Silly question: would you give insulin to a patient who was NPO before surgery? It seems like the answer could be obvious, but I am feeling a little guilty. Scenario: Mr. Smith was an elderly, diabetic patient admitted at 3am for SBO on a busy night shift. BG in ER initially was 130. I wake up the groggy resident to call for admit orders, and I forget to remind her the patient is diabetic. She states he should be kept NPO for surgery in the AM. About an hour later, I realize I didn't get an order for BG AC&HS or a sliding scale. I grab a blood sugar, and it is 185. I ask my charge nurse if I should wake the resident up again for a sliding scale order, and she states he is NPO and the blood sugar wasn't that high, so I wouldn't be covering regardless. I was hoping the resident would be in early so I could still ask before I left, but they weren't so I ended up passing it on to dayshift. I feel bad now for not covering the patient.
Basal insulins are usually not withheld because they give 24-hour coverage. But other insulins have different actions and really should be addressed by a protocol, standing orders, ot patient-specific orders.
Last edit by rn/writer on Apr 4, '12