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Discussion

Could I get help with a case study?

I am a first year nursing student so I am sure that I am over thinking this! The pt. is in the hospital for CAP. He is a diabetic who is on metformin and rosiglitazone and has a regular diet ordered, for his type 2 diabetes. The doctor ordered maintence IV of D51/2NS. One of the questions asked if this is an appropriate fluid choice. The question says nothing about his glucose levels so I'm assuming his diabetes is managed just fine. I am thinking that the D51/2NS is appropriate because he probably isn't eating very much since he is so sick. The dextrose probably won't cause his blood glucose to spike, and if anything it will help him from becoming hypoglycemic. Am I on track with my thinking?

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    Remind me what CAP stands for.

    Never mind, it's pneumonia, got it... Um... The D5 is okay, I've seen many'

    diabetics placed on it. It's not enough dextrose to make their blood sugar

    levels spike too high. The 1/2 NS, I think will provide the patient more

    hydration than just NS. So I'm voting yes, it's appropriate.

    I don't do Med/Surge anymore, haven't for a few years, so I have some

    difficulty with this stuff sometimes. =)

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    The amount of dextrose in the IV is not going to affect blood sugar.

    In the hospital setting.. I would refer to the doctor for the rationale.. and my friendly pharmacist!

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    • Author

    Thank you!

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    • Experts

    I think the patient might need to be on a diabetic or consistent carb diet? Even NIDDM have sugar issues when their body is under stress. We still accucheck them and have sliding scale to cover them while in the hospital. They go back on just the oral meds when they go home. Also any steroids can affect their sugar.

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    If he's controlling his diabetes very well on just the medications, I think a regular diet would be fine, otherwise a constant carb diet would be better. The D5 is not going to be a huge issue unless his blood sugar is whacko, and/ or he's got a fine appetite and is gobbling up all of his food and asking for seconds.

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    If this is truly 1st year, your instructor is looking for you to simply be worried about Diabetes AND D51/2 IVF - the above while true, dug deeper into patho and metabolism of the IV but if its 1st year just say you're worried until more info is provided and connect the diabetes with it.

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