Pls help, dumb ? abt insulin & ss

[lyceeboo]

I'd really appreciate it if anyone could answer a quick question about sliding scale coverage. I'm an RN and just started working LTC night shift. Last night at 2:00 am one of our diabetic residents awoke with pain in her right foot and requested her prn vicodin. After giving the pain med I assessed the foot for circulation motion and sensitivity and found nothing unusual.

So I decided to check her sugar since we were taught in school that this is an independent nursing action. Her BS was 325 and she has orders for sliding scale coverage. My question is can a nurse administer the sliding scale insulin after doing a random accucheck? It seems most ss orders read "acccucheck at 6am and 9pm with sliding scale for BS > 200." Or something to that effect.

She ended up asking to go to the ER because the pain became more severe. The ER doc gave her Demerol and insulin coverage then sent her back. I probably should know this but...if she hadn't gone to the ER could I have administered the sliding scale without waking the nursing home medical director?

I'll ask the DON when I go back to work Wednesday but would appreciate any feedback. Many thanks!!

[lyceeboo]

S/S hypo or hyper? Well she looked kind of drowsy/tired but I'm new to the NH so I don't know what this residents baseline energy level is. Then again we all look tired at 2am! Guess I checked BS because I was thinking diabetic neuropathy. (I did VS too just to have the info available if I needed to call the doc.)

This may sound manipulative but I felt that by demonstrating my genuine concern and giving her a lot of attention I could get a better idea of what was causing her pain. ie -- She may have been in moderate pain but also suffering from lonliness. I couldn't tell because I don't know her well enough.

She did seem much happier and showed fewer s/s pain when the CNA started making such a fuss about how I needed to sent her to the ER right away. But like they taught us in shool...The pain level is anything the pt says it is!

BTW do you know why it says warn at the bottom of my last reply? Guess I'll have to check what those symbols mean. Thanks for your feedback ktw! Have a good one.

[ktwlpn, LPN]

S/S hypo or hyper? Well she looked kind of drowsy/tired but I'm new to the NH so I don't know what this residents baseline energy level is. Then again we all look tired at 2am! Guess I checked BS because I was thinking diabetic neuropathy. (I did VS too just to have the info available if I needed to call the doc.)

This may sound manipulative but I felt that by demonstrating my genuine concern and giving her a lot of attention I could get a better idea of what was causing her pain. ie -- She may have been in moderate pain but also suffering from lonliness. I couldn't tell because I don't know her well enough.

She did seem much happier and showed fewer s/s pain when the CNA started making such a fuss about how I needed to sent her to the ER right away. But like they taught us in shool...The pain level is anything the pt says it is!

BTW do you know why it says warn at the bottom of my last reply? Guess I'll have to check what those symbols mean. Thanks for your feedback ktw! Have a good one.

Gotcha..A little TLC goes along way in LTC.Sometimes we don't have much time to offer it...And when all you can do is lie in bed you do tend to focus on all of your aches and pains-and she probably does have some neuropathy.We use lots of neurontin and lyrica with good results.It's a shame your ltc does not contract with a private ambulance service.We do and never have to feel as though we have wasted the administrator's dime on a run to the er...(the warning at the bottom of your post is for keeping a running tally of how many times you violate the TOS-anyone can click on it to alert the mods if they feel offended by something you've written.Things are kept pretty civilized on this board)

[AfloydRN, BSN, RN]

Call the Md. S/S insulin is to be given @ a specific period of time. If you give it that late and she doesn't eat and it bottoms her sugar out, then what?

[kukukajoo, LPN]

It is very common to have less insulin control overnight esp in elderly. We had a home health pt who needed a nurse overnight because although she was fine during the daytime hours, her levels went crazy at night and this is when she was in the most danger.

[CoffeeRTC, BSN, RN]

Being in pain could have made her BS increase too.

In LTC, our orders read something like this. "Accu checks BID with sliding scale coverage using regular inuslin (sliding scale is listed)." Of course you can always do a prn check, but you don't have an order to cover it...you would need to call the doc for it.