE
- Epinephrine
- Glucocorticoids
- BETA BLOCKERS HIDE THESE
- ↓40 = Cerebral Dysfunction
- Coma to DEATH
Noticing: Assessment & Recognizing Cues:
- Nocturnal Hypoglycemia
- Severe Symptoms – 50% happen at night
- DM Type 1
- Subjective (DELIRIUM)
- Slurred Speech
- Blurred vision
- Psychosis → Injury
- Seizures
- Objective
- Vitals
- Tachycardia & Hypotensive
- Vitals
Interpreting: Analyzing & Planning:
- Labs
- Finger stick
- Serum Blood Glucose
- Look for underlying cause
- LIVER Failure or ETOH
- AST/ALT
- Pancreatic Disease/Cancer
- Amylase/Lipase
- LIVER Failure or ETOH
- Diagnostics
- Heart Monitor- Dysrhythmias
- Remember our airplane – We can die from this
- Heart Monitor- Dysrhythmias
Responding: Patient Interventions & Taking Action:
- ABCs & Underlying Cause
- Maintain airway if unconscious
- Supplemental 02
- Pharmacology
- IV GLUCOSE BOLUS 50% dextrose
- Follow D10W IV infusion until patient can eat
- No IV Access = glucagon
- If ETOH abuse = thiamine
- Nonpharmacological
- Monitor for seizure activity
- Seizure precautions
- Adjunct medical therapy
- Endocrinology, Diabetic Educator
Reflecting: Evaluating Patient Outcomes:
- Hypoglycemia
- High rate of injury from falls
- ABCs
- Remember that your patient can die from this. They will code.
- Blood glucose normalized = Prevent Seizure
- Patient teaching – Beta blocker hide s/s of hypoglycemia
Linchpins (Key Points):
- Notice
- Symptoms of hypoglycemia
- EARLY WARNING
- DOn’t forget that BB hide sx
- Interpret
- Blood glucose level
- Respond
- QUICKLY
- Under 40 = Coma
- Reflect
- Symptoms resolved?
- Seizure free?
- Blood glucose check compliance
Transcript
References
- AACN, and Tonja Hartjes. AACN Core Curriculum for Progressive and Critical Care Nursing. Available from: Pageburstls, (8th Edition). Elsevier Health Sciences
- Dennison, R. D., & Farrell, K. (2015]). Pass PCCN!. Elsevier Health Sciences (US).
- Kupchik, N. (2020). Ace The Pccn! you can do it!: Study guide. Nicole Kupchik Consulting, Inc.
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System