Diabetes question

[dennall]

We are studying diabetes and were given an assignment showing some doctors orders. We are to explain why the order is right or wrong. Maybe I am not understanding, but I just don't feel I was given enough information. I am especially having trouble with #3 on the the list which I copied below. I really would appreciate help, thanks.

Physician Orders for the seriously ill Diabetic patient

1. Regular diet

2. Up ad lib

3. Start an IV D5W @ 80cc an hour

4. Measure & Culture wound on Right leg

5. Call results when available (what other info will the physician ask for if any?)

6. Daily dressing change using kaltostat & cover

7. Daily weight

8. VS every 4 hours

9. Start Vancomycin IV 15mg/kg/per dose every 12hours at 12Noon & Midnight run over 60 minutes (what rate should this IV be set at? What is Vancomycin mixed with?))

10.Peak & Trough on 3rd dose

11. Blood Glucose at 0800, 1200, 1600 & 2000 call

12. Continue Humulin 70/30 --18 Units in am

13. Regular Insulin/ sliding scale

350 and above - notify physician

250-300 6units

200-249 4 units

150-200 2 units

14. Blood cultures x 3

15. MRSA precautions

[PsychNurseWannaBe, BSN, RN]

Hi,

I think you have enough information.

You have a seriously ill diabetic patient... do you think they should get a regular diet or maybe a diet with no concentrated sweets (NCS)? So for me... I would question this order.

So just keep thinking about a seriously ill diabetic patient and the ramifications, medical and nursing interventions and answer accordingly. If you are still are a little confused, I would suggest you re-read your pathophys book regarding DM.

[Daytonite, BSN, RN]

The patient is seriously ill; is on Vancomycin which is a very potent antibiotic which tells me that they must have a whopping infection on the leg. The patient's blood sugars are being monitored and being covered with Humulin and sliding scale insulin every four hours during waking hours. With a serious infection you can expect high blood sugars in these patients. A liter of D5W contains 170 (or 200) calories depending on how you calculate it, so in a 24-hour period this patient will get 326 (or 384) calories along with the calories he/she consumes with their food.

What is your feeling about the diet? I'm not as bothered about the IV fluid as I am about the diet. Normally NS or 1/2NS is ordered for diabetics. However, there are electrolyte problems with long-term infusions of these two fluids. Chart of Commonly Used IV Fluids [attach]5949[/attach]