Question

S---- Patient c/o fever, nausea, and vomiting for three days prior to admission due to a viral illness.  States stopped taking her insulin because she was not eating.    Son took her to the ED very early this morning.  Glucose 600 in the ED.  Admitted to the step down unit for hyperglycemia.

B---Diabetes Mellitus for last 15 years and dependent on insulin for last 3 years.  Lives alone with three cats.  Has son who lives in town.

A---IV insulin infusing at 8 ml/hr.  Last FSBS at 1800 was 90.  IV NS infusing at 100 ml/hr.  Continues to have poor appetite.  Patient is alert and oriented.  Assessment unremarkable.  

R---Continue to monitor hourly FSBS (Finger Stick Blood Surgar)                    

What are two nursing diagnoses for this patient.

What teaching points would you give to patient about sick-day management to prevent future episodes of hyperglycemia?

What is the only preparation of insulin used for IV insulin administration?

Answer 1

What are two nursing diagnoses for this patient.

1. Hyperglycemia related to inadequate blood sugar testing and insulin deficiency.
2. Ineffective health management related to poor thoughtful judgements.

        

What teaching points would you give to patient about sick-day management to prevent future episodes of hyperglycemia?

• Explained to the patient on detail about what is diabetes, the signs, the results, treatment and home care. Explain in detail about hyper and hypoglycemia. Explain the characteristics of hyper glycemia and hypoglycemia. Blurred vision, fatigue, poor wound healing, dry mouth, dry or itchy skin, frequent hunger, thirst and urination.
• Instruct to have regular meal timings and exercise regimens. Increase fiber and water intake. Reduce carbohydrate intake.
• Instruct to eat healthy food, avoid junk food and artificially sweetened ones. Reduce the intake of sugars in the diet.
• Exercise must be regular and less strenuous. Brisk walking regularly increasing the speed gradually is a better option. Do not exercise before food, do it after a snack. Do not exercise if the blood sugar is over 240 mg/dl. Do not exercise before going to sleep. It is better to check blood sugar after exercise.
• Have your insulin on time daily. Always keep ready the food before taking insulin. NEVER skip the doses without consulting physician.
• Check the blood sugars whenever you feel a change in the health status.

Have a look on blood sugar before and after eating food, until you get an idea how it will be on a usual way.

• Avoid psychological stressors, which can contribute to hyperglycemia due to chemical changes in the body. The stress may cause hormonal changes in the body, causing hyperglycemia.
• If the patient felt any symptoms of hyperglycemia, check the blood sugar immediately, and consult the physician in case the blood sugar levels are very high. The insulin must be taken as per the prescription.

What is the only preparation of insulin used for IV insulin administration?

The insulin prepared for IV administration is 250 units of regular insulin in 250 ml of NS with a dose of 1 unit insulin in 1mlof fluid.

In the infusion pump, 50 units insulin is diluted in 50ml fluid to make the rate as 1unit/ml.