Nursing Care Plan (NCP) for Hypoglycemia

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Outline

Pathophysiology

Hypoglycemia occurs when the blood glucose levels drop below 70mg/dL. Once this happens, the counterregulatory hormones stimulate the autonomic nervous system to elicit a response such as tremors, sweating, irritability, tachycardia and hunger.

Etiology

Causes of hypoglycemia are varied, but it is seen most often in diabetic patients. This condition typically arises from abnormalities in the mechanisms involved in glucose homeostasis. The most common cause of hypoglycemia in patients with diabetes is injecting a shot of insulin and skipping a meal or overdosing insulin

Desired Outcome

The patient is expected to have blood glucose levels above 70 mg/dL and the patient should be able to recognize signs and symptoms of low blood glucose.

Subjective Data

  • Hunger
  • Irritability
  • Headaches
  • Anxiety
  • Weakness
  • Double Vision

Objective Data

  • Tremors
  • Seizures
  • Clammy
  • ↑HR
  • Glucose level below 70 mg/dL
  • New confusion
  • Change in LOC (Level of consciousness)

Nursing Interventions

Intervention

Rationale

Check blood glucose

The best way to detect and prevent hypoglycemia is by doing frequent blood glucose  checks. Should be done in the morning, before each meal and at bedtime.

Replace glucose

If patient can take PO, give 15-20g of glucose. Recheck BG in 15 minutes and repeat if necessary. If unstable, Glucagon may be given IM or SubQ. IV Dextrose may also be administered.

Educate on prevention strategies

Patient should understand how to prevent hypoglycemia. Ensure they know th have adequate food intake, they have a regular BG check schedule, limit alcohol consumption

Monitor for signs of infection

Extremes in BG levels often occur in the presence of infection. ↑HR or fever may indicate infection Blood cultures may need to be collected.

Educate on treatment at home

It is important for patient to be able to treat mild to moderate hypoglycemia at home. Keep glucose tablets if prone to hypoglycemia; ½ cup of juice; hard candy; Honey or syrup.

Lesson Details

Writing a Nursing Care Plan (NCP) for Hypoglycemia

A Nursing Care Plan (NCP) for Hypoglycemia starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.

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Transcript

This is the nursing care plan for hypoglycemia. So, hypoglycemia or low blood glucose occurs when a blood glucose level drops below 70. Once this happens, the counterregulatory hormones stimulate the autonomic nervous system to elicit a response such as tremors, sweating, irritability, tachycardia, and hunger. Some nursing considerations that we want to keep in mind are, we want to check that blood glucose, we want to do frequent checks. We want to monitor the vital signs. We want to initiate hypoglycemia protocol. We want to educate on signs of hypoglycemia. The desired outcome for this patient is that this patient is expected to have a blood glucose level above 70, and the patient should be able to recognize signs and symptoms of low blood glucose. 

So a hypoglycemic patient. Um, first thing I want to do is I just want to remember that you remember this mnemonic, remember cold and clammy need some candy. If you just remember that, uh, you’ll know a lot of the signs and symptoms for this patient. So, let’s look at some of the subjective data. They’re going to complain about being hungry. So, there’s going to be hunger. They are going to be irritable. These patients are going to complain of having headaches, anxiety, weakness. And so what are some things that we are going to observe. Remember, cold  and clammy needs some candy? So, these patients are going to have cold clammy skin. 

They’re going to have tremors. They could possibly have seizures. They’re going to have an increased heart rate. And remember they’re going to be tachycardic. And on the glucometer, we are going to see their blood glucose is going to be less than 70. There’s also going to be some confusion as it goes on. 

 

So, what are some nursing interventions? What are some things that we can do to, uh, help take care of this patient? Well, the first thing that we can do is we need to do a blood glucose check. So, let’s do a blood glucose check. Okay. The best way to detect and prevent hypoglycemia is by doing frequent blood glucose checks. This should be done in the morning before each meal and at bedtime. So, we do that, uh, AC HS. So AC is before meals,HS is at bedtime. The next thing we should do is we should replace the glucose. If a person is hypoglycemic, what do we need to do? We need to give them some glucose. Remember, if a patient can take anything by mouth, if they’re alert and oriented enough to swallow that it’s best to give them something PO, we want to give them 15 to 20, 15 to 20 grams of glucose. Then,  we want to recheck in 15 minutes, we can repeat this. If necessary, if they are unstable, they are responsive, then we can give glucagon. Glucagon, and that can be given IM or sub Q. We can also give IV dextrose as necessary as well. So, we can also, uh, educate. Education is very important in prevention. How do we prevent hypoglycemia? Remember the patient needs to understand how to prevent being hypoglycemic. They need to ensure that they have adequate food intake. They need to make sure that they have a regular blood glucose check schedule, and they need to limit alcohol consumption. 

The next thing that we want to do is to monitor for signs of infection. Signs of infection. Extreme blood glucose levels often occur in the presence of infection. We can have an increased heart rate, increased temp. This may indicate infection. At this point, we will need to draw some type of blood cultures in order to get a definitive diagnosis. Finally, we want to educate this patient on managing hypoglycemia at home. A lot of times hypoglycemia makes a patient feel so sick and all you need to do is correct it. So, this will avoid unnecessary hospital visits. We want to educate on home management. Some of the things that we could tell them is it’s important for them to be able to treat mild to moderate cases. They want to keep glucose tablets at home. If they’re prone to hypoglycemia, remember they can have a half a cup of juice. They can take some hard candy, even honey or syrup. Taking it at home can help bring those blood glucose levels up. 

 

So, the key points. So, the pathophysiology is that hypoglycemia simply occurs when blood glucose levels drop below 70. The subjective data. This patient is going to be hungry. They’re also going to complain of having some headaches, some anxiety, they’re going to be irritable and weak. Some things that we’re going to notice. Some of our objective data is these patients are going to have some tremors. They’re going to be at risk for seizures. Their skin is going to be cool and clammy. Remember, cold and clammy needs some candy. They’re going to have an increased heart rate. And on the glucometer, their reading is going to be less than 70. So, we’re going to teach them how to prevent hypoglycemia. We’re going to prevent hypoglycemia by  ensuring that they have adequate food intake. They’re going to do regular blood glucose checks, and they’re going to limit alcohol consumption. If for some reason they do become hypoglycemic, we want them to be able to manage it at home. The way we can teach them that, is to make sure that they have glucose tablets. Remember, they can drink some juice, take some hard candy, or eat some honey, some syrup, or some saltine crackers. These things will keep them from going hypoglycemic. We love you guys. Go out and be your best self today. And remember as always, happy nursing.

 

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