What did the Doctor mean! Someone help

Nurses LPN/LVN

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Specializes in PN NURSING SCHOOL.

Here is the problem. Ok i went in to check one of my resients blood sugar level and it was 425. So on the sliding scale it says to notify the doctor for anything more than 400 of course! So i called the on call dr about the blood sugar results and he said to give 50 units of regular insulin and recheck again in four hours. So I reread what he said, give 50 units of regular insulin and recheck again in four hours and he said yes and after taking the order i wrote RBVO per (doctor's name). So I gave her the 50 units and rechecked her within the four hours that was told and it went up to 435. I called him back and told him the results and he said give her 15 units of regukar insulin and recheck in 2 hours so read it back to him give her 15 units of regular insulin and recheck in two hours he said yeah one five just like the last time! And I was thinkin justlike the last time. What do you mean the last time you told me 50 units and I read back the verbal order. Does this mean trouble. I mean the first order I did read back and he agreed. The second order I read back and he agreed. What got me is when he said 15 units just like the last time! Im like what the hell is he talkin bout! Im scared! Any opinions or advice of what can happen would be greatly appreciated!

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Specializes in geriatrics, dementia and like, insurance.

I would discuss this with your charge nurse and/or DON. Did you report this during the shift change report? Is anyone else aware of your concerns? Make sure you write down everything that occurred in your own personal journal to keep a written dated record for yourself but also be sure to discuss it with your charge nurse and/or DON. I don't know who in your facility reviews written verbal orders but be sure to report your concerns because they might questions the veracity of the order or even call the doctor to confirm prior to signing off on it. Your charge nurse or DON will determine what you need to do, if anything, and you will have covered yourself and your facility by making sure you reported this. Good luck. And always remember to document for your personal records things that occur while you are working. It's the best way to protect and defend yourself.

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Specializes in PN NURSING SCHOOL.
I would discuss this with your charge nurse and/or DON. Did you report this during the shift change report? Is anyone else aware of your concerns? Make sure you write down everything that occurred in your own personal journal to keep a written dated record for yourself but also be sure to discuss it with your charge nurse and/or DON. I don't know who in your facility reviews written verbal orders but be sure to report your concerns because they might questions the veracity of the order or even call the doctor to confirm prior to signing off on it. Your charge nurse or DON will determine what you need to do, if anything, and you will have covered yourself and your facility by making sure you reported this. Good luck. And always remember to document for your personal records things that occur while you are working. It's the best way to protect and defend yourself.

No I haven't told anyone! I didnt know who to talk to! I'm on days off right now! I explained the situation to my husband and he said don't u think if something was kinda fishy or if something happened to the resident they would call u cuz u were the one who signed the order off and u actually did read back the order! I never told anyone! I'm scared because what if try say y did u wait until two days later to voice ur concerns! The only reason I think I'm covered is because I read back the order to him and he okayed it! Do u think I should just let it be and if there was a problem they would call!

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Specializes in PN NURSING SCHOOL.
No I haven't told anyone! I didnt know who to talk to! I'm on days off right now! I explained the situation to my husband and he said don't u think if something was kinda fishy or if something happened to the resident they would call u cuz u were the one who signed the order off and u actually did read back the order! I never told anyone! I'm scared because what if try say y did u wait until two days later to voice ur concerns! The only reason I think I'm covered is because I read back the order to him and he okayed it! Do u think I should just let it be and if there was a problem they would call!

Or should I call my DON I'n te morning! What should I tell her? Help plz

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I've never heard of 50 units of regular insulin in LTC. Fifteen sounds much more likely for a BS of 425. Also, 15 can sound a lot like 50. What were the sliding scale doses for lower blood sugars? Most important, how is the patient?

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Specializes in PN NURSING SCHOOL.
I've never heard of 50 units of regular insulin in LTC. Fifteen sounds much more likely for a BS of 425. Also, 15 can sound a lot like 50. What were the sliding scale doses for lower blood sugars? Most important, how is the patient?

The resident is ok. Nothing us wrong! The point us I'm scared and they never called me or anything! So I'm worried! I think it takes the dr 24 hrs to sign off the order and u font know if he did it yet! Should I call one of my co workers and see if he did or if anything is suspicious about the order! I'm loke scared and dont know what to do! If I should call and talk to my DON or what! Do u think I should?

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Specializes in LTC, MDS, plasmapheresis.

All it really means is that if the patient had received 15 units the first time, rather than 50- he would have beed dead 4 hours later, and you would then have been able to save the 15 units you gave him at that time. Because insulin doesn't work real good on a dead patient, I hear.

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Specializes in LTC, MDS, plasmapheresis.
I've never heard of 50 units of regular insulin in LTC. Fifteen sounds much more likely for a BS of 425. Also, 15 can sound a lot like 50. What were the sliding scale doses for lower blood sugars? Most important, how is the patient?

I have given 100 units of regular many many times. There are some crazy blood sugars in LTC, and you can rest assured (not) that the quality of many of those machines is questionable. As far as telephone orders- I graduated in 1987- at that time LPNs copuld not take a telephone order. I liked that better, because the nurse will always lose when a disgruntled physician claims not to have given an order. Fact.

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I have given 100 units of regular many many times. There are some crazy blood sugars in LTC, and you can rest assured (not) that the quality of many of those machines is questionable. As far as telephone orders- I graduated in 1987- at that time LPNs copuld not take a telephone order. I liked that better, because the nurse will always lose when a disgruntled physician claims not to have given an order. Fact.

Wow. I have never given that much. But if I did receive an order for that much coverage I would be checking and double checking every which way I could to make sure that it was an appropriate dose.

Anyway, usually before calling the doc I do a quick review of the patient's dosing history so I have some idea of what is normal for that patient.

At any rate, something about this situation really isn't making sense.

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Specializes in PN NURSING SCHOOL.
Wow. I have never given that much. But if I did receive an order for that much coverage I would be checking and double checking every which way I could to make sure that it was an appropriate dose.

Anyway, usually before calling the doc I do a quick review of the patient's dosing history so I have some idea of what is normal for that patient.

At any rate, something about this situation really isn't making sense.

She usually gets a dose of 55 units of 70/30 and thats y I didn't really think nothing of it! But I thought about it because I'm a new nurse and I'm scared! This is my sec week

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Specializes in PN NURSING SCHOOL.
I have given 100 units of regular many many times. There are some crazy blood sugars in LTC, and you can rest assured (not) that the quality of many of those machines is questionable. As far as telephone orders- I graduated in 1987- at that time LPNs copuld not take a telephone order. I liked that better, because the nurse will always lose when a disgruntled physician claims not to have given an order. Fact.

So u think I should just stop over reacting and let it ride and if something would happen they would call and let me know the situation and I would explain what was said to me cuz I actually read back the order and he agreed cuz after I left she was I'n stable condition and that was 6 hrs after I gave it to her and I passed it on to the next sceduled nurse I'n report and she never questioned what I said and she's been a nurse for years. I'm just scared! I haven't received a call and it happened since sunday

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Specializes in LTC, MDS, plasmapheresis.

I've seen 180 units also. LTC people are totally out of control, and there is little motivation to attempt tight control, due to costs and he time involved, so they keep getting insulin thrown at them. Besides, the food in those places doesn't help.

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