hi. i have a new student in school that started on monday. i am a new nurse so PLEASE bear with me and understand that this is my first job out of school (whether you agree that it should be or not, i really need advice and some help.)
the different situations are:
1. the student came in today for her bg test and snack at 10:30 AM. her bg was 182 and i told her she didn't need a snack. she demanded that she get a snack and that she needs one whether her bg is normal or not. the doctor's order defines normal or between hypo and hyper between 70-250. i gave her the snack but told her to adjust her insulin pump to account for the carbs. now i know that this was a mistake and i really regret giving her the snack. i also called her doctor at this point and left a message but there was no return phone call. so i already know this was a mistake and i'll NEVER give her the snack just because she asks for it again. UGH!!! SO MAD AT MYSELF!! (not really a question, i know.)
2. when the student came in for her bg check before lunch her glucose was around 270. i had her take a ketone test and it came back negative. then i had her drink some water, as per the doctor's order, and then i had her program the pump with the bg result and the carbs for lunch.
3. when the student came back before gym (which was only about 10 minutes after finishing lunch) her glucose was 299. i had her take another ketone test and this time it was trace or small amounts. again, as per the doctor's order, i had her drink some water and then i called her mother to let her know that her bg was very high. i had her put the bg into the pump to receive a bolus of insulin and retested her bg and it went up to 330 in about 5 minutes so then i sent her gym to run around and hoping that her bg would be lower.
4. then she came back after gym which is about 15 minutes before dismissal and her bg lowered to around 310. i had her drink water and then she was dismissed.
i really feel like i do not know what i am doing. for the first time i really feel incompetent. (a student had a seizure in school and i knew exactly what to do and i felt really good. now i feel like an idiot). please let me know if i am doing everything wrong with this student. she has had uncontrolled diabetes since 2004 and was sent to this school specifically because she is non-compliant.
I have a Kindergarten student with an insulin pump. I'm also a new school nurse.
I wish now we had all met prior to school and I had gotten training on the pump.
I've been in contact with the manufacturer's rep who actually trained this family regarding the pump. She did a class a couple of weeks ago that I attended.
Also, their website had a lot of great information and specifically for school nurses. Who manufactures your student's pump? Could you get some help from them?
I would hope at 17 that this young lady would be managing her own diabetes. Our goal with this Kindergarten student is to get him self-reliant way before high school. He's pretty darn savvy right now.
It is scary to go into a situation like this without training. And physician's orders need to be clear and then a health plan needs to be written during a 504 meeting with the mom.
the pump is animas. the thing is with this student, she understands her diabetes completely, she knows how to use the pump correctly, and she understands the implications of hypo and hyperglycemia- she just doesn't seem to care.
I hate to say it, but the teen years are tough, very very tough. I would be very careful to keep my calm with her. If numbers are high DON'T ask in an accusing tone if she snuck something, or ate extra food. Depending on how long she's had diabetes she may simple need a break. Not sure how much help she gets at home, but at 17, probably not much. She needs someone to understand, to help, to listen. She definitely doesn't need someone to be on her all the time. She has plenty of people like that. Our job is to make sure she's safe and doing what needs to be done. But, in this case, do it with as much compassion as possible. Diabetes is such a tough disease, many people don't realize that. Is there any other disease in the world where the person who has it is totally responsible for keeping themself healthy? Adjusting their 'medication'? Is there any other disease that is knocking on your door 24hrs a day, 7 days a week? To a teenage (and most kids) the day to day gets old fast. So you are right. Right now she could probably care less. And that is so dangerous for her in the long run.
the pump is animas. the thing is with this student, she understands her diabetes completely, she knows how to use the pump correctly, and she understands the implications of hypo and hyperglycemia- she just doesn't seem to care.
Here is the link I was sent for nurse stuff - there is no voice over at this time though. Just slides.
thank you SO much! and you are exactly right...she needs somebody that is going to approach her with compassion and caring and i am trying to be that person. at first she was causing me a lot of anxiety but i've calmed down a bit so i hope she is able to see that i can be that person for her. she has it tough at home- her mom has MS and is wheel chair bound. she is 17 but is in the 9th grade due to dyslexia and other learning disabilities. she is such a sweet girl, always polite and well-mannered. i really hope that i am able to help her.
Spidey's mom, ADN, BSN, RN
11,305 Posts
I have a Kindergarten student with an insulin pump. I'm also a new school nurse.
I wish now we had all met prior to school and I had gotten training on the pump.
I've been in contact with the manufacturer's rep who actually trained this family regarding the pump. She did a class a couple of weeks ago that I attended.
Also, their website had a lot of great information and specifically for school nurses. Who manufactures your student's pump? Could you get some help from them?
I would hope at 17 that this young lady would be managing her own diabetes. Our goal with this Kindergarten student is to get him self-reliant way before high school. He's pretty darn savvy right now.
It is scary to go into a situation like this without training. And physician's orders need to be clear and then a health plan needs to be written during a 504 meeting with the mom.
Good luck!