Quote from NancyNurse08
I would have explained to the patient the rationale for giving insulin to cover her, and that just because she receives insulin perioperatively does in no way mean she will be on insulin when she goes home. Then, I would have allowed her to make her choice (because the patient has the right to refuse treatment, and if she insists on no insulin, you can't force her to take it), and documented what I did and why.
The biggest concern to me is that she's eating solid food so soon after surgery. But, if she's tolerating food without vomiting, then she certainly can take her PO meds, meaning she can take her Metformin, so there's no reason she shouldn't have it if she wants it and it's ordered.
Yup I did explain to her that recieving insulin is just to cover her since she hasn't had her metformin for the day. That its not a permanent thing. She still didn't want the insulin and asked why she couldn't have her metformin since she didn't have it in the morning. (I thought good question and asked 2 senior nurses). As far as eating and drinking so soon after surgery doc gave her orders for it, she wanted to eat (we're talking very very minor surgery and nothing to do with the abdomen). So she ate right away and had no issues. I did chart what I did and that patient refused insulin.
Quote from Ruthiegal
What orders did you have for insulin coverage or giving the Metformin? I would have followed the orders or called the doc explaining the patients concern and obtaining his orders for what should follow. This outcome was good, but the next time it may not be, always consider the patients safety first. Call the doc that's what they get paid for!!
I had sliding scale orders, and orders for Metformin 1000mg PO QD. She skipped her dose of metformin since she was NPO... so technically it was a missed dose and I could have given it. I did call the doc later and discussed it with him, he had no issue with it and we rechecked her BS twice and it came back down within 3 hours. I agree I probably should have called but at the time didn't see the issue with it.
Quote from bill4745
You should have called the doc with the elevated glucose.
I didn't call since it was only 255 and she was diabetic with orders for insulin coverage and metformin, I thought a diabetic without meds who has eaten its expected to be high.
I see your points I should have called doc first just to be safe... Ugh being a new nurse is hard get such conflicting answers from everyone, at the time I didn't see it as anything to call about. And I'm fairly doc call happy.