tpn feedings

you are comparing apples to oranges. The range you quote is for a FASTING blood sugar. Now rethink and post back.

I am confused. I took my first exam for Med/Surg and I am terribly disappointed in myself, I studied and studied but apparently it was not the right information or maybe I am still not a good "critical thinker" But my question was

A patient is on tpn feeding and has a blood glucose levels of 120 what do you do?

a call doctor

b give insulin as ordered

c recheck in 4 hrs

I chose b because the normal range is 70-99. most in my class say that its C. Is a or C correct and why?

I jumped to the conclusion that since it was elevated it was high. I did not take into account that was fasting. TPN has a high calorie and dextrose count? would that make the glucose elevated? I don't know why I don't think of this when I am testing.

I jumped to the conclusion that since it was elevated it was high. I did not take into account that was fasting. TPN has a high calorie and dextrose count? would that make the glucose elevated? I don't know why I don't think of this when I am testing.

I would answer B. Although they really should state how much and what type of insulin is ordered to be administered.

Assuming this a scheduled dose of insulin, such as 10 U 70/30 every morning, than I would give it. This person is getting a continuous infusion of dextrose so hypoglycemia, while possible, would be rather unlikely. You want to stay on top of glucose control with TPN patients because by rechecking in 4hrs you might be dealing with a blood sugar of 250. I wouldn't call the doctor over a BS of 120.

Normally people on TPN that are getting glucose checks have parameters to go along with it. Usually in the form of a sliding scale and parameters of when to call the doctor, such as BS>400 or

Cover with aspart

2U BS 150-200

4U BS 200-250

6U BS 250-300

8U BS 350-400

call MD if BS 400