A nurse is caring for a diabetic client scheduled for major abdominal surgery in the morning. The client's preoperative blood glucose is 180 mg/dL, and the anesthesiologist has ordered to hold all oral diabetic medications. What is the most appropriate nursing action to ensure client safety?

Diabetic clients undergoing surgery require careful glucose management to prevent complications. Oral diabetic medications are typically held preoperatively, but insulin coverage may be needed to maintain glucose control and prevent hyperglycemia-related complications during the perioperative period.

Core Nursing Explanation This question tests the nurse's understanding of perioperative management of diabetes mellitus. The core principle is balancing the risk of hypoglycemia from medications with the risk of hyperglycemia from surgical stress, both of which can impair wound healing and increase infection risk. Key Concept Analysis The client with Type 2 Diabetes Mellitus (DM) is scheduled for major surgery. The stress of surgery triggers the release of counter-regulatory hormones (cortisol, epinephrine, glucagon), which promote insulin resistance and gluconeogenesis, leading to a high risk of hyperglycemia. The preoperative blood glucose of 180 mg/dL (target is typically

Nursing Clinical Practice Guide Clinical Scenario You are the preoperative nurse for Mr. Johnson, a 58-year-old with Type 2 DM. He is anxious about his surgery and mentions, "I didn't take my diabetes pills this morning like they told me, but I'm worried my sugar will go sky-high." His preoperative fingerstick glucose is 210 mg/dL. Nursing Intervention Strategy 1. Assessment: Confirm NPO status, review home medications, and establish a baseline with frequent blood glucose monitoring (e.g., every 1-2 hours pre-op). 2. Communication: Contact the surgeon or anesthesiologist to report the elevated glucose and discuss an insulin order. Document the communication clearly. 3. Implementation: If an insulin sliding scale is ordered, administer subcutaneous insulin as per protocol based on the blood glucose result. Always use the "Two-Nurse Check" for insulin verification. 4. Education & Reassurance: Explain to the client that holding the pills is for safety and that insulin will be used to carefully control his sugar during and after surgery. Reassure him that this is a standard procedure. 5. Evaluation: Monitor for effectiveness (glucose trending into target range) and for adverse effects (signs of hypoglycemia: sweating, tremor, confusion). Patient Safety and Precautions • Key Point! Hypoglycemia is the acute danger. Have a source of rapid-acting carbohydrate (e.g., IV dextrose, oral glucose gel) readily available. • Know the facility's protocol for "critical value" blood glucose levels that require immediate intervention. • Be aware of the signs of hyperglycemic hyperosmolar state (HHS), which can occur in Type 2 DM, especially in the elderly.
Nursing Procedure & Medication Flow Administering Sliding Scale Insulin: 1. Perform hand hygiene and don gloves. 2. Obtain a blood glucose reading via fingerstick. 3. Check the physician's order for the specific sliding scale (e.g., "For BG 151-200, give 2 units of regular insulin subQ"). 4. With another nurse, perform an independent double-check of the insulin type, dose, and expiration date. 5. Draw up the correct dose into an insulin syringe. 6. Administer subcutaneously, typically into the abdomen, at a 45- to 90-degree angle. 7. Document the blood glucose value, insulin dose given, site of injection, and the client's response.
A Word from Your Senior Nurse Managing diabetes during surgery is a perfect example of why nursing judgment is irreplaceable. The computer might flag that a medication is overdue, but you understand the bigger picture: the client is NPO, the stress of surgery is coming, and hyperglycemia is a real threat to healing. Picking up the phone to clarify and advocate for an insulin plan isn't just following an order—it's creating the safe pathway for your client. On the NCLEX and at the bedside, always connect the dots between the disease process, the current situation, and the missing piece of care. That's what keeps patients safe.