u/Legitimate_Jelly_118

I'm a nurse, and a lot of the standard order sets for our patients come with a set of default parameters around when to notify the provider that I typically sort of ignore because I assume that clogging up your inbox with a bunch of messages every time there's a vital sign or blood sugar check thats slightly abnormal but asymptomatic, unchanged, or not clinically urgent seems annoying and distracting, and I feel fairly confident i exercise good judgement when it comes to VS notification.

But, I am kind of curious about the BG checks. Our standard orders for all diabetic patients say to notify the doctor anytime a fingerstick is >150 which seems insane to me, especially bc we don't even give sliding scale insulin for BG <180. In practice, nobody actually follows those order parameters as written on my floor, but I'm just curious if there's a clinical reason or scenario in which the doctors actually would want to be notified every time a blood sugar reading was >150? Maybe for DKA patients I can imagine wanting that kind of aggressive notification, but is there any other scenario where you'd want to be urgently notified about the results of standard BG checks? Typically I only notify for hypoglycemia, excessively labile BG checks throughout the day, or BG >300, and even then i consider it more of an update/providing information to reevaluate insulin orders rather than an urgent notification most of the time. Just curious if there's somethign im overlooking here that I should be considering.

I've been getting a lot of tiktok content from POTS creators lately and I genuinely just can't understand the treatment for POTS without glitching out. Maybe its because I've spent my entire nursing career working on various cardiac floors, but I just can't seem to wrap my head around the almost outrageous daily sodium intake requirements these patients are treated with. I get that the goal is to treat fatigue & orthostatic symptoms by increasing blood volume in order to increase perfusion to the brain. But I think the part that loses me is that these patients aren't actually hypovolemic right? The root of the problem as I understand it, isn't a volume issue but a circulation issue caused by nervous system dysfunction. Their BP remains stable. So the excessive recommended sodium and fluid intake to expand blood volume is more about targeting symptom management rather than targeting the disease process itself right?

Again, I know this is probably just my bias coming from the world of inpatient cardiac care where sodium and fluids are basically the ultimate boogeymen and managing preload is treated with the utmost meticulousness and care, but i just don't understand how increasing blood volume in a euvolumic patient for symptom management is an effective do no harm approach to healthcare. I get that these are mostly young patients with healthy functioning hearts and kidneys, so concern over their bodies ability to self regulate hemodynamics & fluid balance might be limited, but I've seen plenty of previously healthy patients go into cardiogenic shock or develop cardiomyopathy in pregnancy & labor due to the massive increase in maternal blood volume and the strain it puts on the heart. I guess I just worry that intentionally increasing BP and blood volume in non hypotensive, non hypovolemic patients feels like an insanely short sighted approach in a country where like 90% of all mortality & morbidity is the direct result of hypertension and cardiovascular disease.

What am i missing here??