Abnormal findings are charted as a chain — finding, severity, comparison to the individualized target or baseline, the risk it creates, and the skilled action taken.
A glucose value or pattern below the individualized target with symptoms — hypoglycemia, severe if accompanied by confusion, seizure, or unresponsiveness.
A glucose pattern persistently above the individualized target, or a regimen no longer controlling glucose — hyperglycemia requiring regimen review.
Very high glucose with dehydration, Kussmaul respirations or fruity breath, and mental-status change — concerning for diabetic ketoacidosis or hyperosmolar hyperglycemic state.
Hypotension, profound weakness, and mental-status change in a steroid-dependent patient or after abrupt steroid cessation — concerning for adrenal crisis.
A new foot lesion or loss of protective sensation — high-risk for limb loss (route to Wounds and Touch/Sensation).
High fever with tachycardia or atrial fibrillation, agitation, and confusion in a hyperthyroid patient, or hypothermia with bradycardia and obtundation in a hypothyroid patient — concerning for thyroid storm or myxedema (route to Neck/Thyroid).
Incorrect insulin technique, dosing errors, or a lapse in monitoring — a safety risk requiring re-teaching and possibly notification.
Laboratory trends indicating worsening glycemic control, an electrolyte disturbance, or declining renal function — requiring provider collaboration.
