D5 1/2 NS and insulin coverage - page 2
What are your thoughts? Pt has a history of DM. Pt has a GT feeding which is being held for surgery. Pt on 1/2NS IVF. I called the MD and received an order to change to D5 1/2NS (I was worried about his glucose level). PRIOR... Read More
- 0Oct 3, '11 by ShortStackRNI would not have covered it. Yes there are some medications that you should have an MD permission to hold but your nursing judgment and critical thinking should come into play here. Several of you have stated that you will ask an MD before holding anything...does that mean that if your patient has a BP of 90/60 at 1am you're going to wake the MD up to tell him that you're going to hold the med? If so then I imagine you have a lot of upset docs on your hands.
In my facility we use a barcode scanning system which gives you an option to exception off medications with reasons like "clinical decision, Low/Normal BP, Low BG, etc."
My thought process on insulin is that I do not administer if it is like your patient at 153 if the patient is NPO ESPECIALLY if it's a high dose algorithm. You could be asking for a major drop. Of course as many have stated you can administer D50 if need be, however by doing this you are a.) compromising your IV site and b.) their blood sugar is going to rise dramatically and it will become a vicious cycle.
I also work on a diabetic floor so we deal with this day to day. Hope this helps.
- 0Oct 3, '11 by birdie22Unless the blood sugar is greater than 200, my personal philosophy is NPO=no insulin. I always like them a little on the high side than on the low side. And when I have to list a reason on the EMR as to why I didnt administer insulin with a BS of 185 or something, I put 'Pt. not eating/NPO' or something like that.
- 1Oct 17, '11 by Soon2BNurse3We have a sliding scale at my hospital & once pt is NPO we switch to doing the accu chks Q4. We have different algorithms & depending on which one it is, we would definitely cover the pt. For 153, I think we'd only give 1 unit but we definitely don't use our discretion with insulin...we follow the guidelines.
- 0Oct 29, '11 by bryanvalefor me i will still still give the ordered dose..since in our hospital anaesthesia doctors will call for a consult for diabetic patients..then IM doctor will order for NPO and will put the patient in sliding scale.. and to check the BS q6h or more frequently if the BS is very high..and the doctor will also will order for ivf usually D5W at a slow rate..