I am a new nurse. Still learning and afraid of getting in trouble or hurting my patients.
my patient has been refusing meals. Given ensure with some encouragement and had dinner time BS sugar of 269
humalog 5 units after meals
and SC humalog - so (from what I remember, 3 units? Is what I gave
i held the 5 units due to her not actually eating anything. She took maybe 1/3 of the ensure.
my preceptor says I was wrong and should have not held the additional 5 units.
what do u all think? I am learning and just curious what others would have done
Sep 3, '17
Btw I meant sliding scale not sc... sorry I am tired
Sep 3, '17
I would have given normal long acting and withhold sliding scale. Ensuring recheck of bgls 1-2hrs later
Sep 3, '17
This can sometimes seem like a gray area & not everyone will agree on the best course.
What does policy say? My facility policy is to hold short acting insulin if less than 50% of meal is consumed . This is part of a protocol order set which also includes orders for D50 prn for results <60.
You say she had been refusing meals. Did you go back in the chart & look at what her blood sugars had been running? Was she usually well over 200 like she was for you? Had other nurses covered her with the ordered dose + sliding scale? If you look at the trends, you'll be better able to tell if it is safe to give insulin even if she isn't eating so well. Some patients' diabetes is so poorly controlled that giving insulin with little intake is not going to bottom them out. Perhaps she normally is 350+.
Now, on the other hand, if this is the first day she has started refusing meals, it is appropriate to be more cautious & perhaps hold short acting insulin all together. (You don't mention long acting insulin; always give long acting unless you get an order to hold.) Does this person even take insulin at home? Physicians at my facility frequently order sliding scale insulin on diabetics who only take oral hypoglycemics at home which makes it a little more difficult to know exactly how a patient will respond.
This would probably have been best discussed with your preceptor at the time to help you work thru it. Did she give her rationale for giving the full dose? Are you in a LTC facility where perhaps your preceptor knows this resident very well & knows that the extra insulin will likely be tolerated well?
Your charge is also a good resource to give you direction & if nothing else, sometimes you just have to call & ask the MD what they prefer & get parameters. And make sure you have access/orders for D50 if needed.
Sep 3, '17
I don't understand - did you give 3 before dinner? The 5 units after dinner should've been ok either way (whether you gave 3 before dinner or not), because the patient had 269 plus the bit of Ensure, but they might end up a little low in that scenario.
I do hate 'set' amounts of insulin, though, because obviously, someone's blood sugar always varies. I NEVER give a set amount without checking their blood sugar level first.
Last edit by djh123 on Sep 3, '17
Sep 4, '17
As far as I'm concerned, you did 100% the right thing. You gave the correction dose (SC). Now we can argue that 3u isn't going to correct 269, but you followed the order.