gotta love LTC nursing...

kermitlady · Dec 6, 2008

In all honesty, I probably would have done exactly what you did. You called the doc for orders the first time, and attempted the second time. Just make sure everything is charted including how many times you paged the doc.

morte, LPN, LVN · Dec 6, 2008

you dont mention how much sugar was in the water you gave by tube..give as much by tube as you would give by mouth....and as freq...unfortunately the inst. may eat that ambulance run, since the patient was actually improving at that point......obv some adj. in insulin orders are req.!!

barefootlady, ADN, RN · Dec 6, 2008

You did a good job, doc needs to get on insulin and feedings, new orders needed.

DON needs to make a inquiry regarding supplies. Especially glucose. Good luck.

SuesquatchRN, BSN, RN · Dec 6, 2008

Clearly, reg ins isn't doing the trick for this guy.

You did good. What else could you have done?

leslie :-D · Dec 6, 2008

Clearly, reg ins isn't doing the trick for this guy.
You did good. What else could you have done?

funny...

i was just thinking how i despise lantus.

but he does sound overloaded with insulin...

esp when it's in the 250's, less aggressive tx, imo...

leslie

Xbox Live Addict · Dec 6, 2008

so, obviously the problems are understaffing, overacuity, and undersupplying.
I had a resident who was 1st night in. BS at 8PM was 351..ok, he's getting tube feeds q6hrs, ok, that's cool. gave him his 10U of scheduled regular, 8U reg sliding scale, and his 30 of lantus. Then we went ahead and gave his midnight tube feed....before I gave him the tube feed, checked sugar. 248. Gave him his 10U of scheduled regular...hooked him up. took him out at 2am...was acting fine. at 3, sweaty, confused, etc. BS of 37!!!! gave a amp of dextrose(the only amp in the ENTIRE facility). Resident is NPO, trach and tube feed. called doc...ok, don't treat the new BS of 247 after dextrose, monitor him. checked a hr later= 30!!!!....hooked him up to tube feeding early, called doc....no extra amp, so hooked him up to dextrose 5% in .45 at 80hr. gave him some sugar water in tube....
ok, hr later....still 37!!!!! called doc to see if he wanted me to send out...no call back....so me and other nurse decided to send him out.....by time the EMTs came they got 51 on their meter....so he's coming up, and making more sense. so we sent him out, I called family, and he's got a hx of this...so, I don't feel as bad. But should I have sent him out earlier??? I don't know....but I don't think I did anything wrong or too slow....advice?

You did aggressive follow-up with both the resident and his physician. Your actions were appropriate. As long as you documented your interventions and the Physician's responses, all should be good. No reasonable nurse should object to what you did. We all know how hard it is to keep some diabetic residents regulated. I would have done exactly what you would have done. The resident may benefit from your actions in the long run with titrated insulin orders.

Granted, there are a large number of unreasonable people out there, which is why you document what you did.

Jo Dirt · Dec 7, 2008

As long as it was coming down, if I couldn't have gotten ahold of the doctor, I would have probably left it alone. Glad it turned out okay, though.