1. The client is brought to the emergency Department with hypoglycemic blood glucose level of 25...

Hypoglycemia is a condition in which the blood sugar (glucose) level is lower than normal. Severe hypoglycemia level ll  is when the blood glucose level falls below 54 mg/dl which requires immediate action.

If the blood sugar levels drops very low as 25 mg/dl, the client may anytime loss his/her consciousness or have a seizure. So it is important for the nurse to act this situation quickly and wisely.

The management of severe hypoglycemia involves,

For clients with severe hypoglycemia and are conscious and able to swallow, give oral CHO (rapidly absorbing glucose or sucrose containing foods ) and monitor blood glucose level continuously every 10 minutes. If the client is having full recovery of baseline activity , consider discharge. If the client is still confused or hypoglycemic, start continuous IV infusion of glucose 10-20% at the rate of 50-200 ml/hour.

For clients who are unconscious and not able to swallow, immediately administer 20-50 ml of 35-50% of glucose bolus. And start continuous IV infusion of glucose 10-20% at 50-200 ml/hour. If the client is fully recovered, observe for 24 hours and consider discharge.

If the client is still unconscious and confused and are still hypoglycemic, repeat IV bolus glucose and increase the rate of IV glucose infusion. And the client recovered from hypoglycemia observe for 24 hours and consider discharge according to hospital protocols. If the client is still unconscious, admit the client and consider IV Glucocorticoids (100-200 mg) Hydrocortisone and continue aggressive treatment of hypoglycemia. If not hypoglycemic, consider other causes of disturbed consciousness.