Situation: A 44-year-old man has chronic pancreatitis from l… | 마이메르시 MyMerci
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Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination
문제

Situation: A 44-year-old man has chronic pancreatitis from long-term alcohol use and stopped drinking 3 months ago. He has diabetes caused by the pancreatitis and uses insulin glargine and insulin lispro. He also takes pancrelipase capsules. During that admission his glucose is 52 mg/dL (2.9 mmol/L). He is awake and able to swallow, and the nurse gives 120 mL of fruit juice. Fifteen minutes later his glucose is 72 mg/dL (4.0 mmol/L), and his next meal will not arrive for 2 hours. What should the nurse do next?

해설
Under the Rule of 15, glucose is rechecked 15 minutes after 15 g of fast-acting carbohydrate, and the fast-acting dose is repeated only while glucose stays below 70 mg/dL (3.9 mmol/L). Once it is above 70 mg/dL, a snack or meal follows to prevent a recurrent low; with his meal 2 hours away, a snack is given now. Glucagon is reserved for a client who cannot swallow or is unconscious.
같은 주제 다음 문제Situation: A 58-year-old man with alcohol-associated cirrhosis is admitted with tense asci…이 문제가 수록된 문제집PLNE Question Bank 150014,000원 · 무료 체험 가능

심화 해설

Applying the Rule of 15
Under the Rule of 15, a client who is awake and able to swallow and whose glucose is below 70 mg/dL (3.9 mmol/L) takes 15 g of fast-acting carbohydrate, such as about 120 mL of fruit juice, then rechecks glucose after 15 minutes. The fast-acting dose is repeated only while glucose remains below 70 mg/dL. His glucose has risen from 52 to 72 mg/dL, so the treatment has worked and another fast-acting dose is not needed.

Preventing a recurrent low
Fast-acting carbohydrate raises glucose quickly but briefly. If the next meal is not due soon, glucose can fall again as the juice is used up, especially with insulin on board. Once glucose is above 70 mg/dL, the next step is a snack or meal. Because his meal is 2 hours away, the nurse gives a snack containing protein and starch, such as crackers with cheese or bread with peanut butter, to provide a slower, sustained rise. After correcting hypoglycemia, follow with a snack if the next meal is more than about an hour away.

StepAction
Glucose below 70 mg/dL, able to swallowGive 15 g fast-acting carbohydrate
Recheck at 15 minutesIf still below 70, repeat the 15 g
Above 70 mg/dLGive a snack or meal to prevent recurrence
Unable to swallow or unconsciousGlucagon or intravenous glucose as ordered

Why the other actions are wrong
Another 15 g of fast-acting carbohydrate is not indicated because his glucose is now 72 mg/dL. Glucagon is reserved for a client who is unconscious or cannot swallow safely; he is awake and improving. Simply rechecking in another 15 minutes without giving food leaves him at risk of another low before the meal arrives. Watch out! Do not stop at the number; the Rule of 15 includes the follow-up snack. His diabetes caused by pancreatitis also makes lows more severe because glucagon secretion is impaired.

Exam takeaway
Treat, recheck, repeat if needed, then feed. Key point! Once glucose is above 70 mg/dL, give a snack with protein and starch if the next meal is not soon. The nurse also reviews the cause of the low, such as insulin timing, missed meals, or reduced intake during illness.

임상 시나리오

Hypoglycemia Follow-UpRule of 15 and the next step

For glucose below 70 mg/dL (3.9 mmol/L) in an alert client, give 15 g of fast-acting carbohydrate and recheck in 15 minutes; repeat only if still below 70.

His glucose is now 72 mg/dL and his meal is 2 hours away, so give a snack with protein and starch to prevent another low.

Glucagon is for a client who cannot swallow or is unconscious.

Caution

Rechecking without giving food leaves the client at risk of recurrent hypoglycemia before the meal.

핵심 개념

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