Published Aug 27, 2008
KalipsoRed
215 Posts
I'm a new nurse, graduated in May, and have passed boards. I have two weeks left in orientation. To night I had a 82 year old patient with a type B aortic disection. And for all of you out there who didn't even know there were catagories of aortic dissections here is what a type B is: Type B dissection involves the descending aorta and begins just below the subclavian artery (the artery to the left arm). This type of dissection traditionally has been managed with medication. I sure as heck didn't know.:) Anyhow I went to give her insulin 70/30 injection in her abdomen like I had so adamantly been taught to do by the diabetic nurse educator and her son told me I couldn't give it there. I tried to explain to the patient (who was every bit of A&O x 3) that insulin is best absorbed in the abdomen. During my short explination her son inturrupted me several times and told me I was not going to give the insulin in her stomach. However the patient had already raised her gown to allow me to stick her, but afterward told me she didn't like to do it in her abdomen because it makes it so sore. Well then I felt like crap because I felt like I forced her to take it in her abdomen (and to be honest I bet she could tell I was getting a bit frustrated with her son because he wouldn't let her talk therefore just let me do what I wanted to make me feel better). I just feel so bad about this and it makes me wonder if it is so important to give it in the abdomen like the diabetic educator insisted. I know that you can rotate sites and use the arms and legs, but the educator just kept saying that unless there was some medical reason they couldn't have it in their stomach that is where it should be given. How do you guys feel about this?
Jolie, BSN
6,375 Posts
The patient has the right to refuse any aspect of care. If, upon explaining the risks/benefits of various sites, she didn't want the insulin given in the abdomen, you should have given it elsewhere and documented your reason for doing so.
blondy2061h, MSN, RN
1 Article; 4,094 Posts
Why not give it in an arm or thigh instead? It's really not that big of a difference, especially if the patient isn't exceptionally active.
BelleKat, BSN, RN
284 Posts
I always ask established diabetics where they want their insulin b/c they know where they have to give it more often and they might not have the chance for someone else to give it. So I might be able to give their most used site a rest. Also they have the right to refuse any aspect of care unless they've been declared incompetent and the paperwork is done declaring someone else health care surrogate.In which case you can give them meds they might not want if they're ordered and medically indicated.
BTW,Heparin is indicated in the abdomen only,I wouldn't give it elsewhere unless there were extenuating circumstances like an abdominal surgery or something.
canoehead, BSN, RN
6,901 Posts
I tend to give inpatient diabetics their insulin in their arms because that's a site hard for them to reach at home, and probably the least used. The abdomen would be my last choice, because they probably use it at home, and it would require them to undress partially.
TopazLover, BSN, RN
1 Article; 728 Posts
Usually for inpt. I also give in arms for same reason, difficult to self administer there. Since she had a visitor I probably would have not chosen abd. due to maintaining privacy. Overall I think the important thing is to put in an area where it can be absorbed. Sometimes you can feel lumpy areas of old scar tissue from poor absorption.
For most people there is lots of fat tissue in abd so it is a good site.
Thanks for all the replies so far.:) I do realize that patients have the right to refuse. In this situation it was her son who was talking and not letting me or his mother get a word in edge wise. She went ahead and lifted her gown for me, which I took as a sign that she was willing to have the injection in her stomach. Then afterward told me that she didn't like doing them there because it made her sore. I just felt so awful.
nursecass
110 Posts
Did the son ever give a reason why you shouldn't give it in the abdomen, or was he just saying not to give it to her in her abdomen?
Next time you have a family member insisting something you can either ask them why they are insisting, or directly tell them that you would like the answer from the patient. Some family members will get huffy over being told this, but usually when I say that I look directly at the patient and ask them directly my question (body language will do a lot for you in this case).
You are also free to ask the family members to step out of the room so that you can assess the patient and provide care in private, without compromising her modesty.
cardiacRN2006, ADN, RN
4,106 Posts
Me too. It almost always goes in the arms.