NURS 1566 Clinical Form 3: Clinical Medications Worksheets (You will need to make additional copies of these forms

) Generic Name regular insulin Peak 2-4 hr Trade Name Humulin R, Novolin R Onset 30-60 min Classification antidiabetics Dose 125 units Route IVPB Time/frequency Infuse per physician’s order, change daily at 1200

Duration 5-7 hr

Normal dosage range Dose depends on blood glucose, response, and many other factors. 0.1 unit/kg/hr as a continuous infusion. Rate should
be ordered by physician, and infusion placed on an IV pump for accurate administration.

Why is your patient getting this medication Diabetes mellitus

For IV meds, compatibility with IV drips and/or solutions Medication errors involving insulins have resulted in serious patient harm and death. Clarify all ambiguous orders and do not accept orders using the abbreviation "u" for units, which can be misread as a zero or the numeral 4 and has resulted in tenfold overdoses. Insulins are available in different types and strengths and from different species. Check type, species source, dose, and expiration date with another licensed nurse. Do not interchange insulins without consulting physician or other health care professional. Do not confuse regular concentrated (U-500) insulin with regular insulin. Regular insulin is the only insulin that can be administered IV. Do not use if cloudy, discolored, or unusually viscous. Do not administer regular (concentrated) insulin U-500 IV. May be diluted in commonly used IV solutions as an infusion; however, insulin potency may be reduced by at least 20-80% by the plastic or glass container or tubing before reaching the venous system. Y-Site Compatibility: amiodarone, ampicillin, ampicillinsulbactam, aztreonam, cefazolin, cefotetan, dobutamine, esmolol, famotadine, gentamicin, heparin, imipenemcilastatin, indomethacin, magnesium sulfate, meperidine, meropenem, midazolam, milrinone, morphine, nitroglycerin, nitroprusside, oxytocin, potassium chloride, propofol, ritodrine, sodium bicarbonate, tacrolimus, terbutaline, ticarcillin, ticarcillin/clavulanate, tobramycin, vancomycin, vitamin B complex with C. Y-Site Incompatibility: dopamine, nafcillin, norepinephrine, ranitidine. Additivie Compatibility: May be added to total parenteral nutrition (TPN) solutions.

Mechanism of action and indications (Why med ordered) Lower blood glucose by increasing transport into cells and promoting the conversion of glucose to glycogen. Promote the conversion of amino acids to proteins in muscle and stimulate triglyceride formation. Inhibit the release of free fatty acids.

Nursing Implications (what to focus on) Contraindications/warnings/interactions Allergy or hypersensitivity to a particular type of insulin, preservatives, or other additives, Stress, infection (temporarily increase insulin requirements). Common side effects Lipodystrophy, HYPOGLYCEMIA.

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) Beta blockers may block some of the signs and symptoms of hypoglycemia and delay recovery from hypoglycemia (Lopressor). Chronic use of alcohol may increase insulin requirements. Acute use of alcohol and beta blockers (nonselective) may decrease insulin requirements.

Nursing Process- Assessment (Pre-administration assessment) Blood sugar monitoring. Assess for signs and symptoms of hypoglycemia (anxiety; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nausea; nervousness; rapid

Lab value alterations caused by medicine May cause ↓ serum inorganic phosphate, magnesium, and potassium levels. Be sure to teach the patient the following about this medication Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, external pumps, alcohol swabs), storage, and place to discard syringes. Discuss the importance of not changing brands of insulin or syringes, selection and rotation of injection sites, and compliance with therapeutic regimen Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term. Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional. Advise patient to notify health care professional of medication regimen prior to treatment or surgery. Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood glucose levels are not controlled. Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur. Patients with diabetes mellitus should carry a source of sugar (candy, sugar packets) and identification describing their disease and treatment regimen at all times. Emphasize the importance of regular follow-up, especially during first few weeks of therapy. Assessment Evaluation Why would you hold or not give this Check after giving med? Control of blood glucose Hypoglycemia levels without the appearance of hypoglycemic or hyperglycemic episodes.

pulse; shakiness; unusual tiredness or weakness) and hyperglycemia (drowsiness; flushed, dry skin; fruit-like breath odor; frequent urination; loss of appetite; tiredness; unusual thirst) periodically during therapy. Monitor body weight periodically. Changes in weight may necessitate changes in insulin dose.

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