GLUCAGON STIMULATION TEST		version 4/11/2023		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	Once	S	1 treatment	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	Once	S	1 treatment	
		Test to be done between 8-9 am.		
	☐	Nursing communication	Once	S	1 treatment	
		Ensure patient fasts from midnight		
	☐	Insert Peripheral IV or Access Portacath	Once	S	1 treatment	
		No details available for preview		
	☐	sodium chloride 0.9% flush 10 mL	Once	S	1 treatment	
		10 mL, intravenous, PRN, line care, Starting when released, for 10 doses		
	☐	sodium chloride 0.9% infusion 250 mL	Once	S	1 treatment	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag, Starting when released, Until Discontinued		
	☐	HEParin, porcine injection 500 Units	Once	S	1 treatment	
		500 Units, intra-catheter, once PRN, line care, Starting when released, Until Discontinued
	Heparin flush for Implanted Vascular Access Device Maintenance.		
	☐	Discontinue IV	Once	S	1 treatment	
		No details available for preview		

Pre-Injection 	

	
	Interval	Defer Until	Duration	
	☐	Weigh patient	Once	S	1 treatment	
		Clinic Performed, Normal		
	☐	Measure blood pressure	Once	S	1 treatment	
		Clinic Performed, Normal
	Every 30 min during test IF patient is symptomatic.		
	☐	POC glucose	Once	S	1 treatment	
		Routine, Point Of Care
	Every 30 min during test IF patient is symptomatic.		
	☐	POC glucose	Once	S	1 treatment	
		Routine, Point Of Care
	Perform ONLY IF blood glucose between 70-180.		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	glucagon injection 1 mg	Once	S	1 treatment	
		1 mg, intramuscular, once, Starting when released		
	☐	glucagon injection 1.5 mg	Once	S	1 treatment	
		1.5 mg, intravenous, once, Starting when released
	ONLY for patient more than 90 kg.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	Once	S	1 treatment	
		MARK collection tubes with the following:
	1. Patient's name; 
	2. Date of test; 
	3. Time point (i.e. time=0, +15, etc.); 
	4. Actual clock time sample was collected.		

Post-Injection 	

	
	Interval	Defer Until	Duration	
	☐	Growth hormone	Once	S	1 treatment	
		STAT, Normal, Clinic Collect
	At 0 minute post Glucagon injection		
	☐	POC glucose	Once	S	1 treatment	
		STAT, Point Of Care
	Capillary blood glucose at 0 minute post Glucagon injection		

At 30 Minutes 	

	
	Interval	Defer Until	Duration	
	☐	Growth hormone	Once	S	1 treatment	
		STAT, Normal, Clinic Collect
	At 30 minutes post Glucagon injection		
	☐	POC glucose	Once	S	1 treatment	
		STAT, Point Of Care
	Capillary blood glucose at 30 minutes post Glucagon injection		

At 60 Minutes 	

	
	Interval	Defer Until	Duration	
	☐	Growth hormone	Once	S	1 treatment	
		STAT, Normal, Clinic Collect
	At 60 minutes post Glucagon injection		
	☐	POC glucose	Once	S	1 treatment	
		STAT, Point Of Care
	Capillary blood glucose at 60 minutes post Glucagon injection		

At 90 Minute 	

	
	Interval	Defer Until	Duration	
	☐	Growth hormone	Once	S	1 treatment	
		STAT, Normal, Clinic Collect
	At 90 minutes post Glucagon injection		
	☐	POC glucose	Once	S	1 treatment	
		STAT, Point Of Care
	Capillary blood glucose at 90 minutes post Glucagon injection		

At 120 Minutes 	

	
	Interval	Defer Until	Duration	
	☐	Growth hormone	Once	S	1 treatment	
		STAT, Normal, Clinic Collect
	At 120 minutes post Glucagon injection		
	☐	POC glucose	Once	S	1 treatment	
		STAT, Point Of Care
	Capillary blood glucose at 120 minutes post Glucagon injection		

At 150 Minutes 	

	
	Interval	Defer Until	Duration	
	☐	Growth hormone	Once	S	1 treatment	
		STAT, Normal, Clinic Collect
	At 150 minutes post Glucagon injection		
	☐	POC glucose	Once	S	1 treatment	
		STAT, Point Of Care
	Capillary blood glucose at 150 minutes post Glucagon injection		

At 180 Minutes 	

	
	Interval	Defer Until	Duration	
	☐	Growth hormone	Once	S	1 treatment	
		STAT, Normal, Clinic Collect
	At 180 minutes post Glucagon injection		
	☐	POC glucose	Once	S	1 treatment	
		STAT, Point Of Care
	Capillary blood glucose at 180 minutes post Glucagon injection		

At 210 Minutes 	

	
	Interval	Defer Until	Duration	
	☐	Growth hormone	Once	S	1 treatment	
		STAT, Normal, Clinic Collect
	At 210 minutes post Glucagon injection		
	☐	POC glucose	Once	S	1 treatment	
		STAT, Point Of Care
	Capillary blood glucose at 210 minutes post Glucagon injection		

At 240 Minutes 	

	
	Interval	Defer Until	Duration	
	☐	Growth hormone	Once	S	1 treatment	
		STAT, Normal, Clinic Collect
	At 240 minutes post Glucagon injection		
	☐	POC glucose	Once	S	1 treatment	
		STAT, Point Of Care
	Capillary blood glucose at 240 minutes post Glucagon injection		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	Once	S	1 treatment	
		650 mg, oral, every 4 hours PRN, mild pain (score 1-3), Starting when released, Until Discontinued
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	diphenhydrAMINE (BENADRYL) tablet 25 mg	Once	S	1 treatment	
		25 mg, oral, every 6 hours PRN, itching, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	Once	S	1 treatment	
		25 mg, intravenous, once PRN, for minor infusion reaction, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg	Once	S	1 treatment	
		50 mg, intravenous, once PRN, for severe infusion reaction, Starting when released, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.5 mg	Once	S	1 treatment	
		0.5 mL, subcutaneous, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Once	S	1 treatment	
		100 mg, intravenous, once PRN, for infusion reaction, Starting when released, Until Discontinued		
	☐	promethazine (PHENERGAN) tablet 25 mg	Once	S	1 treatment	
		25 mg, oral, every 6 hours PRN, nausea, vomiting, Starting when released, Until Discontinued		
	☐	sodium chloride 0.9% infusion 250 mL	Once	S	1 treatment	
		250 mL, intravenous, once PRN, Hydration, Starting when released, Until Discontinued