Question for someone more "seasoned" than I...

[sunshine13]

As a nursing student, I am able to observe a lot on my M/S floor; with that comes many questions, and sometimes the nurses do not want to answer my questions, or just don't have the time. I'm hoping I can throw something your way: New pt. admitted from the ER with high sugar level (360), 55 year old F, DM, 100 temp. I checked her pulse (100, reg.) RR was 22, BP was 155/66. She seemed drowsy, her face was flushed, and she was restless. I also noted that even though the nurse was told by ER that insulin was given, it was not noted on the ER flow sheet.

I was asked to administer The 18 u Humulin Reg. / 38 u Novolin per doctor's orders before breakfast. Was that OK? I think I was bothered by the fact that no documentation was made on the ER sheet. Also, what are the signs and symptoms she was experiencing reflecting?

Thank you in advance for any help.

[leslie :-D]

As a nursing student, I am able to observe a lot on my M/S floor; with that comes many questions, and sometimes the nurses do not want to answer my questions, or just don't have the time. I'm hoping I can throw something your way: New pt. admitted from the ER with high sugar level (360), 55 year old F, DM, 100 temp. I checked her pulse (100, reg.) RR was 22, BP was 155/66. She seemed drowsy, her face was flushed, and she was restless. I also noted that even though the nurse was told by ER that insulin was given, it was not noted on the ER flow sheet.

I was asked to administer The 18 u Humulin Reg. / 38 u Novolin per doctor's orders before breakfast. Was that OK? I think I was bothered by the fact that no documentation was made on the ER sheet. Also, what are the signs and symptoms she was experiencing reflecting?

Thank you in advance for any help.

symptoms of hyperglycemia typically are increased thirst, increased urinating, headache, drowsiness, dry mouth, dry/flushed skin.

as for the er administering insulin, i would've found out exactly when the insulin was given, how much, and done a fs.

why would they give novolin r with humulin r?

or was it novolin n?

leslie

[ShayRN]

I personally would have rechecked the blood sugar. But that is me, I want to see the numbers myself.

[guest2210]

If the hospital you are in in online with their medical records, that might be why you didn't see it documented on paper. You know the old saying-if it's not documented, it wasn't done. I would have had the receiving nurse place a call to the ED and found out for sure. Then rechecked the bs.

[nursej22, MSN, RN]

Definitely need a little more info. How long ago was the glucose done; time, amount, type and route of insulin given in ED; Hx of DM (type 1 or 2); is this patient's usual dose?; any other disease processes like infection/inflammation?; will she be able to eat?

And I would be rechecking the glucose before giving any more insulin, it could be higher or lower. That reported glucose could have been done 4-6 hours prior to arrival to the floor.

[Altra, BSN, RN]

What stands out to me is the elevated temp - think about the clinical picture of someone with a fever. Flushed/hot? Unable to get comfortable? Feeling like crap? The last time I had a temp of around 100 I felt all of these things.

And since fever is a strong indicator of infection, remember that active infection usually raises blood sugar.

Bottom line - remember that you can always check a blood sugar on a patient when you feel it's warranted. You don't need an order, a policy, or anything other than your own good nursing judgement. :)

[sunshine13]

I thank you all for responding so quickly to my question. As for the Novolin, I don't remember which one it was; I am just getting familiar with the meds and my instinct (as of yet) would not have been to question it. However, I wondered why the glucose level wasn't checked again and fully apree that a new fingerstick was warranted. The ER usually documents all meds on the flow sheet; apparently the admitting RN went on the word of the ER nurse. (?) It all seemed a bit vague to me watching it unfold, not to mention trying to think of Nursing Diagnoses and putting all the S/S together. Unfortunately my questions were not always welcomed and I got the impression that I was a 3rd wheel.

Oh, forgot to mention that she had a stage II decubitus on right foot. Possibly the reason for the fever?

[NurseAdida]

As a nursing student, I am able to observe a lot on my M/S floor; with that comes many questions, and sometimes the nurses do not want to answer my questions, or just don't have the time. I'm hoping I can throw something your way: New pt. admitted from the ER with high sugar level (360), 55 year old F, DM, 100 temp. I checked her pulse (100, reg.) RR was 22, BP was 155/66. She seemed drowsy, her face was flushed, and she was restless. I also noted that even though the nurse was told by ER that insulin was given, it was not noted on the ER flow sheet.

I was asked to administer The 18 u Humulin Reg. / 38 u Novolin per doctor's orders before breakfast. Was that OK? I think I was bothered by the fact that no documentation was made on the ER sheet. Also, what are the signs and symptoms she was experiencing reflecting?

Thank you in advance for any help.

I would find out what time was the Blood sugar checked in the ER and how much insulin was administered?

I would then recheck the blood sugar prior to administering insulin.

A high temp could cause restlessness and a flushed face. Possible infection.

Drowsiness...did she receive any narcotic pain medication? Or sedatives? Or was the insulin she had in the ED cause her blood sugar to drop significantly?

About the stage 2 decubitus...it could be the cause of high temp but only if its infected...ie it has pus, its red, foul smell etc.

Do not be afraid to ask your primary nurse questions...she probably rechecked the blood sugar and did not mention this to you, she just asked you to go ahead and cover the insulin. Always know the most current blood sugar before administering insulin.