Abdominal pain??

[turtles]

Hi everyone,

Today I did an assessment on a patient in an institution I am doing clinical at, let me know what you think:

Male in mid 40s, presenting with Left upper quadrant abd. pain. radiating to other quadrants. Pain on VAS scale was 9 out of 10 and increased on palpation, BS present x4, BP-110/78, O2S - 98%, P-89, T- 36.6, R - 17. No constipation or gas. Hx of cirrhosis of the liver and is a Type 1 diabetic. His BS was 21.5. He appeared slightly jaundiced. After assessment I gave him 60cc of insulin and transferred him to ER. They admitted him with abdominal pain with unknown cause and are doing further tests.

So does anyone have any ideas what this man could be suffering from? (I figured it may have had something to do with his liver) and whether I could have done anything else/better in my assessment? thanks for your advice....

[cardiacRN2006, ADN, RN]

21.5 mmol/L (387 mg/dL)

Multiply by 18

What are mg/dl and mmol/l? How to convert? Glucose? Cholesterol?

So, IMO, 6 units is not enough for a BS of 387.

[Antikigirl, ASN, RN]

My hospital is doing this wierd thing with diabetics. Not only do you do a certain sliding scale with novolog back up, but now you have to count carbs a pt eats and divide it by 15 and the number gotten is the amount of units of novolog insulin to give. It is driving me nuts!

I can't be assured that that patient ate that much (maybe a family member ate some?), subjective between people on guessing anyway, and what do you do in cases of emisis? Oh and don't get me started on NPO status but they snuck in a snack a family member brought! UHGGGGGGGGG. I think it is insane and a huge liablity!

Anywhoooo..when I hear of CBG I hear it as say 215, and know it is high and look at my orders on sliding scale for what range the MD wants insulin tx on, and it is written how much. Norm for fasting is above 120 high, below 80 low. But I had to giggle and grown when I couldn't remember the unit of measurement anymore because it is just how our glucometers work...LOL!

So I looked it up! MG/DL for us...if you need a different scale or what not...lab is called in for a blood draw. If we get results above 350 or below 65 a blood draw is done and needs to be ordered by our policy (and MD notified).

[GeminiTwinRN, BSN]

has anyone evaluated this gentleman for a PE? we recently had a pt come in with similar symptoms and the intensivist caught a PE.

just a suggestion. the belly pain, the acidosis, the blood sugar, etc all could point to PE.

[vampiregirl, BSN, RN]

.....

[turtles]

So when I went in today, patient was still in hospital undergoing tests. They have concluded that it is either pancreatitis or some sort of renal/bowel cancer! But that is all the info I could get, they are still doing tests. Thanks for all your thoughts.