Missed fingerstick

[CC918]

I am a new grad nurse and just started working on an acute psychiatric inpatient unit 3 months ago. The patients are not bed bound and are up and about on the unit. I had a patient who has fingersticks TID before meals and is on sliding scale. I was finishing up an admission and realized it was already 11:45 and lunch gets served at 11:30. I went to find my patient but she was already done eating her lunch.

I asked another nurse what I should do regarding her 11:30 fingerstick and the nurse told me to skip that one since the patient knows she's supposed to get fingerstick before lunch and she didn't wait or ask for it. But as the day went on, I am rethinking what I should have done. I just want someone else's opinion and rationale behind what should have been done. I will probably find out if there is some official policy regarding missed FS the next time I'm back at work. TIA!

[JulieCVICURN, BSN, RN]

I concur- diabetes has nothing to do with bad choices. You might be able to avoid developing it if you eat a healthy diet and exercise, but if you're genetically predisposed to getting the disease then you may not be able to avoid it no matter what you do. This is why there are some 400 lb people who never develop it and some normal sized people (like everyone on my father's side of the family) who get it no matter what eating and lifestyle choices they make. To say that most of the people with diabetes have it because of bad choices is just uneducated and terribly incorrect misinformation.

I'm pretty sure they are lying.

You would likely be incorrect on this as well. A diabetic's blood sugar can increase over time even though nothing at all is consumed. I have taken care of many patients on insulin drips who have blood sugars over 500 even after not eating for well over 12 hours. Please re-educate yourself on the way diabetes works. It seems as if you may not be serving your patients as well as you could be.

[Pepper The Cat, BSN, RN]

Most of them have diabetes because of bad choices (like drinking soda all day or eating ice cream before dinner).

Diabetes is not caused by bad choices. My nephew was diagnosed at age 15 - never liked sweets, ate healthy, very active.Is not overweight. Admitted to ICU with a sugar of 54 (norm 3.7 - 7.3). In other words, very very high.

There is a strong family history of diabetes on his mother's side.

He's doing great now, but to have someone say he CAUSED this, is really really annoying.

[Finallydidit]

" My nephew was diagnosed at age 15 - never liked sweets, ate healthy, very active.Is not overweight. Admitted to ICU with a sugar of 54 (norm 3.7 - 7.3). In other words, very very high."

Dang!! Am I missing something?

[talaxandra]

Perhaps the fact that: onset of T1DM is wholly unrelated to lifestyle, that some people with diabetes can be totally compliant with management and still have labile glycemic control, and that over 15% of people diagnosed with T2DM are not and have never been overweight?

[CoffeeRTC, BSN, RN]

" My nephew was diagnosed at age 15 - never liked sweets, ate healthy, very active.Is not overweight. Admitted to ICU with a sugar of 54 (norm 3.7 - 7.3). In other words, very very high."

Dang!! Am I missing something?

This is in a different country? They have different measuring units than in the US.

Canada? England?

[CoffeeRTC, BSN, RN]

I would check their BS and then probably treat it accordingly. I work in LTC and many of the residents eat at odd time. Most of them have diabetes because of bad choices (like drinking soda all day or eating ice cream before dinner). Some of the residents will have BS of over 400 regularly. When I ask them if they have consumed anything between lunch and dinner they will say no but I'm pretty sure they are lying. And these aren't patients with dementia or confusion.

I think you mean they have uncontrolled or poor control of their diabetes due to poor food choices and not the other way around.

I work LTC and we have a more relaxed diet orders (yes...it just makes me wonder sometimes). We have young and old residents that we take care of. What we as nurses need to do is educate and give the risks/ benefits of following a good diet and then document. As far as the lying part....sometimes just being sick, stressed and in a different environment will cause the BS to be elevated. Maybe at home they watch what they eat...Could it be the food that your place serves...CCHO diets are still heavy on the carbs?

Getting back to the OP question..take the blood sugar and call the doc is the right response. If it is ordered before meals and you get it after the meal or during...you are not following the order.

In reality....most people (LTC setting) would take the reading and cover it per the sliding scale. How many times do you hunt down the resident (10 or so on my hall) and by the time the trays come...someone has started eating.

[talaxandra]

This is in a different country? They have different measuring units than in the US.

Canada? England?

Well, I feel like an idiot for noticing the wrong thing in the post this post was responding to! And that's because Australia (where I am) and New Zealand use mmol/L. As does everywhere except Burma, Liberia and the US (thank you, Wikipedia).

[SharonH, RN]

If you check the BS within 2 hours after eating, you run the risk of treating an artificially high BS and bottoming them out later, so I would agree with your co-worker to skip. If she had just started her meal, I might have checked and treated but not after. Also you will need to do an incident report as that is a missed treatment.