Edwin Olivas
Dr. Elena M. Russo
Linda Stevens, LPN, works on the medical floor at the local hospital. One of the patients she has
been assigned to take care of is Frank Gibbons, a 72-year-old newly diagnosed with diabetes (a
condition in which the body does not produce enough insulin to control blood sugar levels). Part
of Linda’s process of preparing to care for her patients is to review the patients’ charts for any
new physician orders. She notes that Dr. Romero was in the previous evening and ordered the
patient’s blood sugar to be checked at 8 a.m. According to the results, insulin is to be given. (The
higher the level of blood sugar, the greater the amount of insulin that is given, based on a
formula defined by the physician.) Linda is a “thinking nurse” and starts to question if this is an
appropriate order. She realizes that breakfast trays arrive at 7:30 a.m. on her floor and that Mr.
Gibbons will already have eaten when she checks his insulin level at 8 a.m. She knows that after
eating, a person’s blood sugar normally increases for a few hours. This is why blood sugar tests
are usually ordered when the patient has not eaten for a number of hours. Linda reasons that if
she calculates the amount of insulin based on the temporarily elevated blood sugar levels, Mr.
Gibbons will receive too much insulin and may have a negative reaction. Linda calls Dr. Romero
to clarify the order. Dr. Romero states that he believed the breakfast trays did not arrive until
8:30 a.m. He thanks Linda for catching the error and changes the order.
What might have happened if Linda had simply performed the blood sugar test exactly as
ordered?
If Linda had proceeded to perform the blood sugar test exactly as ordered without questioning
the timing, there could have been several potential consequences for Mr. Gibbons:
Inaccurate insulin dosage: As Linda suspected, if the blood sugar test was conducted after Mr.
Gibbons had already eaten breakfast, the test results would likely show a higher blood sugar
level due to the post-meal spike. This would have led to the administration of insulin based on
misleading data. As a result, Mr. Gibbons might have received an excessive amount of insulin,
leading to a significant drop in his blood sugar levels (hypoglycemia).
Hypoglycemia: Hypoglycemia occurs when blood sugar levels drop too low. If Mr. Gibbons had
