Insulin question - page 2

Pretty much every patient that I have taken care of has been on sliding scale insulin or an insulin gtt. So I completely understand checking the BS before injections or according to protocol, then... Read More

  1. by   CarVsTree
    The SSI insulin was held. The accucheck was before breakfast. The pt ate 100% of his tray. The scheduled insulin was given at 9 without checking the BS again. The next AC check was done before lunch...that was the low BS.
    This is where the error occurred. Giving insulin because someone ate makes no sense unless they were on carbohydrate coverage which is a whole other ball o' wax.

    Did you guys talk to your instructor about all this? What did she have to say? I don't see the learning experience. You're at clinicals to learn and it sounds like your instructor is leaving a lot to be desired here.
  2. by   nurse4theplanet
    Quote from suemom2kay
    I'm still confused... You were a STUDENT in charge of a STUDENT??? Where was the instructor in all of this?
    This is our final semester. It's geared towards nursing leadership. In previous clinicals in past semesters we are responsible for our own pts under the leadership of the CI alone. In our last clinical rotation a student is assigned as charge nurse (everyone gets two chances to charge) and has three of their peers to supervise at one time. We make the assignments, get report, pass on report, check to make sure their charting/meds are given on time, assist the students with procedures, make sure they are checking pt charts and staying on task. The CI is responsible for everyone but it trains you for leadership responsibilities.
  3. by   nurse4theplanet
    Quote from suemom2kay
    This is where the error occurred. Giving insulin because someone ate makes no sense unless they were on carbohydrate coverage which is a whole other ball o' wax.

    Did you guys talk to your instructor about all this? What did she have to say? I don't see the learning experience. You're at clinicals to learn and it sounds like your instructor is leaving a lot to be desired here.
    The insulin was not given 'because the pt ate breakfast'. It was given because it was a scheduled dose, and I cannot remember the exact order (which I take full responsibility for), but it was not regular or long acting insulin...I am sure it was an intermediate insulin. The scheduled dose was ordered to be given (if it had been on the floor) at the same time as the SSI, but the sliding scale was held because the BS was within normal limits. All medication is checked by the CI with the student administering the medicine, not with the student charge nurse. The scheduled dose (from my understanding of the information I am receiving here) would not have been held unless the BS was low. What complicates the problem is that the scheduled insulin was not in the pt's med drawer at the appropriate time it was supposed to be administered. It came up an hour and a half later after the student had gotten the go ahead to give it from the CI at the appropriate time. The student gave the medication without my knowledge or the rechecking with the CI...I guess she assumed it was okay. No BS was taken before giving the scheduled dose. When the next accucheck was due for the SSI...the low blood sugar reared its ugly head. Nothing was said to the student or to me that a mistake was made on our parts by the CI. It was only after I got home, that the incident started to bother me and I had all these questions about scheduled insulin. So I came here for insight.

    Like I said, we should have taken the BS before giving the scheduled dose, because it was an hour and a half after it was initially supposed to be administered. If it had been in the med cart on time, it would have been administered anyway because the morning BS was not abnormally low. I have learned a very important lesson here.
  4. by   vegnurse21
    I cannot stress enough (even as a brand new nurse) how important it is to recheck blood sugars that are either <70 or >300...I had an aide come up to me once and said a pt's BS was 453. Well luckily I was in orientation still and my preceptor said to check it again. Well, we did and he was 124. Checked again on the opposite hand and it was 128. Can you imagine what would've happened if the guy had 12 units of insulin?! Phew. Definitely a learning experience cuz my immediate thought was 'give insulin NOW!'.
  5. by   CarVsTree
    Quote from asoldierswife05
    The insulin was not given 'because the pt ate breakfast'. It was given because it was a scheduled dose, and I cannot remember the exact order (which I take full responsibility for), but it was not regular or long acting insulin...I am sure it was an intermediate insulin. The scheduled dose was ordered to be given (if it had been on the floor) at the same time as the SSI, but the sliding scale was held because the BS was within normal limits. All medication is checked by the CI with the student administering the medicine, not with the student charge nurse. The scheduled dose (from my understanding of the information I am receiving here) would not have been held unless the BS was low. What complicates the problem is that the scheduled insulin was not in the pt's med drawer at the appropriate time it was supposed to be administered. It came up an hour and a half later after the student had gotten the go ahead to give it from the CI at the appropriate time. The student gave the medication without my knowledge or the rechecking with the CI...I guess she assumed it was okay. No BS was taken before giving the scheduled dose. When the next accucheck was due for the SSI...the low blood sugar reared its ugly head. Nothing was said to the student or to me that a mistake was made on our parts by the CI. It was only after I got home, that the incident started to bother me and I had all these questions about scheduled insulin. So I came here for insight.
    I see, now this is making sense to me. I thought the student gave the SSI insulin after the pt. ate. Didn't realize it wa scheduled insulin. Therefore, it was not in error. And I don't think I would have re-checked at that point. Looks like the pt's insulin schedule needs to be revised.

    I still don't like the idea of a student being in charge of a student though. We "pretended" to be in charge when I was in my last semester, but we never oversought the administration of meds. In real life charge nurses don't make sure people are giving meds on time either. They help when needed.

    Don't feel bad, pt. just bottomed out. Thanks for clarifying everything and don't sweat it.

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