A practical nurse (PN) discovers a client with type 1 diabetes mellitus unresponsive in bed. The client is profusely diaphoretic, and a stat capillary blood glucose reading is (). The client does not have established intravenous (IV) access. Arrange the following emergency interventions in the safest priority sequence from first to last.
- 1Administer the prescribed dose of emergency intramuscular (IM) glucagon.
- 2Place the client in a lateral side-lying (recovery) position.
- 3Perform a follow-up capillary blood glucose check in minutes.
- 4Verify the return of a robust gag reflex and ability to safely swallow.
- 5Provide an oral snack containing a complex carbohydrate and a protein.
Answer
The correct sequence is to first administer IM glucagon, immediately position the client on their side to protect the airway, recheck the glucose in 15 minutes, assess the gag reflex upon awakening, and finally provide an oral snack once safe swallowing is confirmed.
In severe hypoglycemia where the client is unresponsive and lacks IV access, the immediate priority is raising the blood glucose using IM glucagon. Because glucagon frequently causes nausea and vomiting, the client must be immediately turned to a lateral side-lying position to prevent aspiration while they remain unconscious. Once the airway is physically protected, the PN follows the 'rule of 15' by rechecking the capillary blood glucose 15 minutes post-intervention. As the client regains consciousness, the PN must assess their gag reflex and swallowing ability to ensure oral intake is physically safe. Finally, providing a complex carbohydrate and protein snack is necessary to replenish hepatic glycogen stores and prevent a subsequent drop in blood glucose, as glucagon's metabolic effects are short-lived.
Step-by-Step Solution
Key Concept
Management of severe hypoglycemia with IM glucagon requires immediate airway protection due to the high risk of treatment-induced emesis, followed by strict protocol reassessment.