A few years ago, I was working as a Nurse Practitioner in an endocrinology practice. One of my longstanding elderly patients, age 82, called me to report that the paramedics had to come to her house because she passed out....
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I scheduled her for an appointment the next day, and took her history. She'd had diabetes for about 15 years, and was taking a long acting insulin at bedtime and rapid acting insulin before her meals. I reviewed her activities of the day (meal times, insulin doses and times, and activity level). She reported that she had her dinner, and then next thing she knew she was passed out at the dinner table. I performed a complete physical exam, which was normal. I was ready to order a battery of lab tests, and considering testing her for gastroparesis since it appeared that she'd had a severe hypoglycemic reaction so soon after eating.
I reviewed her recent episode with her again, stating "so you ate your dinner, and then you passed out…" at which point she interrupted with "no, I did not eat my dinner, I HAD it, it was right in front of me on the table, and then I passed out…." The conclusion was that she had a severe hypoglycemic reaction because she delayed her dinner.
Lesson learned: Obtain a complete history from the patient, choosing words carefully, and make sure you and your patient are speaking the same language and have the same meaning! The lesson learned from this case saved a lot of time and money from unnecessary testing and work up.
Louise DeRiso, MSN, CRNP, CCRC
Coordinator, Vascular Clinical & Translational Research Center
University of Pittsburgh
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