New to nursing

[beckakc]

I am a lpn at snf. Recently saw an order for diabetic foot care for a pt with a dx of diabetes insipidus... is this an appropriate intervention.? No dx of dm.

[nutella, MSN, RN]

May I point you towards a webpage that contains the education you may need to answer part of your question?

Diabetes Insipidus | NIDDK

Right in the first paragraph it tells you that :

"People with diabetes insipidus have normal blood glucose levels; however, their kidneys cannot balance fluid in the body" and

"Diabetes insipidus and diabetes mellitus—which includes both type 1 and type 2 diabetes—are unrelated, although both conditions cause frequent urination and constant thirst. "

Now look at the order again:

The foot care that was ordered pertains to a person with diabetes mellitus - high blood sugar - and not diabetes insipidus - high amount of water being peed out of the body -.

Is it a valid order?

Since it pertains typically to diabetes mellitus you have to find out if the patient also in addition suffers from diabetes mellitus!

You can have lice and flies - right? The patient could theoretically have both, in which the order makes total sense. How you would know? You can look at the face sheet in the SNF that often contains the whole list of illnesses -they are often also listed on the medication administration record. Chances are that your patient - especially with a higher age or weight also has Diabetes mellitus.

Here is how prevalent diabetes mellitus is in people age 65 and over:

\Statistics About Diabetes: American Diabetes Association®

"Prevalence in Seniors: The percentage of Americans age 65 and older remains high, at 25.9%, or 11.2 million seniors (diagnosed and undiagnosed)."

Basically a quarter of those folks have diabetes mellitus.

If you find a diagnosis of diabetes mellitus the order pertains to the diagnosis and therefor does not need questioning.

If you do not find a diagnosis that pertains, the order may still be appropriate because perhaps somebody forgot to code the illness and it is not in your papers when in fact the patient has diabetes meillitus - and the doctor just knows this patient or has ordered this before.

Or the order is a "wild order" that was entered or written in mistake.

So at that point you would ask the physician and point out that you have failed to connect the order to high blood sugar /DM and if this was entered by mistake.

That way you clarify if the provider wanted this intervention or if it was entered in error.

A provider may still enter this intervention even though there is diabetes mellitus because something about the foot requires this type of care - for example vascular problems and there is just no other way of ordering it. It is just a label for a specific type of foot care that may apply to patients for other reasons.

Also hot tip: Now that you have read this - you are still new to SNF - you may want to find a trusted colleague - unit manager/ supervisor - and run your thoughts by them. There might be something that they know that you do not know. The laws of SNF are sometimes hard to understand...