H.B. is a 62-year-old male in the rehabilitation center. He is recovering after

Question

H.B. is a 62-year-old male in the rehabilitation center. He is recovering after a spinal cord injury. The night nursing assistant checks H.B.’s blood glucose level at 6:45 AM. The day shift nurse assesses the value and compares it to the sliding scale at 7:25 AM. The day shift nurse then administers his medication at 7:50 AM. H.B.’s breakfast arrives at 8:35 AM.

1. The patient voices concern with the nurse that there is such a long time span between the blood glucose check, the insulin administration, and the meal. How would the nurse explain the answer? Use EB resources as rationale for your answer.

Explanation / Answer

In the above case, the post prandial (post meal) insulin level raises substantial to severe level inside the blood in H.B so that initial glucose monitoring observed at 6.45AM followed by prior meal finally after meals. The amount of glucose absorption is to the blood after meals will be higher compared to premeal glucose concentration so that it is essential to administer insulin to minimize high glucose level as per sliding scale measurement. Therefore, there is such a long time span between the blood glucose check, the insulin administration corresponding to meal finally it is possible to reduce diabetes

Explanation:-meal & insulin administration:

The main theme of nursing management in this article is to prepare the best nursing care plan to the two different types of patients such as “critically ill patients with insulin dependent diabetes” & non-critically ill patients with diabetes” with a basal plus correction insulin regimen. The insulin regimen is mainly included to correct the dose if there is higher incidence of hypoglycemia with good nutritional intake. Apart from , diabetes care to the patients in nursing home & hospitals, it is crucial to prevent persistent hypoglycemia using specific hypoglycemia management protocol finally these events must be documented in the patient electronic medical record and tracked (Diabetes Care in the Hospital ADA 2015)

Patient care: The impact of the article has describing that the “critically ill patients with diabetes” must be given insulin treatment regimen at a threshold of no greater than 180 mg/dL by observing blood glucose level (hyperglycemia of glucose range 140 – 180 mg/dL) for chosen patients in the nursing home or hospital without significant hypoglycemia

The non-critically ill patients must be given insulin that have premeal glucose concentration targets of 140 mg/dL & random blood glucose levels are 180 mg/dL with stringent glycemic control in which stable glycemia. It has preferred to less stringent targets in patients with severe co- morbidities

A plan of care:

Random blood glucose monitoring: Regular blood -glucose level checkups are essential to check the level of type I diabetes

Anti-hyperglycemic agents use in hospitalized diatbetic patients: Nurses must respect patient autonomy and implement ethical based decisions to control hyperglycemia. This glycemic control can be obtained by “preparing adequate insulin dose for intravenous infusion. In case if the patient is ICU, it is crucial to insulin administration as subcutaneous therapy. Apart from insulin therapy, it is crucial to use metformin & glipizide as anti-hypertensive agents. Correction of insulin dose is essential if patient experience severe hypoglycemia to avoid fainting (Diabetes Care in the Hospital ADA 2015)

Medical nutrition therapy in nursing home & hospital as per American Diabetic Association diet guidelines must be prepared as nursing care plan for diabetes patients for optimization of glycemic control. This nutritional diet is going to provide adequate calories of energy for metabolic demands followed by creating discharge plan

Medication reconciliation is essential for cross-checking patient medication. Patients’ self-management care education is given to patients

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