Steveo123

Yeah, as mazy and Nolli said, there are many things that influence how the body reacts to the insulin that is given. It depends on whether or not the patient is eating/has eaten, their tolerance for the insulin, and/or medications that are being taken, etc. You have to remember that onset determines when an effect will happen, peak is the point in which it has its greatest effect, and duration is how long that effect will take place. Each are important for different reasons, however for this question onset of action will be your answer. If you were to take out all other variables, what would be the first of the three characteristics (onset, peak, and duration) to take effect? Hence why the onset is the most important (for this question).

The answer is 0800. It's one of those questions where they want you to understand the concept of how quickly it takes the insulin to create a change in the body. Regular insulin takes effect within about a half hour. A rapid acting insulin would act within about 10-15 minutes, hence why is should be given with the patient's meal in front of them. At around 0930 you would expect an intermediate insulin to start taking effect and around noon a long-acting insulin would start causing a decrease in blood sugar.

Oh yeah, I know that for sure. I'm not saying I disagree with you, I'm just saying that I know things vary far from what you're taught from what actually happens in the real world. That's why I was just curious as to whether or not checking for a residual volume is one of these lessons from school that isn't practiced or if it should be and the nurses I work with just don't.

I know it only takes a few seconds. I've done it dozens of times myself. But on the floor I work on I work directly with one nurse all day, assisting in everything that I do so I know for sure that they don't do it.

I did mean the need for checking residuals. As far as placement, I was always taught that placement needed to first be verified by an xray (KUB) before the tube can be used. After being verified by xray, subsequent checks would be performed at bedside by checking the external length of the tube, the aspiration of stomach contents, and by checking the pH of the aspirated fluids. I was told that the "whoosh" method (listening for placement) is never an acceptable measure to determine location (but that it is still the most common technique). But I've never seen a nurse do anything that you described that you do. It just baffles me that I have never seen it done, but now I at least know that it happens on your unit.

As a nursing student, I have always been taught that before you place anything down an NG tube or Corpak that you should always verify the residual volume of stomach contents. During my clinical experiences and my work on a gastroenterology floor as a nursing assistant, I have never once seen a nurse check a patient's residual volume. Again, I was taught that before administering medication, increasing a tube feed, and even on a regular basis the residual volume should be measured to ensure that gastric emptying is occurring. Being on a floor where gastroparesis is common, I thought that it would happen for sure but it never does. Is this uncommon for me to see or in reality are residual volumes not usually measured unless specifically requested by the physician?

Being in nursing school, I am more than aware that "Right Route" is one of the Patient Rights in regards to medication administration. However, I have noticed through my clinical experiences that there are some orders written to give a medication inappropriately relating to the situation (example: the patient is unable to swallow and the medication should be given through his/her NG tube but the order states PO). Other orders for the patient will specify to give the medications per the correct route, however there always seems to be one that is incorrect and the nurse administers it to the patient in the way it should be. My question: is it appropriate for a nurse to give a medication through the intended route instead of what the order says, or does the nurse HAVE to have the order changed by the physician to state the correct route before the medication can be given legally?