New nurse and going on my first month in LTC (first nursing job) and boy, is it difficult. I don't get a break, barely pee and just overwhelmed. They say I'm doing a very good job and happy to have me, but I feel just like a bumbling idiot most of the time. I constantly question my interventions, and having a hard time building that confidence.
Here is my question, a very crazy evening and did not get a chance to check a blood sugar until about 10:15 ish, it was due at 9. It showed 62. For this resident that's pretty low, but I knew it wasn't critical. So I held the Lantus, gave a shake. About this time it was shift change, gave report and explained the situation to the night nurse, wasted my Lantus right in front of her because she said she would draw up her own. I informed her that my thought was it would be better for her to finish the shake, but wasn't going to give the Lantus until after she finished and waited a bit or so (30 mins -ish).
Well, now I realize, I really didn't need to hold the Lantus (its that slow) at all. residents blood sugar was very high the next morning around 450 something (that isn't rare for her anyhow) And resident was pleasant, calm, no s/s hyperglycemia, to her it was just another morning. But still, when I came on the next evening..... I saw that the Lantus was never given later that night after I left.
When I asked the night nurse about why she didn't give it she informed me that she can't give a medication that was ordered within my time to give. There is the "hour before and hour after" rule. But technically the Lantus is written for HS, only the BS check is for 9pm. Either way, why didn't she just tell me--hey, I'm not gonna give the Lantus? Or explain to me, "ya know, you don't need to hold the Lantus?"
So all in all, I made the error cause I made the choice to hold it, thinking I was doing the right intervention ( I did make a note on holding). Doctor of course gave me a stearn NEVER hold Lantus lecture. I respectively chalk it up to lesson learned....but I feel kinda like I got thrown under the bus here...and now I have a med error I guess? So frustrated. Just need some encouragement.
Well you learned a lesson about Lantus that you would be surprised a lot of nurses may not know! That nurse is full of it, she probably forgot and is blaming you so she doesn't look bad.
If it makes you feel any better, Im learning from your experience. Im a brand new Nurse and have not been in this situation yet, but now I know not to hold Lantus!
I understand the rationale behind not holding Lantus, but we hold it all the time where I work and I've never heard of someone getting in trouble for it. Especially if it's a new introduction and the patient's bsbs hasn't been over 70 all day. I'm going to hold it if the patient needs d50. If it's borderline I'll possibly call. Or I'll gove lantus and hold regular if bs is 120s.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I wrote a detailed article regarding Lantus several months ago. Feel free to read it by clicking on the link below. By the way, do not hold the Lantus!
I would have clarified whether to hold the lantus or not with the MD. However, next time recheck the blood sugar after giving the glucose. Then, nine times out of ten the lantus should still be given.
The other nurse was a jerk. Knowing that the patient didn't have her lantus she should have called the doctor if she felt uncomfortable giving it late. And at the 2am check the patient's blood sugar was already getting high, but the nurse on shift was apparently unconcerned about that.
Insulin is one of the most misunderstood and wrongly dosed medications. Like others have said, you learned something good. The patient probably got a correction dose of short acting insulin and her 400 blood sugar was corrected within a few hours. If you ever have a patient with a high blood sugar (really anything over 250) make sure he/she gets lots of water. The kidneys clean the extra glucose out of the blood, but need water to flush the glucose out of the system.
It's true, never hold Lantus, and I think maybe some graham crackers and skim milk would have been a better snack to give than a shake. But how are you supposed to know these things when you're a new nurse and have no experience to draw on?! Shame on the night nurse for throwing you to the dogs and letting you fend for yourself and take a med error hit instead of helping you and explaining to you! But it's minor over all, and some doctors just like to yell because it makes them feel all powerful and stuff! But put this one down in your "New Nurse" diary so that you can look back at it someday and chuckle!
My hubby actually takes his at 1900 just because there isn't as great a chance to forget, because even our 8 year knows to ask him if he has taken it. I had the same nagging thing happen my 2nd semester of school, pt was 72 and was at least 45 minutes to an hour from breakfast, his was ordered 0700, well I asked my instructor because I was going to hold it and he reminded me of the onset and no true peak of Lantus so I gave it and the pt's 1100 glucose was 122.
SwansonRN
465 Posts
Well you learned a lesson about Lantus that you would be surprised a lot of nurses may not know! That nurse is full of it, she probably forgot and is blaming you so she doesn't look bad.