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?

·         How should the RN proceed regarding the lack of information from the CHF patient?

1) The best course of action regarding the patient with a blood sugar of 54mg/dL is to have the patient immediately ingest 15 grams of carbohydrates. (This is fine because the patient is alert and communicating with you, showing they are capable of tolerating oral forms of glucose). I would stay online (via telehealth) with the patient and have the patient recheck his blood sugars in 15 minutes to see if there is improvement. If his blood sugars remain low, I would have the patient repeat the steps again, even until a third time if necessary. I would then ask the patient what doses of insulin he takes and how often, and what his blood sugar trends were this past month. After I would inform the physician (via telephone or electrical transmission) about the patient’s status and blood glucose trends to determine if insulin doses needed to be adjusted or lowered for the patient.

2) The RN should call the CHF patient on the phone to determine how he is doing. If the patient does not answer, the nurse can call an emergency contact to see if they can get a hold of the patient. If there is still no response, the RN can have emergency services go to the patient’s home to ensure they are safe or if they are needing immediate transport to the nearest Emergency Department.  The fact that the patient did not send any information, when he usually does on a regular basis, is of concern and requires these actions by the nurse.