covering an npo pt

NeuroICURN · Feb 5, 2004

You should cover it.

It's not as though you are covering a pt that's in the 100s. You also imply that the person's BGM is this high without even eating, so that's yet another argument to cover it. The fact remains that the pt. is high! And most sliding scales are such that while it will drop the blood sugar, it's not usually gonna drop it to a dangerous level from 300!!

Also, you know when your insulin peaks and you should ALWAYS be watching for a hypoglycemic reaction.

If all else fails, ask the MD if he still wants to use coverage.

Hope this helps.

caroladybelle, BSN, RN · Feb 5, 2004

Originally posted by milicarr
i have a question...
if i have a diabetic on a sliding scale who is npo for surgery, and the 11 am bs is 300. do i cover with insulin? i was under the impresion that you do not cover them. but there is another nurse who said that i should. i have tried looking for the answer in manuals. and every nurse i ask tells me that no, do not cover. who is right? and can i get any refrences so i can show this nurse if she is right or wrong. ty

It depends on the MD. While most generalists will opt to not cover (figuring to play it safe and easy) , quite a few Endocrinologists have a formula for covering NPO patients, and administering partial doses of scheduled NPH/or 70/30 to maintain stable blood glucoses during an NPO period. However, given that surgery/procedures frequently get rescheduled, one cannot count on them occurring on schedule.

What would be optimal, would be for diabetics to have their procedures on schedule and in the AM, and to receive decreased doses of insulin, ordered by a diabetic specialist. Also, for MDs to obey newer guidelines, that patients only need to be NPO for 4 hours prior to surgery. However, given the current state of profit motivated healthcare (Let's keep the pt NPO all flipping day, because we may "possibly" be able to fit them in - to heck with what is healthy for them), what is optimal is frequently not done. And when was the last time, that one of your patients was seen by a diabetic specialist before surgery>

Dayray, RN · Feb 5, 2004

Call the doc.

This patient needs insulin. While 300 may not be to high for them it defiantly needs treatment. However, you don't know how the patient will react to xx units of regular insulin but hopefully the doc that manages their insulin will know. Every diabetic is different some will bottom out fast and others are hardly effected by insulin.

This is one of those situations where you don't want the consequents (either of giving insulin or not giving it) on your license, so you call the doc and let them take the responsibility.

RNPATL, DNP, RN · Feb 5, 2004

I would cover the patient. A BGM of 300 is high and should be covered, but when you are in doubt like that, it is always a good thing to call the physician and let them know to see what action they may want you to take. He/she may cut the sliding scale down a little as a pre-op order and them reinstate the normal sliding scale after surgery. It is worth the call to the doc.

fourbirds4me · Feb 5, 2004

We usually cover (depending what type of fluid they are on). Some of our doc use D5LR. IMHO I think this works well because they are getting some sugar/nutrients to offset hypoglycemia.

L&D_RN_OH · Feb 5, 2004

I would cover it. You can't count on them being NPO to decrease the blood sugar, and the stress of surgery can increase BS.

What type of IV fluid are you using?

cannoli · Feb 5, 2004

I agree with covering it.

Do you have an education nurse or a MD or a Diabetic Educator who can give an inservice to all the staff so that everyone has the same understanding of what is involved? Use those people as resources and spread the wealth of knowledge.

SmilingBluEyes · Feb 5, 2004

We would cover it but with regular insulin, not long-acting insulin.

Yes 300 needs to be treated, as others state, bs can skyrocket in stressful events such as surgery. They can also plummet in these cases. Diabetics, especially brittle ones, can be very labile and need tight control/monitoring at all times.

milicarr · Feb 7, 2004

thanks for the replies.

i have been more actively pursuing to have an endocrinologist to see diabetic patients at the hospital where i work. i have been working in this hospital for 6 months, and since i am a new lvn and an rn student; sometimes my opinions get overlooked. i question policies where i am told "are just done this way". i appreciate the input. i could not find a specific answer to my question in any text book.

:)

nursemary9, BSN, RN · Feb 7, 2004

Hi

I would give the coverage because the coverage is for that high sugar; 300 is absolutely too high.

I, however, would check with MD's first. Most MD's will want it but there are still a few out there who would not want it given.

This is a subject we are currently having problems with;

We have several nurses on our unit who, for some reason, never give the coverage! There is always some excuse. They simply don't get it that these sugars are too high and people are going to end up with more complications!

RedSox33RN · Feb 7, 2004

I just want to point out, as a Type 1 myself, I'm surprised the patient was not given instructions prior to surgery, especially if they manage their own care. I've had many surgeries as a diabetic, not diabetes-related, but the surgeon or his staff always gave me instructions.

Before I was on a pump, I took 3/4 of my normal insulin, then checked every 2 hours, covering high's above 200 with a unit of short-acting (I'm on small doses, even though a Type 1). They wanted to have me between 150 and 200 during the surgery, which is higher than my normal, but not high enough I'd start going through tons of fluids.

The pump has made that a lot easier, but the same still goes with checking my b.s. every 2 hours or more often prior to and immediately following surgery.