A diabetic patient who is put on NBM for a CT scan. What should the nurse do?

AIIMS Delhi NO - 2017

Medical & Surgical Nursing

Hard

Appeared in: AIIMS Delhi NO - 2017

Explanation

When a patient is NBM, their glucose intake from food is zero, which significantly reduces the need for insulin.
To prevent a dangerous drop in blood sugar (hypoglycemia), the total insulin dose must be reduced.
Standard protocol involves holding mealtime (prandial) insulin and often giving a reduced dose of the basal (long-acting) insulin.
This adjustment balances the risk of hypoglycemia from too much insulin and the risk of hyperglycemia or DKA from too little insulin.

Option A: Completely postponing or withholding all insulin, especially basal insulin, can lead to uncontrolled glucose production by the liver. This causes severe hyperglycemia and can precipitate Diabetic Ketoacidosis (DKA), a life-threatening condition.
Option B: The scheduled dose is calculated to cover the patient's normal diet. Administering this full dose to a fasting patient will cause their blood glucose to drop to dangerously low levels, resulting in hypoglycemia.
Option C: Increasing the insulin dose in a patient who is not eating is extremely dangerous and would lead to severe, potentially fatal, hypoglycemia.

Clinical Relevance

Nursing practice connection: Use the key finding related to Insulin management for diabetic patients with NBM (Nil By Mouth) status to guide bedside assessment, documentation, and the next nursing action.
A primary nursing responsibility is patient safety, which includes preventing hypoglycemia in diabetic patients who are NBM. Always question an order for a full dose of insulin in a fasting patient.
Nurses must perform frequent blood glucose monitoring (typically every 4-6 hours) for NBM patients on insulin to detect and manage fluctuations in blood sugar promptly.
What if? If the CT scan is unexpectedly cancelled after the patient has already received a reduced dose of long-acting insulin? The nurse must continue to keep the patient NBM, monitor their blood glucose closely, and notify the physician. An order for an IV dextrose infusion may be required to prevent hypoglycemia.

How to Approach the Question

First, identify the core clinical scenario: a patient with diabetes is not eating (NBM).
Next, analyze the physiological impact: No food intake means no glucose absorption from the gut.
Connect this to the medication: Insulin's primary job is to lower blood glucose. Giving insulin without a glucose source will cause hypoglycemia.
Evaluate the options based on safety. The main risk here is hypoglycemia.
Eliminate options that increase the risk of hypoglycemia: 'Administer scheduled dose' and 'Increase the insulin dose' are incorrect.
Consider the risk of withholding insulin entirely ('Postpone the dose'), which is hyperglycemia and DKA. This is also unsafe.

Concept Tested & Keywords

Concept Tested: Insulin management for diabetic patients with NBM (Nil By Mouth) status.
Stem keywords: diabetic patient, NBM, CT scan, insulin
Lead-in keywords: What should the nurse do
Clinical cues: The patient's NBM status is the critical cue, as it signifies a lack of carbohydrate intake, directly impacting insulin requirements.

QOBtqboySfcxZLohKjC_sH

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 1-3