I'm a new RN, and new to home health. I'm doing shift work (spent 8 hours with the patient over night). Mom does all care during the day. I'm in the home 2 nights a week. I'm looking for someone with more experience for input on whether this is "normal" or common in the disease process. Short and sweet:
12Y old male, DMI, gets Novolog insulin by insulin pump using a bolus wizard. Manual dose calculations for meals inputted by Mom. On TPN and Lipids at night, also initiated by Mom infusing to a CVC.
Mom is Spanish-speaking only, kid's bilingual. Spoke to the RN case manager on the case who states she had him for almost a year and he was just as poorly controlled as he is now. Over 600 and into the 800's several times in a month (or even in the same week). Full time RN on the case states same. Also had a history of hypoglycemia between 0400 and 0600 for previous RN's down into the 30-50 range. I've read about the dawn phenomenon and wonder if this is what has occurred - though the patient never had rebound hyperglycemia?
It just seems like I'm missing the "whole picture" ... The other RN seems so unconcerned. And when he went to over 600 with the other RN the night before I came on, she brought Mom in to give insulin (as the pump won't deliver on a BG that high). But didn't document an MD call or follow up ... Or even that she had Mom check for ketones. Am I not understanding something? Am I overreacting? Do patients have Diabetes that is this poorly controlled without ramifications to their future health?
Thank you for any and all input. I know we "newbies" often miss the clinical picture.
