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Original Question
Name: Branden Johnson; Gender: Male; Age: 23; Marital Status: Single Weight: 220 lb (99.79 kg); Height: 73 inches; Race: Caucasian; Religion: : Christian Allergies: None known; Immunizations Up to date; Major Support Name: Mrs. Johnson, Relationship: Mother, Phone: 951-262-3062 Occupation: Programmer.; Address: New York, USA; Provider: Dr. Tyler, MD, and RN and Nursing Assistant History: Branden presents to the ER with nausea and vomiting for the past 4 hours, feels tired and confused, and feels short of breath. Branden tells the physician that he had been on a cruise for the past week and returned late last evening. He felt tired and slightly nauseous this morning but went out to eat a pancake breakfast with his girlfriend. When he returned home, he began vomiting and feeling short of breath. Upon examination, it was determined that the patient had fruity-smelling breath. Branden denies any past medical history other than an appendectomy at age 18. Medications: Insulin Regular Human on a high sliding scale 10 units subcutaneous Daily 0900 Notes Vital signs: • Temperature 98.6 F • Pulse 72 • Respirations 26 • B/P 122/78 A serum blood glucose was ordered and resulted at 560 mg/dl. The patient was given 12 units of Insulin Regular Human in the ER. Recheck of a finger stick blood glucose resulted in 272 mg/dl. The patient was admitted to the Med/Surg floor for frequent blood glucose monitoring and a possible Insulin IV drip. Delegation of obtaining finger stick blood glucose monitoring was given to the nursing assistant by the RN. The nursing assistant was observed getting the finger stick blood glucose without wearing gloves and throwing the sharp lancet in the trash can. Orders: Insulin Regular Human on a high sliding scale: High Dose Less than 70 mg/dl: Initiate Hypoglycemia Guidelines 70 – 139 mg/dl: 0 units 140 – 180 mg/dl: 4 units subcutaneous 181 – 240 mg/dl: 6 units subcutaneous 241 – 300 mg/dl: 8 units subcutaneous 301 – 350 mg/dl: 10 units subcutaneous 351 – 400 mg/dl: 12 units subcutaneous Greater than 400 mg/dl: Notify provider NPH Human Insulin: 10 units subcutaneous daily In reference to Branden’s, what (if any) unsafe practices should the nurse report and possibly intervene?
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