2. Ordered parameters and notify thresholds
The following are this patient’s individualized ordered glycemic targets and notify thresholds. They are written to be acted on without prior knowledge of the patient. Confirm each against the current physician orders and plan of care at every visit and update if the order changes; where a specific order differs from a figure here, the order governs. Diabetes targets are individualized — do not substitute a generic target.
Ordered parameters — notify thresholds (self-contained) A nurse covering this patient acts on the values below without prior knowledge of the patient. Confirm against the current physician orders and plan of care each visit; the figures here are the standing thresholds unless the order states otherwise. Individualized glucose range: maintain glucose within the ordered individualized range (state the value, e.g. 80–180 mg/dL — confirm the order; frail or older adults often have a higher, looser target). Notify the provider for a pattern of readings outside the ordered range. Hypoglycemia: treat per protocol for glucose below 70 mg/dL; a reading below 54 mg/dL is clinically significant hypoglycemia. For severe hypoglycemia with altered mentation, give glucagon per order and activate EMS. Notify the provider for any hypoglycemic event and for hypoglycemia unawareness. Hyperglycemia: notify for a sustained pattern above the ordered ceiling (state the value, e.g. persistent readings >250 mg/dL), or a regimen no longer holding glucose in range. Ketone check: check ketones when glucose exceeds the ordered threshold (commonly >240 mg/dL) or during illness per the sick-day plan; notify for positive ketones — a marker of impending ketoacidosis. Sick-day rules: during illness, continue insulin (do not stop it), monitor glucose more frequently, check ketones, maintain hydration, and notify per the ordered sick-day plan; escalate for persistent vomiting, positive ketones, or an inability to keep fluids down. Emergency signs (activate EMS, then notify): severe hypoglycemia with confusion, seizure, or unresponsiveness (give glucagon first per order); or very high glucose with dehydration, deep rapid breathing or a fruity odor, and altered mentation (possible ketoacidosis or hyperosmolar state). Diabetic foot: inspect the feet each visit; notify for any new lesion, break in the skin, or new loss of protective sensation — high amputation risk (cross-reference Wounds and Touch/Sensation). |
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