I'm a CNA on med surg floor where I am responsible for taking accuchecks in the am and then reporting to the nurse. I'm trying hard not to sound dumb but here goes.
I hear of so many kinds of insulin. Could someone please explain why a certain type of insulin is used on a pt? Also, what do you consider a low bs that needs to be treated? My hospital says anything below 60 needs to be treated but wouldn't I also need to take in account what symptoms the pt is exhibiting? For ex, last weekend at work I took a pts bs and the result was 73. She was diaphoric (sp), checked vitals they were stable. She said that she felt like she had low bs. She lives with diabetes so I'm inclined to believe her. But according to policy, I should not have given her OJ. Yes, the nurse was notified and I did give her OJ. She wasn't happy that I had to interrupt her report.
I take accuchecks at approx 0700 when day shift nurses are just arriving and night shift are leaving the floor. It is common for the aides to be on the floor alone for up to 30 mins until a nurse appears on the floor after receiving report.
When I said earlier that I report the results to the nurse, that means the results are given sometimes 30-45 mins after the bs were taken, unless of course a result was abnormal. So it's up to me to determine what's abnormal when abnormal to me may be normal to that particular pt.
For low bs, what is the usual course of tx? Do you give OJ or OJ with sugar, etc. NO ONE has ever told us anything concerning this. There are no manuals laying around where I can look this up.
And could someone please explain the carb deal at meal times? I have googled everything but I prefer to hear it from nurses who work the floor.
Oh, and did I mention I'm looking for other jobs? I just don't feel safe working in this environment anymore. No nurses on the floor while in report? Is this normal?
I apologize that this is long but I am very curious. Thank you!
At my hospital, a BG below 70 mg/dl is considered low enough to treat. However, it a pt has become accustomed to high BG levels, s/he might have symptoms of low BG even at 100 or 120. Also, the glucose meters are not exact. If the machine says 73, actual BG might be anywhere from 60 to 90.
If the pt has symptoms, treat them, but don't go overboard. (Nurses tend to over treat low BG.)
Standard treatment for low BG is 15 grams of fast acting carb. 4 oz juice without added sugar will do the trick. (No OJ for dialysis pts--too much potassium). Another choice is 8 oz of skim milk. If pt is within one hour of next meal, just recheck BG in 15 minutes. If next meal is more than 1 hr away, give snack of slower acting carb (starch) such as 1 slice of bread, or roll, graham crackers, or peanut butter & crackers.
If pt is NPO and has symptomatic low BG, don't hesitate to get the nurse out of report!
Many doctors still give Regular insulin, because it's what they learned in med school. However, it's no longer considered the best choice. It takes too long to act (should be given 30 to 45 minutes before meals). Novolog or Humalog are better choices for mealtime insulin because they start to work much faster and can be effective even if given in the middle of the meal.
Lantus and Levemir are newer long acting insulins given for basal needs (insulin required even when person not eating). NPH (cloudy insulin) is one of the older intermediate acting insulins, but requires 2 injections daily--one before breakfast and one at bedtime.
Your post points out a common problem in many hospitals. BG checks may be done at 0700 to 0730, but insulin and meal may not be given until 0800 or 0830, when BG may have changed significantly. In my hospital, I've seen as much as a 2 hour gap between the time BG is checked and time insulin is given. This is not good practice.
Hope this helps.
Last edit by Myxel67 on Apr 1, '07