Help with Prioritizing Interventions

[RStudentRN]

Hello I am new to this and I hope I am doing it correctly... I need some extra help with this worksheet about Diabetes.

This is the Scenario given:

The nurse is assigned to a 56 year old female. She was admitted with the Diagnosis of end-stage renal disease. She has a 30 year HX of Type 1 DM. She is scheduled to have hemodialysis this AM. The night nurse indicated that she has a 2-cm dry, ulcerated circular area on the lateral outer aspect of her right great toe and an AV fistual in the right forearm. She has an order for NPH Insulin 15 units Sub-Q qAM and blood glucose fingersticks ac and HS. It is 0730 when the nurse get out of report and breakfast arrives on the unit at 0800.

The Interventions Given to Prioritize are:

1) Check chart for blood glucose fingerstick results

2) Assess AV fistula

3) Administer NPH 15 units Sub-Q

4) Get patient ready for breakfast

5) Perform a body systems physical assessment

It say's rationale why you put the interventions in order as you have.

So I though first the chart should be checked for fingerstick results because breakfast will be here in 30 min, Second perform the assessment on the patient, Third administer the NPH insulin because she is about to eat, Then get the patient ready for breakfast because the insulin was administered, Last assess AV fistula after she eats.

I have tried several ways to do this but there seems to be something that I am missing. If you have a different way that you would do these interventions please let me know. Thanks

[Daytonite, BSN, RN]

1) Check chart for blood glucose fingerstick results - maintain disease management protocol

2) Administer NPH 15 units Sub-Q - maintain medication management of disease as per hospital protocol. Insulin is usually given prior to meals.

3) Perform a body systems physical assessment - with nothing else on my list of things to do for the patient I would take the time while in the room with the patient after given the Insulin to perform the daily physical assessment. That will include. . .

4) Assessing the AV fistula

5) Get patient ready for breakfast - because the breakfast tray should be coming by the time I have completed the above tasks.

[neneRN, BSN, RN]

I agree with Daytonite- that's the order I would go with in the real world. But the textbook type answer your instructor might want may be different; just thinking about the nursing process (ADPIE), where you always assess first?

[truern]

The Interventions Given to Prioritize are:

1) Check chart for blood glucose fingerstick results

2) Assess AV fistula

3) Administer NPH 15 units Sub-Q

4) Get patient ready for breakfast

5) Perform a body systems physical assessment

It say's rationale why you put the interventions in order as you have.

So I though first the chart should be checked for fingerstick results because breakfast will be here in 30 min, Second perform the assessment on the patient, Third administer the NPH insulin because she is about to eat, Then get the patient ready for breakfast because the insulin was administered, Last assess AV fistula after she eats.

That all sounds okay, but NPH is an intermediate acting insulin with onset about 2 hrs after administering, peaks 4-12 hrs later, and has a duration of about 18-24 hrs.

In your rationales it sounded as though you were describing regular insulin.