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Following Hypoglycemia Protocol
nursing • easy

Following Hypoglycemia Protocol

EasyCommonMajor: nursing

Scenario

During a routine blood glucose check, your patient’s BG reads 48 mg/dL.
The patient is awake, alert, and oriented, with mild diaphoresis and slight tremors.
You have access to glucose gel, juice, and IV access.

Question: What are your immediate nursing actions, and how do you ensure adherence to hospital protocol?

Best Practice Answer

  1. Recognize and Confirm the Emergency:
    A blood glucose of 48 mg/dL is critical hypoglycemia. Even though the patient is awake, you must act promptly — neuro changes can develop rapidly.
    Always begin with protocol-driven action, not waiting for new provider orders.

  2. Apply the “Rule of 15” for Conscious Patients:

    • Give 15 grams of fast-acting carbohydrate, such as:
      • 4 oz (120 mL) fruit juice, or
      • 3–4 glucose tablets, or
      • 1 tube glucose gel.
    • Encourage the patient to remain sitting to prevent aspiration and ensure full consumption.

  3. Recheck Blood Glucose in 15 Minutes:

    • If BG < 70 mg/dL, repeat the same step again (another 15 g).
    • Continue until BG ≥ 70 mg/dL and symptoms resolve.
    • Once stable, provide a complex carbohydrate snack (crackers with peanut butter or milk) to sustain blood sugar and prevent rebound hypoglycemia.

  4. If Patient Becomes Drowsy or NPO:

    • Do not give oral carbohydrates.
    • Administer IV D50 (usually 25–50 mL of D50W) per standing order.
    • If no IV access, give 1 mg IM glucagon and call the provider immediately.

  5. Identify and Correct the Underlying Cause:

    • Review insulin timing — was insulin given but meal delayed?
    • Check for missed meals, extra activity, or dose error.
    • Assess medication list for sulfonylureas or insulin stacking.
    • Report findings to provider for further adjustment.

  6. Document Thoroughly:

    • Record BG reading, interventions, recheck values, and patient response.
    • Note communication with provider and any medication adjustments.
    • Many hospitals audit these events for quality metrics — clear documentation demonstrates accountability.

Real-World Application

This scenario reflects one of the most common competency checks in med-surg and telemetry units.
Nurses are evaluated on:

  • Rapid recognition
  • Proper sequencing (intervene → reassess → report → document)
  • Patient safety and prevention of recurrence

This protocol is also often referenced in phone-screen interviews to test clinical recall and prioritization.

Tip: In interviews, say explicitly —
“I’d follow the Rule of 15: treat, recheck, repeat if needed, then document and identify the cause.”
That phrasing demonstrates systematic thinking, protocol familiarity, and clinical safety.