Case Study- Week 10

A newly hired registered Nurse (RN) is assigned to work at the telehealth work center.  The RN is monitoring the in coming data from home-bound (based) patients from arount the county, checking to see if there are any situations which require nursing interventions and taking the appropriate actions. One (1) patient is a type II diabetic. He reports his fasting blood sugar level of 54. Another patient who has congestive heart failure (CHF) and regularly reports in on daily basis does not send in any information (data).

• What is the best course of action for the RN to take regarding the diabetic patient?
• As the nurse I would call the patient and talk to him as soon as possible. First, I would instruct him to not take his regular diabetes medications or insulin. I would tell him to eat something with sugar such as milk and graham crackers if available because this increases blood glucose over an extended period of time. If this is not available he should drink juice, eat jelly, or take a glucose tab to get a spike in blood glucose. Last, I would instruct the patient to call somebody or have somebody that lives with him sit with him until his blood glucose rises, is within normal range, and is stable. I would instruct the patient to check his blood glucose levels every fifteen minutes until they are stable in order to gage if he needs more sugar or not. 
• How should the RN proceed regarding the lack of information from the CHF patient?
• As the nurse I am worried about this patient due to his regular reports every day. At this point I would try to get a hold of the patient by calling their house or cell phone. If I did not get a response I would call his family members or emergency contact to see if they have heard from him and could go check on him. I would also call his primary care provider, or the agency that provides home health for this patient to have them contact this patient as well.