Week 7 & 8/ Test 2 - Regular Insulin & NPH Insulin & Heparin

Isophane suspension insulin

NPH or Humulin N or Novolin N Intermediate acting Onset: 1-2 hrs Peak: 6-12 hrs Duration: 18-24 hrs

The nurse understands that heparin may be drawn up in a ____________ syringe. A) tuberculin B) insulin C) heparin D) IM

A) tuberculin May be drawn up in tuberculin (1mL) syringe •Marked in hundredths of a mL May be drawn up in 3 mL syringe •Marked in tenths of a mL

Heparin subcut needle gauge & length

25-27 gauge 3/8"-58" needle

Heparin is one of the most commonly reported medications involved in errors that have cause harm to patients. A) True B) False

A) True Causes include: - Calculation errors - Mix-ups with concentrations - Confusion with total amount ina vial of heparin and total amount per mL - Insufficient monitoring of client

What patient education should the nurse provide to the patient with diabetes who is planning an exercise program? A) Monitor blood glucose levels before and after exercise. B) Exercise may increase insulin needs. C) Withhold insulin prior to engaging in strenuous exercise. D) Take extra insulin prior to exercise.

A) Monitor blood glucose levels before and after exercise

The nurse knows that heparin must be drawn up for subcutaneous injections in a 25-27 gauge 3/8-5/8 inch syringe. A) True B) False

A) True

The patient is scheduled to receive 5 units of Humalog and 25 units of NPH insulin prior to breakfast. Which nursing intervention is most appropriate for this patient? A)Make sure the patient's breakfast is available to eat before administering this insulin. B) Offer the client a high-carbohydrate snack in 6 hours. C) Hold the insulin if the blood glucose level is greater than 100 mg/dL. D) Administer the medications in two separate syringes.

A)Make sure the patient's breakfast is available to eat before administering this insulin.

Heparin is classified as a medium-alert medication. A) True B) False

B) False Heparin is a high-alert med

Hypoglycemia

Blood glucose < 60 - 70 mg/dL Depends on the patient •What is their usual glucose level? Often very rapid onset IF IN DOUBT - TREAT!

Nursing considerations in insulin therapy

Blood glucose monitoring Monitor food intake and exercise Monitor for signs and symptoms of hypoglycemia Treat hypoglycemia quickly - if in doubt treat

What is diabetes mellitus?

Blood sugar stays above normal Fasting BG >126 mg/dL

The nurse is initiating discharge teaching with the newly diagnosed patient with diabetes. Which of the following statements indicate that the patient needs additional education? A) "If I am experiencing hypoglycemia, I shouldn't take 5 units of Regular insulin." B) "My insulin needs may increase when I have an infection" C) "I must draw the NPH insulin first if I am mixing it with regular insulin." D) "If my blood glucose levels are less than 60 mg/dL, I should notify my health care provider."

C) "I must draw the NPH insulin first if I am mixing it with regular insulin."

Heparin can be administered: select all that apply A) intramuscular B) oral C) intravenous D) subcutaneous

C) intravenous D) subcutaneous

Types of insulin - How are they categorized?

Categorized by time frame of action •Clear or cloudy •Route of administration •Ability to be mixed with other insulins

Characteristics of diabetes mellitus

Chronic Disease Systemic Disease Metabolic and vascular complications

Clear vs. Cloudy

Clear: - Rapid-acting (lispro, aspart, glulisine), - Regular - Levemir (long-acting) - Lantus (long-acting) All others are cloudy (including NPH!)

When calculating the amount of heparin to draw up the nurse has an amount of 0.578. The nurse will administer: A) 0.6 mL B) 0.578 mL C) 0.57 mL D) 0.58 mL

D) 0.58 mL Round to the nearest hundredth

A patient receives NPH and regular insulin every morning. The nurse is verifying that the client understands that there are two different peak times to be aware of for this insulin regimen. Why is this an important concept for the nurse to stress? A) The patient needs to plan the next insulin injection around peak times. B) Additional insulin may be needed at peak times to avoid hyperglycemia. C)It is best to plan exercise or other activities around peak insulin activity. D) The risk for hypoglycemia is greatest around the peak of insulin activity.

