Question

A patient with well controlled Type 1 diabetes has been nil by mouth since midnight in preparation for surgery in the morning. As the patient is preparing to administer their usual morning insulin, the nurse notes there are no pre-operative orders in relation to the patient's insulin administration. The most appropriate nursing action is to: a) ask the patient not to administer the insulin because none is ordered and they are nil by mouth b) ask the patient not to administer the insulin until you have contacted the doctor to clarify whether the insulin is to be given or not c) allow the patient to administer their insulin dose as usual d) direct the patient to administer half their usual dose because they will not be having breakfast today

Answer 1

ANSWER) b. ask the patient not to administer the insulin until you have contacted the doctor to clarify whether insulin is to be given or not.

Inferences: Being nill per oral prior to surgery may develop hypoglycemia, but the neuroendocrine stress response of the body during surgery may lead the diabetic patient to develop ketoacidosis, delay wound healing,fluid and electrolyte shift and hyperosmolar states. Therefore the insulin has to be given preoperatively to prevent these conditions. But the dose of insulin has to be adjusted by the diabetologist prior to surgery with clear written orders. So,mpatient must be instructed not to administer insulin untill the dose has been clarified by the doctor. Usually half of the dose is administer but doctors written order is a must as insulin is a high alert medication.