HEEELLLLLLOOOO N.U.R.S.E.!!!

For as crazy and outlandish as many of my posts are, I think you guys may be figuring out after all these "school postings" that I am a little "anal". I was a Surgical and Pediatric ICU nurse for 14 years For The Love of God...so YES, I like things clear and concise.

This is something I wrote up for Joe's nurse when he started K-garten. Our 504 plan is more "general" than what this document covers. (Wendy from candyheartsblog.com has an awesome 504 Plan here). This is more of the "nuts and bolts" of Joe's daily care needs and "how to's". As with all the documents, please feel free to use/tweak/etc. You can access this document by either "copying and pasting" OR clicking here to access it on Scribd. OR you can access all documents I have uploaded to date by clicking the tab on the upper right corner of my blog.

Side Note: Please make sure to give a copy of glucometer manual and pump manual..etc to the Health Office. Also, many product manuals can be accessed on-line.

Onto the DOCUMENT....

DAILY CARE FOR JOE 2009/2010

I will send in “Daily Care Log” (for "Daily Care Log" click here) each day. This will have Joe’s morning blood sugar on it. It will also have a list of foods that we packed for Joe for that day with carb counts. The nurse or designated persons will write down blood sugars and amounts of insulin given throughout the day. Please tuck the “Daily Care Log” in the pack where Joe’s glucometer is kept at the end of each day and place the pack in Joe’s backpack.

BLOOD SUGAR CHECKING ROUTINE

Joe’s blood sugar may be checked by the School Nurse or designated persons.

1. Check daily prior to morning snack.
2. Check daily prior to lunch.
3. Check prior to P.E.
4. Check daily @ 1:45 – 2:00.

*Joe’s blood sugar must be checked promptly when he appears LOW.

TREATMENT FOR LOW BLOOD SUGAR

If blood sugar level is less than 70, Joe will need sugar. He usually takes glucose tablets to treat a low (each tablet contains 4 grams of carbohydrate).

***If Joe’s blood sugar is less than 70 - Give 3 glucose tablets OR a juice box

After giving Joe sugar, wait 10-15 minutes to recheck blood sugar level. It is important that Joe not eat anything during the 10-15 minutes, as other food components can slow down the absorption of the sugar given to treat the low. If the repeat number is less than 70, treat again using the directions above.

If Joe is UNCONSCIOUS OR HAVING A SEIZURE:

1. Have someone call 911 and then parents
2. Give Glucagon (in the red container - needs to be "reconstituted) 1mg into the front of Joe's thigh
3. Roll Joe onto his side
4. Once he regains consciousness...have him take sips of juice if he is able
   

WHEN TO GIVE INSULIN

1. Daily with morning snack.
2. Daily with lunch.
3. Daily with any extra food
4. To correct a high blood sugar

*Extra insulin will be needed when there are ketones present…call parents for instructions/or Joe may need to go home for large ketones.

HOW TO GIVE INSULIN (note this is for the Animas Ping Pump - I also give a copy of the Ping Manual to the Nurse for her office - this is a "cheat sheet").

For Carbs with Blood Sugar Check:

1. Unlock pump by pressing up and down arrows at the same time (sometimes I have to do it twice)…the pump will make a beep and the home screen will appear.
2. Select menu on the pump and press “OK”
3. Select “Bolus” and press “OK”
4. When having food with carbs select “eZCarb” and press “OK”
5. Enter in carbs (using arrows) and select “OK”
6. Enter in blood sugar (using arrows…it will start you at 80) and then press “OK”
7. The pump will say “show result” select “OK”
8. The pump will then show Carb…/BG…/IOB (insulin on board) with numbers by them…then, there will be a row that says “Total”…use the number of units stated by total for dosing. Use the up arrow to get to the number listed by “Total” then press “OK”. You then need to press “OK” again for the pump to deliver the insulin.
9. Press the up and down arrows at the same time to lock pump.
   

For Blood Sugar Correction Only: (correct blood sugars > 200)

1. Follow steps 1-3 above
2. When correcting for blood sugar only select “eZBG” and press “OK”
3. Using arrows, scroll up to the number that corresponds to Joe’s blood sugar and press “OK”
4. Select “show result” and select “OK”
5. Next to the word “total” there will be the number of units of insulin you should give Joe
6. Use the arrows and scroll up to the number displayed by the word “total” and then press “OK”
7. Then press “OK” again for the pump to deliver the insulin
8. Press the up and down arrows together to lock the pump.

WHEN TO CHECK KETONES

Ketones must be checked if Joe has two consecutive readings greater than 250 and/or if he complains of abdominal pain or vomits. Please call parents if he has moderate to large ketones (a blood ketone reading > 0.6 or moderate to large urine ketones). He may need his pump site changed (parents will change) and extra insulin and/or he may need to go home for closer monitoring. Please have him drink water and have liberal access to the bathroom.

WHAT TO DO FOR P.E.

Please check Joe’s blood sugar prior to P.E. If his blood sugar is less than 70 (treat the LOW, as outlined). If his blood sugar is 70-140, please give him 2 crackers from his cracker pack (8grams). If his blood sugar is 140-220, do nothing. If his blood sugar is greater than 240 (do ½ a correction).

WHEN TO CALL PARENTS

1. Blood sugar less than 70
2. Blood sugar greater than 250
3. Moderate to large ketones
4. If Joe’s pump becomes disconnected
5. If Joe’s pump is alarming
6. If Joe becomes sick or vomits
7. For questions on carb counting
8. For ANY questions or concerns

PHONE NUMBERS (I list my phone #, my husband's phone #, our email address, and the Endocrinology phone # here).

And that-is-that...HOPING to make your "day-in-the-life" a little easier FRIENDS.