Help! Problems At Work Re: Diabetic Pt, Rights

nightmare, RN · Jun 21, 2008

I have one like this and unfortunately because she is alert and in her right mind that is her choice! No matter what we say she is non compliant with her diabetes management and there is nothing we can do about it.I fact the more we try and persuade her the worse she gets.

Batman24 · Jun 22, 2008

Your DON is right. The patient has the right to eat sweets even if it will harm her. Chart, chart and chart some more to protect yourself. Your intentions were good here so don't feel bad but make sure you document.

nightmare, RN · Jun 22, 2008

Moved to Geriatric and LTC for more input.

bluegeegoo2, LPN · Jun 23, 2008

We had a similar situation with a man who was ESRD, out to dialysis 3x wk, A/O, who INSISTED on as much fluid as he wanted. As his nurse, I would yet again reiterate why he was on fluid restriction and the possible complications of drinking too much water and then would give him his water. I would chart something like: Res requests fluids beyond restricted parameters as rx'd. Res taught reasoning for restriction, voiced understanding of poss complications. Given 120cc fluid per res request. There! Covered my butt, and saved myself the aggravation of trying to get him to stay in compliance. We can only help those that want to be helped.

Lovely_RN, MSN · Jun 23, 2008

I have numerous residents that are non-compliant diabetics. I do the best I can to educate them about their choices and I document very thoroughly when they are participating in self-destructive behaviors. Alert and oriented patients always have the right to refuse care even if refusing care results in increasing illness or death. It used to really bug me when I was doing my best to care of a non-compliant resident but at this point I throw up my hands because I cannot care more about a person than they care for them self.

psalm, RN · Jun 23, 2008

AND we wonder why our kids don't listen to us!!!

CoffeeRTC, BSN, RN · Jun 23, 2008

Yep...you can't do much except provide them with the risk of not following docs orders. We also have a form for them to sign.

CapeCodMermaid, RN · Jun 26, 2008

As long as the resident is competent he or she can decide for themselves. Document that you've discussed the possible ramifications of eating all that sugar and be done with it. It's hard for providers to 'let' residents do what we know is bad for them, but it is their right. I have MY care plan written already in case I have to go to a SNF some day:

No thickened liquids, NO dietary restrictions, DNR, no g-tube, no shoes no socks, NO BINGO (!), and wine with dinner.

Daytonite, BSN, RN · Jun 28, 2008

Do you think that maybe it was the way you approached and interacted with this other patient that brought up the issue of patient rights? Rather than tell the resident who is able to go out to quit buying the diabetic patient sweets, perhaps another way to have approached this would have been to educate the resident about diabetes, sugar substitutes and why they would be better choices for the diabetic patient, but still let her make up her own mind.

IowaKaren · Jun 28, 2008

We also have a form they must sign if not wanting to stay in compliance with Dr.'s orders and of course with ESRF, we keep track of Input/Output also.

Seonaid · Dec 13, 2008

I often wonder why there is not a sliding scale ordered for "extra" snacks for those that eat such carb laden treats on there own. If they are going down to a snack bar and getting pretty much the same thing each time --couldn't an injection be taken to cover the number of carbs they injest -you are charting anyway --count the carbs and use a sliding scale. Also to consider -some doctors tend to overdose insulin --over the guidelines for the weight of the patient and they may very well be overdosed. Their bodies could be craving for the sugar they may need --and then overdosing themselves from a low ---or their body is rebounding on its own from the excretion of glucagon from the liver. You have to see how far up the blood glucose goes after their "binge" to see if they need an injection or if they are simply doing what their body is telling them. In the case of the latter- reduction of insulin is needed. Remember 1 unit of insulin per half kilo of weight per day is the guideline. Check to see how much insulin your patient is taking per day -. As people age they need less insulin and the elderly even more so .I have a 90 + patient that now takes a tenth of what she took ten years ago -plus the insulin takes a few hours longer to be effective -even Humolog.