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Endocrine study, Daisy Miller (NPH Insulin (Vallerand, Sanoski,
&…
Endocrine study, Daisy Miller
NPH Insulin (Vallerand, Sanoski,
& Deglin, 2016)
Adverse effects:
- Hypoglycemia
- Hypokalemia
- Local swelling and erythema
Lowers blood glucose by: stimulating glucose uptake in skeletal muscles and fat, inhibiting hepatic glucose production. In this situation the desired effect would be to have her blood glucose levels under control and within the normal range.
Final dose for NPH insulin is 8 units, subcutaneous
- Insulin should be stored in a cool place, but doesn't need to be refrigerated
- Administer 30-60 minutes before meal
- Refer to "Steps to Administering Insulin"
In this situation NPH insulin would be appropriate, since it is an intermediate acting insulin. She will also be taking it 2 times in a day with a 13 hour interval in between doses. Since the duration of NPH is between 12-16 hours, she will most likely by covered until her next dose.
Assessments
- Assess for symptoms of hyperglycaemia and hypoglycemia
- Monitor body weight periodically
- Monitor blood glucose every 6 hours or less
- Monitor for hypokalemia
Novolin Regular (Vallerand, Sanoski,
& Deglin, 2016)
Final dose for Novolin Regular is 7 units, subcutaneous
Novolin in this situation is a reasonable choice, because it is considered to be a short acting insulin (Perry et al., 2010). In a typical diabetic insulin regime, patients will usually have a long acting and short acting insulin taken throughout the day. However, I would suggest to the physician that 3 doses a day might be more conducive, as short acting insulin is normally administered 3 times in a day 15 minutes before meals. I would also discuss with the physician regarding dosage changes based on the patient's active lifestyle in order to prevent a hyperglycemic event.
The medication works by stimulating glucose uptake in the skeletal muscle and fat, while inhibiting glucose production, resulting in a lowered blood glucose. In this situation, it is appropriate because we want to control her glucose levels in order to prevent further complications.
Adverse effects:
- Hypoglycemia
- Hypokalemia
- Itchy skin
- Local swelling
- Do not confuse Humulin with Humalog
- Insulin should be stored in a cool place
- Administer 15-30 minutes before meals
- Refer to "Steps to Administering Insulin"
Assessment
- Assess patient periodically for symptoms of hypoglycemia and hyperglycemia
- Monitor body weight periodically. Changes in weight may indicate a change in dosage
- Monitor blood glucose every 6 hours
- Monitor serum potassium in patient at risk for hypokalemia
Monitoring Blood Glucose at 08, 10, 12, 14, 17, 21, 03
Monitoring blood glucose is important especially when someone is starting on insulin therapy or a new regimen. Frequent monitoring allows the physician to determine any dose adjustments and effectiveness of the drug therapy (Perry et al., 2010)
Nursing Process
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Implementation
- Administer drug before meals
- Ensure patient is following her diet and exercise plan by implementing a food journal
- Ensure warm and quiet environment during time of administration
- Address patient or guardians concerns
- Provide visual distractions such as a stuffed animal when administering
- Give a sticker after to celebrate getting a needle
Assessment (Perry, Potter & Ostendorf, 2010)
- Assess for history of hypersensitivity or allergic reaction to insulins
- Perform a baseline assessment, including vitals and glucose levels.
- Assess administration site for any skin lesions present that show signs of infection
- Assess body systems for changes suggesting complications related to poor glucose control
- Assess diet and activity level, noting any poor habits. Pay close attention to activity levels, because it can alter glucose levels and may require a higher dose of insulin
- Monitor blood glucose levels as ordered to evaluate drug and blood sugar control
- Assess lab values and urinalysis for ketones, glucose in urine and blood, along with renal function.
- Assess patient’s lifestyle and any kind of stressors that could possibly exacerbate glucose levels
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