On Wednesday, 1-26-11, Sarina\'s patient had an admitting diagnosis of diabetic ketoacidosis.  Sarina questioned when his capillary blood sugars needed to be performed.  I instructed her they should be performed when ordered, which were before meals and at bedtime, also if the patient displayed symptoms of hypo or hyperglycemia.  I questioned Sarina on s/s of hypo and hyperglycemia.  She was unable to answer the question.  I informed her of several of the s/s and then told her to research the information that night and bring me the research tomorrow.  
This same patient was scheduled for an EGD at 10 AM.  The patient was prepared for his procedure and sent to procedure room.  I asked Sarina what would her actions be when her patient returned to the floor. She stated she would give him a drink.  I told her he went for an EGD, she would need to check his gag reflex and order prior to giving him a drink.  I encouraged her to tell me what other actions she would take.  She did not know.  I stated vital signs and capillary blood sugar.   

The following day, 1-27-11, Sarina brought me her research on hypo and hyperglycemia and narrative notes for 1-26-11.  When I reviewed her research and notes.  I noted that she wrote her patient\'s capillary blood sugar was 247 and she gave him orange juice.  

I called Sarina in to speak with me.  I told Sarina her research on hypo and hyperglycemia was good.  I questioned her if she knows it now.  She stated that things do not stick with her.  I told her to continue to review and study it--it is important.  I asked her what a normal blood sugar range is.  She could not answer the question.  I encouraged  her to give me a number.  She stated 150 to 350.  I informed her that this was wrong.  I asked her why did she give her patient orange juice when his blood sugar was 247.  She stated that her co-assigned nurse told her to give him orange juice.  I could not believe this.  I told her he must have misunderstood her.  Sarina speaks very softly and is frequently difficult to understand.   

I stressed to Sarina how dangerous her action was and that if she does not know something (such as normal blood sugar level) she needs to research or ask questions.
