The nurse enters the room of a client with type 1 diabetes mellitus and finds the client difficult to arouse. The skin is warm and flushed, and the pulse and respirations are elevated. Which action should the nurse implement?

The nurse enters the room of a client with type 1 diabetes mellitus and finds the client difficult to arouse. The skin is warm and flushed, and the pulse and respirations are elevated. Which action should the nurse implement?

• A. Give the client a glass of orange juice.
• B. Check the client's capillary blood glucose.
• C. Prepare for the administration of an insulin drip.
• D. Prepare for the administration of a bolus dose of 50% dextrose.

Answer: (B)

Determining glucose status at the bedside is the first priority when a client with diabetes has altered mental status. The reason is that the appropriate treatment depends entirely on whether the glucose is low or high, and you cannot safely proceed with one therapy without knowing the actual glucose level. In this scenario, check the capillary blood glucose now to guide the next steps. If the reading is low, you would treat as hypoglycemia with rapid glucose administration appropriate to the patient’s level of consciousness (IV dextrose if unable to swallow, or oral glucose if they can safely swallow). If the reading is high, you would pursue hyperglycemic crisis management (fluids and insulin) rather than giving glucose. Giving orange juice is not ideal here because the patient is difficult to arouse and may not swallow safely, and you still need the glucose measurement to direct care. Starting an insulin drip or a bolus of 50% dextrose should wait until the glucose level is known and the specific crisis is identified.

Determining glucose status at the bedside is the first priority when a client with diabetes has altered mental status. The reason is that the appropriate treatment depends entirely on whether the glucose is low or high, and you cannot safely proceed with one therapy without knowing the actual glucose level.

In this scenario, check the capillary blood glucose now to guide the next steps. If the reading is low, you would treat as hypoglycemia with rapid glucose administration appropriate to the patient’s level of consciousness (IV dextrose if unable to swallow, or oral glucose if they can safely swallow). If the reading is high, you would pursue hyperglycemic crisis management (fluids and insulin) rather than giving glucose. Giving orange juice is not ideal here because the patient is difficult to arouse and may not swallow safely, and you still need the glucose measurement to direct care. Starting an insulin drip or a bolus of 50% dextrose should wait until the glucose level is known and the specific crisis is identified.