First of all, I've been out for Medical-Surgical Nursing for so long, please explain to me as if I am a new graduate. Secondly, please excuse the way I'm posting this. I am quite confused. Thanks. =)
So, there is this patient, not known diabetic, pregnant, who is currently on sliding scale every 8 hours on Actrapid. She was endorsed to me with a blood sugar of 297mg/dl (2 hours after receiving her due insulin based on the sliding scale - 0600H).
Because I can still remember in the back of my mind that 297mg/dl is no good, I decided to check her blood sugar again at 0800H and it was at 205mg/dl (still high) I decided to give her her due 10 units of Actrapid after finding out that it's "quite" same as Regular Insulin according to the hospital pharmacist. I intended to recheck her blood sugar after 30 mins.
Should I have waited for 8 hours to pass before I rechecked her blood sugar? Shouldn't I have check her blood sugar at 0800H? The previous nurse didn't give any insulin for the 297mg/dl reading (she referred it to the resident doctor but there was no order). Are we only suppose to give insulin every 8 hours, just the same time frame as the sliding scale? But aren't we suppose to lower her blood sugar? Was I suppose to give some more time for the Actrapid to work? But they said it's like Regular Insulin and from what I remember in the ER we give another dose of regular insulin as ordered if the reading is still high. Should I have called the doctor regarding her blood sugar instead of relying on the sliding scale?
Back to my patient, I missed rechecking her blood sugar 30 minutes after because I am acting like a new nurse (chaos). Noting the trend of her blood sugar and the patient's "good" general status (that and I started questioning myself if I should only check the blood sugar x 8hrs), I settled with checking her blood sugar at 1200H. It was around 0930H when my LPN asked me if I rechecked the blood sugar (OMG, you remembered and you didn't check!)
. I said that I'll check later because of the reasons I stated above. Anyway, the patient also requested if we could move the testing later.
Is this poor judgment on my part? I think yes.
After that my senior nurse finally arrived (thank God), they took the blood sugar at 1100H which is 168mg/dl and they wanted me to give the due 4 units of Actrapid. I didn't want to because at this point in time did all those previous questions pop into my head. Also, I'm not really familiar with Actrapid. I was worried about hypoglycemia. I also happened to ask my senior if we could check the blood sugar later 2 hours post-prandial but she said there is no need because the order is q8h. (Then why did you check her blood sugar now? Because I gave insulin? But if I give another dose of insulin, aren't we definitely going to check for her blood sugar later?)
My senior said not to worry about giving another dose of Actrapid so soon because it's a short-acting drug. Still I didn't give it, for some reason I am not confident with her explanation. I feel like 168mg/dl is not detrimental compared to 200+ and is still under coverage of the Actrapid that I last gave. Anyway, my break time came, after which, I failed to catch up on that patient (because she's actually assigned to my senior and I only slightly care). In short I forgot about it only to be asked by the LPN if I gave the 4 units Actrapid as we were going home. =O (but I was on an allowed break at that time...)
Now it's haunting me.
I just recently checked the internet for my problems but there is no mention of rechecking the blood sugar after the scheduled sliding scale. There is not mention of giving another dose of regular insulin except for "give it some time".
Please educate me. Thank you.