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Pаtient Chаrt|Simulаtiоn · New-Onset Type 1 DiabetesPhase 2 оf 3 · Day 2 · 1130 NB Nоra Bennett 8 years · Female · 26 kg · MRN 20611 · Pediatrics, Rm 407 ⚠ NKDAHigh blood glucose, new onsetStandard PrecautionsFull Code Phase 2 · Starting InsulinDay 2 · 1130 Click a tab to open that part of the chart. Click it again to close it. You must close the current tab to view other tabs in the chart. Vitals Vitals Temp 36.9 °C HR 92 bpm RR 20 /min BP 100/62 mmHg SpO₂ 99 % RA POC glucose 262 mg/dL Intake & Output Last 24 hr: PO 1900 mL · Urine 1600 mL Trend Flowsheet D1 1000 D2 1130 Temp °C 37.0 36.9 HR 104 92 RR 20 20 Glucose 230 262 Notes Notes RN, Pediatrics1130Nursing NoteSigned Pre-lunch glucose 262 mg/dL at 1125. Lunch tray delivered. Nora says she will eat everything on the tray except the milk: "I don't like milk. I'll just drink my water." Mother will give the injection with supervision. Nora is planning to go to the playroom after lunch. Results Results Test Result Reference Flag Urine ketones Negative Negative Orders Orders Insulin glargine and insulin lispro: see MAR New POC glucose before meals, at bedtime and at 0200 New Carbohydrate-counted diet New Diabetes education with family New MAR MAR Medication Administration Record · Day 2 · 1130 · ✓ GivenDueScheduled Scheduled medications 0800 1200 1700 2100 insulin lispro (HumaLOG) injection High alert Mealtime dose: 1 unit per 20 g carbohydrate · subcut · 3 times daily before meals Give with the correction dose as one injection ✓ Given 3 units at 0805 Due Calculate dose Scheduled — insulin lispro (HumaLOG) correction scale High alert Correction dose: per sliding scale below · subcut · 3 times daily before meals ✓ Given 1 unit at 0805 (BG 196) Due Use pre-meal BG Scheduled — insulin glargine (Lantus) injection High alert 8 units · subcut · daily at bedtime Last given Day 1 at 2105 — — — Scheduled 8 units PRN (as-needed) medications Last given glucagon injection 0.5 mg · IM · PRN severe hypoglycemia (unconscious or unable to swallow) Not given Lispro correction (sliding) scale Blood glucose (mg/dL) Lispro to add Below 150 0 units 150–249 1 unit 250–349 2 units 350 or higher 3 units and notify provider Add the correction dose to the mealtime carbohydrate dose and give as one injection. History History Previously healthy; immunizations up to date. 3 weeks of constant thirst and frequent urination; has started wetting the bed after years of being dry. Lost about 2.5 kg even though parents say she is "eating everything in sight." Very tired for the past week; fell asleep at school twice. Seen by her pediatrician this morning for the bed-wetting; her office blood glucose was 248 mg/dL and she was sent for direct admission. No vomiting or abdominal pain. Family history: maternal aunt with autoimmune thyroid disease. Simulated patient for educational use only Phase 2 · Question 2 of 2 At 1600, after an hour in the playroom, Nora is shaky, sweaty and pale and says she "can't think straight." Her glucose is 58 mg/dL. She is awake and able to swallow. What does the nurse do first?