D) The risk for hypoglycemia is greatest around the peak of insulin activity.

What causes pancreas to secrete insulin?

Food intake Blood glucose increase above 100 mg/dL

Glucagon

Hormone that breaks down glycogen stores in liver when food not present & blood glucose levels are low. Raises BG levels.

Regular insulin

Humulin R & Novolin R Short acting Onset: 30-60 mins Peak: 2.5-5 hrs Duration: 6-8 hrs

Treatment of hypoglycemia

If conscious and able to swallow: Give 15 grams CHO: •4 oz fruit juice •6 oz non-diet soft drink ( ginger ale, cola, etc) •1 tbs sugar, honey, jelly •8 lifesavers •Glucose tablets or gel Re-Check in 15 minutes Repeat fast acting CHO if needed Patient should also eat protein food If unconscious or unable to swallow: •Glucagon IM/SC or IV •If not effective - IV glucose IF IN DOUBT - TREAT!

Heparin rounding rule

If round to hundredth, carry division to thousandth, then round. 0.625mL = 0.63mL If round to tenth, carry division to hundredth, then round. 0.62mL = 0.6mL

Normal Regulation of Glucose Levels

Insulin lowers blood glucose level Glucagon raises blood glucose level

Long-acting insulin

Lantus, Levemir, Tresiba Clear Subcut only Do not mix

Mixing insulins

Lispro & Aspart can be mixed with NPH R & NPH are most common insulins & mixed commonly. -Regular must be drawn up FIRST!

Rapid-acting insulin

Lispro (Humalog) & Aspart (Novolog) & Glulisine (Apidra) Clear Subcut & IV & Pump

Heparin syringes

May be drawn up in tuberculin syringe •Marked in 0.01 mL May be drawn up in 3 mL syringe •Marked in 0.1 mL IV or subcut High-Alert! (2 RNs check correct med & dose)

Type I DM

Pancreas does not secrete insulin. Genetic- you are born with this. Type I, you have NONE, & you can pass this to your SON Treatment: insulin, meal planning, exercise

Role of pancreas in glucose regulation

Pancreas produces hormones called insulin and glucagon, which regulate BP.

Type II DM

Pancreas produces insulin, but tissues resist insulin Poor diet & lifestyle causes tissues/cells to become overused & resistant to insulin. Insulin receptor sites are worn out & stop responding. Type II, the problem is YOU. Treatment: insulin, exercise, meal plan, weight loss, oral anti-diabetic agents,

Function of insulin

Released when BG levels are high. Binds with insulin receptors to allow glucose to enter cells in liver, muscle, fat - this lowers BG Plays a major role in metabolism of carbohydrates (CHO), fat, & protein - Allows body to use food.

Complications of diabetes mellitus

Retinopathy (retina damage, causes vision impairment) Neuropathy (dysfunction of peripheral nerves, causing numbness or weakness) Coronary heart disease Nephropathy (kidney disease) Peripheral vascular disease (narrowing of vessels that reduces blood flow to limbs)

Subcut injection sites

Rotate sites to prevent lipodystrophy. Absorption rate faster in abdomen Lower back, back upper arms, butt, outer thighs.

Routes of admin

SC: All types of insulin Insulin pump: Rapid-acting (Aspart, lispro, glulisine) & Regular IV: Aspart, glulisine, regular

Insulin concentration

U-100 concentration most common (100 units/mL) U - 500 rarely used

S/S of hypoglycemia

•Sweating •Nervousness •Irritability •Tachycardia •Hunger •Weakness •Tremors •Confusion •Eventually: Convulsions & LOC Super New IT Hunk Will Talk Computers Constantly if you Let him!