Cooperative patient care

On the floors at my hospital we are told so often, and in so many different situations to never hold the Lantus, that it has become second nature to give that injection almost without thinking twice.

Over the last couple of days I had a patient that had been receiving tube feeds, which had been discontinued the day before with the exhibition of a normal swallow in this patient post intraoperative stroke. The orders had read to give a half dose of Lantus the previous day and resume the previous daily dose of 50 units in the am when I was to take over the care of the patient. There were two problems with this dose. The first was that the patient had no history of diabetes, and the previous need for insulin was almost completely due to tube feeds. The second problem was that the patient promptly decided that she had no appetite and that she was not going to eat.

Not half an hour after after I gave the dose the hospitalist on call for the weekend showed up, noticed the dose, and in a display of cooperation between disciplines that Happy could learn a lot from spent the next two days working with me to make sure that this lady's sugar never reached a critical low one time. With close monitoring of her blood sugar and intake I was able to inform the physician when the blood sugar dropped from 135-77 in the span of an hour. When half an hour after the administration of 1/2 amp of D50 the blood sugar had dropped to 72, I was able to receive additional orders even though the patient was not technically hypoglycemic.

With continued drops in blood sugars over the course of the afternoon and more D50 for a low of 54, the physician and I were able to work together to formulate orders for maintenance orders for D10 and hourly CBG's that would maintain adequate blood glucose overnight. This was actually a collaborative effort, as I was able to tell her what the nurses were liable to need overnight, and how they were likely to interpret wording of certain orders.

At the end of the day she thanked me for all of my hard work, and expressed gratitude when she heard that I was back the next day. "at least we won't be starting all over again"

The point of all of the care was that this patient, with a recent large stroke absolutely did not need to have further insult caused by repeated severe hypoglycemic events. In fact, due to her neurological status, she likely would have been very hypoglycemic before anyone noticed. I could have had a hospitalist like Happy who walked up to the desk and calmly stated "She is in isolation so I didn't go in the room, but Mrs Smith is awfully diaphoretic and seems to be having a seizure. What do you think that I should do? "The fact that I was working with a physician that was concerned and receptive made an extremely difficult job easier. The last thing that I or this patient needed was for me to have to fight the physicians for appropriate orders while gowning up in isolation gear for c-diff to check her blood sugars every hour. In this case I was allowed to intervene before the emergency and my knowledge was appreciated and sought out. I want to clone this doc!