There are a number of important nursing interventions required for this patient.
The doctor should be informed that the patient’s blood sugar is elevated. The doctor requested that he or she be notified if the level exceeds 280 mg/dL. It is significantly higher than that. The patient requires treatment for this, which would include orders for insulin.
The patient requires blood sugar checks four times a day; this will likely increase to once per hour once insulin has been given.
The patient requires frequent neurological assessments. The patient has a head injury and is also highly intoxicated. It is important to be vigilant for the development of increased intracranial pressure (ICP). Unfortunately, the intoxication makes this assessment more difficult, and therefore even more important.
The patient’s respiratory status must be carefully monitored due to the chest injuries. The patient requires vital signs to be checked hourly until he is stabilized.
The patient’s laboratory results should be monitored for any electrolyte problems.
The patient’s IV needs to be maintained, including checking for signs of infiltration, infection and changing the fluids.
The patient is a fall risk due to his possible head injury and his intoxication.
The patient is at risk for fever and infection due to the injuries he sustained. His temperature should be monitored.
The patient’s sutures should be checked to determine if there is any bleeding or signs of infection developing.
Long-term, the patient requires treatment for alcoholism, which depends upon the patient recognizing that he has a problem.
The patient also requires patient education about diabetes; this diagnosis depends upon the physician determining this. A HgbA1C is required.
The registered nurse will have to perform the neurological assessments, the check for respiratory insufficiency, and any administration of medications, such as insulin. Later on, the RN can delegate the patient education issues to the patient education department, which will be done by another RN. The nurse must also check any lab findings that are returned on the patient. The RN should also look for any signs of infection or fever on the patient. The RN must monitor the IV and change the bag or rate as needed.
The UAP may perform vital checks and the blood sugar checks, with orders to report them to the nurse. The UAP can also monitor the patient frequently to ensure that he has not attempted to leave the bed. The UAP could have also made the bed, ensuring that there is an alarm attached to the bed. The UAP can also notify the nurse if there is any concern with the sutures, such as bleeding. The UAP can take the patient’s temperature.
One of the most important ways to determine if the UAPs in a facility are adequately trained for specific goals is to become interested in the training they receive. A RN should know what the program entails. If the RN does not know what they are taught and how they are taught to do things, the RN cannot be sure that the UAP is qualified to perform a task. Furthermore, the RN should ask the UAP if he or she feels comfortable with a task when the task is assigned to the UAP. While a person may have been trained to perform a task, the person may still not feel comfortable with it. This is particularly true if the person is newer or has not completed the task frequently or recently. Obviously, if an RN has worked with a particular UAP before, the RN should be familiar with that UAP’s skill set. This information is always helpful.