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BENI SUEF UNIVERSITY
Faculty of nursing
INSULIN
STUDENT NAME:
INSULIN
DEFINITION:
Insulin is a hormone that is central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle.
TYPES
Insulin is divided into categories which are based on:
• How fast they start to work
• When they reach the peak of their action
• How long they stay in your system
Types of Insulin Names of Insulin onset DURATION
Rapid Acting Humalog/Lispro
Novolog/Aspart 5 - 15 minutes 30 - 90 minutes
Short Acting Regular –soluble
-semilente 1/2 - 1 hour 5 - 7 hours
12_16 hours
Intermediate -lent
-isophane NPH 2- 4 hours 18 - 24 hours
Long Acting Lantus/Glargine
Protamine ZINC (PZ)
Levemir/Detemir 4 – 6 hours 24 - 36 hours
There are also combination insulin mixtures that are premixed, such as:
• 75/25 mix: 75% NPH (intermediate-acting) and 25% Lispro (rapid-acting)
• 70/30 mix: 70% NPH and 30% Regular (short-acting)
• 50/50 mix: 50% NPH and 50% Regular
Each person responds differently to insulin. Your doctor will determine the best type of insulin and the best insulin schedule for you.
ROUTES OF Administration
SC: (by disposable plastic syringe, pen injection device or insulin pumps) all types of insulin
IV: of soluble insulin in emergency.
Nursing care:
ASSESSMENT
Assess patient 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 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 throughout therapy.
Monitor body weight periodically. Changes in weight may necessitate changes in insulin dose.
Lab Test Considerations: May cause decreased serum inorganic phosphate, magnesium, and potassium levels.
o Monitor blood glucose and ketones every 6 hr throughout therapy, more frequently in ketoacidosis and times of stress. Glycosylated hemoglobin may also be monitored to determine effectiveness of therapy.
Toxicity and Overdose: Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated by ingestion of oral glucose. Severe hypoglycemia is a life-threatening emergency; treatment consists of IV glucose, glucagon, or epinephrine.
POTENTIAL NURSING DIAGNOSES
Knowledge deficit, related to medication regimen (Patient/Family Teaching).
Noncompliance (Patient/Family Teaching).
IMPLEMENTATION
General Info: 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.
o Use only insulin syringes to draw up dose. The unit markings on the insulin syringe must match the insulin's units/ml. Special syringes for doses <50 units are available. Use only U-100 insulin syringes to draw up insulin lispro dose. Prior to withdrawing dose, rotate vial between palms to ensure uniform solution; do not shake.
o When mixing insulins, draw regular insulin or insulin lispro into syringe first to avoid contamination of regular insulin vial.
o Insulin should be stored in a cool place but does not need to be refrigerated.
o Because of short duration of insulin lispro, supplementation with longer-acting insulin may be necessary to control blood glucose levels.
SC: Administer insulin lispro within 15 min before a meal.
IV: Regular insulin is the onlyinsulin that can be administered IV. Do not use if cloudy, discolored, or unusually viscous.
o Regular insulin U-500 is not intended for IV route.
Direct IV: May be administered IV undiluted directly into vein or through Y-site.
Rate: Administer up to 50 units over 1 min.
Continuous Infusion: 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.
Rate: When administered as an infusion, rate should be ordered by physician, and infusion should be placed on an IV pump for accurate administration.
o Rate of administration should be decreased when serum glucose level reaches 250 mg/100 ml.
Y-Site Compatibility:
o ampicillin
o ampicillin/sulbactam
o aztreonam
o cefazolin
o cefotetan
o dobutamine
o famotidine
o gentamicin
o heparin
o imipenem/cilastatin
o indomethacin
o magnesium sulfate
o meperidine
o morphine
o oxytocin
o pentobarbital
o potassium chloride
o ritodrine
o sodium bicarbonate
o tacrolimus
o terbutaline
o ticarcillin
o ticarcillin/clavulanate
o tobramycin
o vancomycin
o Vitamin B complex with C.
Additive Compatibility: May be added to total parenteral nutrition (TPN) solutions.
PATIENT/FAMILY TEACHING
Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, 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.
Demonstrate technique for mixing insulins by drawing up regular insulin or insulin lispro first and rolling intermediate-acting insulin vial between palms to mix, rather than shaking (may cause inaccurate dose).
Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term.
Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified of significant changes.
Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional.
Advise patient to consult health care professional prior to using alcohol or other medications concurrently with insulin.
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 sugar levels are not controlled.
Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur.
Advise patient to notify health care professional if pregnancy is planned or suspected.
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.
EVALUATION
Effectiveness of therapy can be demonstrated by:
Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes.
