Hypoglycemia Case Study
· Read the situation and orders
· Complete an assessment
· Identify important assessment items and risk factors for blood sugar instability
· Complete priority nursing assessments and interventions
· Complete an SBAR to the provider
· Calculate the dosage of the new medication
Situation: 0700 you are receiving report on one of your couplets (mother and baby) at the beginning of your shift. This baby was born vaginally at 0122 this morning weighing 4.9 kg. Mom’s only significant history is gestational diabetes not well controlled with diet, so insulin was added at 36 weeks gestation however blood sugar was still not well controlled. There were no concerns with the delivery. Her APGARS were 8 and 9. She has voided but has not yet passed meconium. She started breastfeeding right after birth but has been very sleepy and has not latched well since the first breastfeeding attempt.
Nursing order give bath when stable.
VS every hour x 4 or until stable then VS every 4 hours.
Breastfeed PRN but at least every 3 hours.
Take blood sugar if exhibiting symptoms of hypoglycemia. Notify physician if blood sugar is less than 50 mg/dL.
Complete CCHD and hearing screen before discharge.
VS: Blood pressure: 80/64, respiratory rate 50 and unlabored, heart rate 99 beats per minute, temperature 96.8 degrees Fahrenheit, oxygen saturation 97% on room air.
Neurological assessment: sleeping and only stirs with vigorous stimulation, lethargic, normal tone, Moro, suck and rooting reflexes intact, slight tremors.
Respiratory: unlabored respirations
Heart: S1 and S2 regular, continuous machine-like murmur noted
Skin: warm, pink and dry
Gastrointestinal: Bowel sounds active x4, soft
Feeding: breastfed 4 hours before without a good latch.
Note the patient’s abnormal assessment findings related to hypoglycemia:
Place the following nursing tasks in order of highest priority to lowest priority:
· Complete newborn education
· Call the provider if blood sugar low
· Take a blood sugar
· Complete the newborn bath
· Compete the CCHD and hearing screen
· Wrap the baby in a warm blanket and put her under a warmer.
· Feed the baby a bottle
Complete your interventions on baby including a brief SBAR to provider:
Provider’s response added orders:
Feed the infant formula through a bottle.
Physician orders a drip of D10 running at 3ml/kg/hr to be weaned per protocol
Take blood sugar every 3 hours or before meals. If greater than 75 decrease IV rate by 2 mls/hour;
if 75-60 decrease IV rate by 1ml/hour; if less than 60 continue at current rate. Notify the physician if blood glucose is less than 50.
Using this infant’s weight, determine how many mL/hour of D10 this baby should receive through her IV.