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At the very early stages as an RN, I worked with a preceptor - a nurse who is vastly experienced in the field and can guide me as a novice nurse. In preparation for independent care of patients I was asked to take care of a number of patients on a singular day. Initially my day started off well. Then sometime during my shift, I entered a patient's room to administer scheduled medication. I noticed the patient was sweating profusely, and just not his usual self.
I asked him what happened and he couldn't explain himself much. I hadn't seen him like that before. I then remembered that he is a diabetic which means that he could be in a hypoglycemic state - his blood sugar is possibly low. Usually when the blood sugar of diabetics drop low, there are some physical manifestations that indicate a decrease in blood glucose level and this sweating was an alarming signal. I then checked his blood sugar and as expected it was 70mg/dL!
Normal blood glucose level is 70-100 mg/dL and I needed to act fast since my patient was heading toward the lower end of normal! Not too long after this discovery the nursing assistant I worked with that day appeared and suggested to give the patient a cup of orange juice to raise his blood sugar since it was so low. I agreed and she quickly obtained a cup of orange juice for the patient. The patient became stable and much better than before.
My preceptor arrived and I informed her of what had happened. When I told her of the orange juice she immediately said "no you don't give a dialysis patient orange juice; you give him apple juice!" Oh yes! now I remembered! Not only is the patient a diabetic he is also a hemodialysis patient! Orange juice is appropriate to give to raise the blood sugar of a diabetic who does not have renal disease.
Patients who are on hemodialysis are those that have diseased kidneys. Hemodialysis is a process by which the blood is filtered through external means. Naturally the kidneys are filters - they filter our blood and produce urine. Many of these patients have end stage renal disease. As a result, their kidneys can no longer function on it's own in the filtering and production of urine, and so these patients are dependent on dialysis to do its former work.
The reason my preceptor reacted quickly was because OJ (orange juice) has a good amount of potassium which is important for the functionality of different cells in the body. Most essentially this potassium excretes from the body through the kidneys and since this patient has malfunctioning kidneys he will not be able to excrete the potassium on his own as quickly as well functioning kidneys would.
In the worst case scenario, this can lead to build up of potassium levels in his blood which will ultimately lead to severe toxicity. Thank God, the patient didn't receive abundant potassium from the OJ to produce excess in his system. He received adequate OJ to raise his glucose level and became stable.
I perceived my story to be a great content for nursing school exam or NCLEX question! Here is a sample nursing question based on the story above:
DV is a 50-year-old male. He has a 10 year history of type 1 diabetes mellitus as well as end stage renal disease. You find DV in his room shaky, confused, and diaphoretic (sweating). You check his blood glucose and it is 65mg/dL. What should you NOT do as the nurse?
A. Call the MD stat!
B. Inform your supervisor
C. Give a cup of OJ
D. Recheck blood glucose in 15 minutes
It is appropriate to notify the MD, and your supervisor of the patient's current status. Choice D is correct after you've instituted hypoglycemic protocol. C is not an appropriate action for a renal patient and that is the correct answer.
Moral of the story: DO NOT GIVE ORANGE JUICE or potassium rich foods to DIABETIC PATIENTS who have RENAL DISEASE and/or are on DIALYSIS!*
I definitely learned from this situation. I want to encourage the new nurses out there to know their patients' medical history before they institute any interventions, and to seek counsel in regards medication administration and other aspects of patient care especially in the early onsets as a new nurse. Don't be afraid to ask questions! At the end of the day, your license is at stake and you must ensure that you provide safe care to patients.
I pray you are inspired.
-Charity
Thank you.
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