Friday, August 25, 2006

Blood glucose of 671

I had computer training on I-Connect this week. I'm not sure what I think of it overall. What I don't like though is becoming 100% reliant on a computer. Our trainer told us we no longer need kardexes, report sheets or MAR's (med sheets). I think that's insane. I plan to keep using my report sheet. I prefer to know what's going on with my patient by just glancing at the info on my report sheet rather than scrolling thru a computer trying to find the info. I caught on rather quickly, many people did not. It's gonna be a mess whenever we do go live. Supposedly the date is October 22nd, but I get the feeling it will be pushed back.

I worked on Sunday - but don't remember much of anything about my patients. It's that short-term memory loss! I worked again last night. I had a patient in his early 60's who will be told today that he has stomach cancer. I don't like knowing information that my patient doesn't know. He was so happy & friendly last night & all I could keep thinking is he has no clue what he's about to be told today.

I also got a new admit diagnosed with chest pain. I looked up his labs before I got report from the ER nurse. I noticed his blood glucose (sugar) level at noon was 671. Wow...not a good number. This is basically the way report went with the ER nurse around 8:30 pm...

ER nurse: I have a patient for you being admitted with pneumonia.

Me: Pneumonia? I thought it was chest pain.

ER nurse: Oh, well maybe it is, yeah...pneumonia & chest pain & possibly even asthma.

Me: Asthma?

ER nurse: Yes, I think so.

Me: You think so? What do the orders say?

ER nurse: They say chest pain & asthma exacerbation.

Me: What about pneumonia?

ER nurse: Oh, I guess he doesn't have pneumonia after all. We also gave him Tylenol for a fever.

Me: How high is his fever?

ER Nurse: I don't know, let me check. Oh, it was 99.1. I guess we didn't give it for a fever, must have been some other reason.


ER nurse:

Me: So has the blood sugar been addressed?

ER nurse: Why would it need to be addressed?

Me: Because it was 671 at noon when he came in.

ER nurse: It was?

Me: Yes, did you not look at the labs?

ER nurse: No, I don't know, I just got this patient at change of shift.

Me: Did the ER doctor not address it?

ER nurse: I guess not.

Me: Don't you think it should be addressed before the patient comes to the floor?

ER nurse: Well, the admitting doctor saw the patient too.

Me: The admitting doctor did not notice the very high blood sugar? (and the fact that the patient has been admitted 5 times in the last 6 months for elevated blood sugars)

ER nurse: I guess not. I'll recheck it & cover it.


That was how it went. Isn't it sad that the floor nurse (me) who has not even layed eyes on the patient nor spent one minute conversing with him knows more than the ER nurse who is caring for him? Or even more about the patient than the doctors that are treating him? She brings him to the floor, says his blood glucose was 384 & she gave him 10 units of regular insulin. Ok, I'm a sucker, I believed her. I decide to give the insulin a little time to work & recheck his blood sugar about 45 min later. It's now 462. Just for those of you who aren't sure what the normal range for blood sugar's 70 to 99. Anything over 400 requires a stat lab draw & a call to the doctor. So we order a stat lab draw...which they come & draw right away.....yet takes an hour to get a result - that's only because I kept calling & bugging them to give me a result so I can call the doctor. Their reading was 447. So I call the doctor...or more like the doctor on call for the doctor that admitted him. I explained the scenario. He orders 5 units of regular insulin IV now. Ok, should I do accucheks on him more often than AC & HS (before meals & right before bedtime)? No, stick with the AC & HS accucheks. So that means I'm not supposed to recheck his blood sugar until at least 6 a.m.????????

I'm not comfortable with that so I have my patient care tech recheck it 2 hours later. It's now 432. Ok, slight decrease, but I still wasn't thrilled at that number...only now I'm stuck. I can't call the doctor & get more orders because I wasn't even supposed to be rechecking it. I run it by my clinical leader, she isn't sure what to do. I decide to give it a little time & hope that it continues to go down. We rechecked it at 5:30 am & it was 226. I'll take that. I'm glad I didn't cover him with anything more as he was NPO (not allowed to eat or drink) & that extra coverage could have made him hypoglycemic (low blood sugar). He was doing fine, just a little irritated that he wasn't allowed to eat or drink anything because of the chance of having a stress test today.

I had to turn in my schedule today for the next 2 months. As I was filling it out, I was thinking "Will I even be working here in 2 months?" I'm really getting that itch to branch out & try something new. I like my hospital, but there is so much change going on not to mention I'm on the low end of the pay scale there. The plus side is that there is plenty of work & our busy season is coming up. Actually, this past week has been super busy. I'm not sure why, but we are completely full in PCU & that's something like 60 beds. I think I will get the ball rolling with a travel nurse agency & at least see what they are offering.

I'm getting sleepy.......bye y'all.


am4039 said...

sounds like another interesting day at work. I'm happy that the patients blood sugar went down. How scary. It doesn't hurt to see what the agencies are offering. Hopefuly more money. That wound be nice.

tendernoggle said...


siennastarr said...

Yikes!   Those sparks that fly between the floors and the ER.  I work in the ER, so I am predjudice a bit at how hard my nurses work.  Granted not all are competent, and some should NOT be RN's at all, but most are very good at what they do.  It's funny reading your take on the conversation and how stupid the ER nurse sounded... when I listen to an ER nurse talk to the floor nurses it's always reversed!  Too funny! lol  It's just that thing where floor nurses/ICU nurses/ER Nurses all think they are better than the other...when in fact they are.. in their own ways, because they all do different types of nursing for the patient.

We have a lot of travelers at our hospital.  They seem to love it.  The pay is good.. the rent is paid for on their apartments by the agency... so they can really save up and it gives them an opportunity to see different parts of the US!

I really do love your journal!  :)