H4
,وكمان رابط لملف ورد منسق مرفوع علي ميديا فير
http://www.mediafire.com/?6k375noetjmykta
Faculty of nursing
INSULIN
STUDENT NAME:
INSULIN
DEFINITION:
Insulin is a hormone that is central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle.
TYPES
Insulin is divided into categories which are based on:
• How fast they start to work
• When they reach the peak of their action
• How long they stay in your system
Types of Insulin Names of Insulin onset DURATION
Rapid Acting Humalog/Lispro
Novolog/Aspart 5 - 15 minutes 30 - 90 minutes
Short Acting Regular –soluble
-semilente 1/2 - 1 hour 5 - 7 hours
12_16 hours
Intermediate -lent
-isophane NPH 2- 4 hours 18 - 24 hours
Long Acting Lantus/Glargine
Protamine ZINC (PZ)
Levemir/Detemir 4 – 6 hours 24 - 36 hours
There are also combination insulin mixtures that are premixed, such as:
• 75/25 mix: 75% NPH (intermediate-acting) and 25% Lispro (rapid-acting)
• 70/30 mix: 70% NPH and 30% Regular (short-acting)
• 50/50 mix: 50% NPH and 50% Regular
Each person responds differently to insulin. Your doctor will determine the best type of insulin and the best insulin schedule for you.
ROUTES OF Administration
SC: (by disposable plastic syringe, pen injection device or insulin pumps) all types of insulin
IV: of soluble insulin in emergency.
Nursing care:
ASSESSMENT
Assess patient 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 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 throughout therapy.
Monitor body weight periodically. Changes in weight may necessitate changes in insulin dose.
Lab Test Considerations: May cause decreased serum inorganic phosphate, magnesium, and potassium levels.
o Monitor blood glucose and ketones every 6 hr throughout therapy, more frequently in ketoacidosis and times of stress. Glycosylated hemoglobin may also be monitored to determine effectiveness of therapy.
Toxicity and Overdose: Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated by ingestion of oral glucose. Severe hypoglycemia is a life-threatening emergency; treatment consists of IV glucose, glucagon, or epinephrine.
POTENTIAL NURSING DIAGNOSES
Knowledge deficit, related to medication regimen (Patient/Family Teaching).
Noncompliance (Patient/Family Teaching).
IMPLEMENTATION
General Info: 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.
o Use only insulin syringes to draw up dose. The unit markings on the insulin syringe must match the insulin's units/ml. Special syringes for doses <50 units are available. Use only U-100 insulin syringes to draw up insulin lispro dose. Prior to withdrawing dose, rotate vial between palms to ensure uniform solution; do not shake.
o When mixing insulins, draw regular insulin or insulin lispro into syringe first to avoid contamination of regular insulin vial.
o Insulin should be stored in a cool place but does not need to be refrigerated.
o Because of short duration of insulin lispro, supplementation with longer-acting insulin may be necessary to control blood glucose levels.
SC: Administer insulin lispro within 15 min before a meal.
IV: Regular insulin is the onlyinsulin that can be administered IV. Do not use if cloudy, discolored, or unusually viscous.
o Regular insulin U-500 is not intended for IV route.
Direct IV: May be administered IV undiluted directly into vein or through Y-site.
Rate: Administer up to 50 units over 1 min.
Continuous Infusion: 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.
Rate: When administered as an infusion, rate should be ordered by physician, and infusion should be placed on an IV pump for accurate administration.
o Rate of administration should be decreased when serum glucose level reaches 250 mg/100 ml.
Y-Site Compatibility:
o ampicillin
o ampicillin/sulbactam
o aztreonam
o cefazolin
o cefotetan
o dobutamine
o famotidine
o gentamicin
o heparin
o imipenem/cilastatin
o indomethacin
o magnesium sulfate
o meperidine
o morphine
o oxytocin
o pentobarbital
o potassium chloride
o ritodrine
o sodium bicarbonate
o tacrolimus
o terbutaline
o ticarcillin
o ticarcillin/clavulanate
o tobramycin
o vancomycin
o Vitamin B complex with C.
Additive Compatibility: May be added to total parenteral nutrition (TPN) solutions.
PATIENT/FAMILY TEACHING
Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, 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.
Demonstrate technique for mixing insulins by drawing up regular insulin or insulin lispro first and rolling intermediate-acting insulin vial between palms to mix, rather than shaking (may cause inaccurate dose).
Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term.
Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified of significant changes.
Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional.
Advise patient to consult health care professional prior to using alcohol or other medications concurrently with insulin.
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 sugar levels are not controlled.
Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur.
Advise patient to notify health care professional if pregnancy is planned or suspected.
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.
EVALUATION
Effectiveness of therapy can be demonstrated by:
Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes.
H4
,وكمان رابط لملف ورد منسق مرفوع علي ميديا فير
http://www.mediafire.com/?6k375noetjmykta
