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Nursing 242 > INSULIN > Flashcards

INSULIN Flashcards

1
Q

When mixing meds from vial and ampule, what order?

A

Vial, then ampule

–> put on filter needle for ampule

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2
Q

If not sure about med compatibility when mixing, what to do?

A
  • Check med compatibility chart

- Phone pharmacist

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3
Q

What kind of vessel does insulin come in?

A

Vials

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4
Q

What to do with intermediate acting insulins prior to administering them?

A

Roll gently to re-suspend (cloudy)

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5
Q

*What to do with insulins prior to administering?

A
  • Check expiry date
  • Check compatibility
  • Back check with doctor’s orders! and MAR
  • Do insulin research
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6
Q

If mixing insulins, which is drawn up first?

Basic procedure for this?

A

Rapid or short-acting first, then intermediate

Air into cloudy, air into clear, draw up clear, draw up cloudy

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7
Q

Can other diluents or meds be mixed with insulins?

A

No other diluent or med should be mixed with any other inslin product unless approved by the prescriber

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8
Q

Which insulins can’t be mixed?

A

Do NOT mix inulin glargine (Lantus) or insulin detemir (Levemir) with any other types of insulin and do not admin IV

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9
Q

If mixing rapid acting with NPH, when is the insulin given?

A

Within 15 mins before meal

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10
Q

How many checks by nurses is required for insulins?

A

2

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11
Q

What to do if too much insulin in drawn up from second vial?

A

discard

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12
Q

*Assessments prior to insulin admin?

A
  • Hypo/hyperglycemia

-

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13
Q

Signs and symptoms of hypoglycemia

A 
Neurogenic (Autonomic)
-	Trembling
-	Palpitations
-	Sweating
-	Anxiety
-	Hunger
-	Nausea
-	Tingling
Neuroglycopenic:
-	Difficult concentrating
-	Confusion
-	Weakness
-	Drowsiness
-	Vision changes
-	Difficulty speaking
-	Headache
-	Dizziness
-	Tiredness
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14
Q

Which s&s can be from both hyper and hypoglycemia?

A

Tachycardia, delirium, sweating

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15
Q

When does first check of insulin take place?

A

As remove from med cart - compare label with MAR

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16
Q

Ensure to do what to vials prior to injecting blunt needle into insulin vials?

A

clean with alcohol swab

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17
Q

Is the procedure during mixing parenteral meds considered sterile?

A

No, aseptic technique is used

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18
Q

Is long acting insulin clear or cloudy?

A

Clear

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19
Q

Which is the long acting insulin?

A

Glargine (Lantus)

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20
Q

When should a second nurse verify the insulin?

A

After withdrawing first (clear) and after second

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21
Q

When is second check of accuracy done when mixing insulins?

A

After both drawn up - compare MAR with prepared med and labels on vials

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22
Q

Third check is done where?

A

At patient’s bedside

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23
Q

WHere to store vials of insulin?

A

In refrigerator, not the freezer. Keep vials currently being used at room temp.

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24
Q

Is it ok to inject insulin straight from the fridge?

A

NO! Do not inject cold insulin!!!

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25
Q

What should insulin vials be inspected for prior to use?

A

Changes in appearance: clumping, frosting, precipitation, change in clarity or colour)
–> indicative of lack of potency

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26
Q

Can you interchange insulin types?

A

No, not unless indicated by prescriber

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27
Q

Where is preferred injection site for insulin/

A

Abdomen, avoid 5cm (2in) radius around umbilicus

- Or outer aspect of thighs

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28
Q

When do children generally start self-administering?

A

By adolescence

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29
Q

If patient can self-admin, should you do it for them?

A

Have pt self-admin whenever possible!

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30
Q

What should those who self admin insulin keep with them at all times?

A

At least 15g CHO

- 4 oz fruit juice or pop, 8 oz skim milk, 6-10hard candies

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31
Q

According to P&P, is rotation of insulin sites necessary?

A

No, because insulins now carry very low risk of hypertrophy

- Just pick an area and rotate within it, to keep absorption consistent

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32
Q

Where is insulin absorption rate fastest? Slowest?

A

Fastest: abdomen
Slow: in thighs

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33
Q

Primary treatment for Type 1 DM?

A

Insulin

34
Q

Broad term for insulin + oral hypoglycemics collectively?

A

Antidiabetic drugs

35
Q

When are type 2 diabetes prescribed insulin?

A

ONly when lifestyle changes and oral drug therapy no longer drug tx nolonger provide adequate management
Or if experience adverse from oral

36
Q

Normoglycemic aka?

A

Euglycemic

37
Q

Two sources of current insulin?

A

Extracted from domesticated animals or synthesized in labs using recombinent DNA technology (using bacteria or yeast for replication)

  • Beef-derived insulin original source but no longer made in Canada (but can be imported from the UK)
  • Porcine also has been replaced by DNA tech
38
Q

By how many amino acids does porcine insulin differ from human?

A

1 amino acid

39
Q

Do exogenous insulins act like endogenous insulins?

A

Yes!

40
Q

If Type 2 is receiving insulin, do they require oral as well?

A

Yes

41
Q

Worst case scenario with overdose of insulin

A

Extreme hypoglycemia leading to shock and possible death

42
Q

Which symptoms could either be a result of hypo or hyperglycemia?

A

Tachycardia, delirium, sweating…

so check blood glucose first!

43
Q

Which drugs can act as antagonists to insulins?

A
  • Result in elevated glucose levels

B-blockers, chlorthalidone, corticosteroids, diazoxide, epinephrine, furosemide, niacin, thyroid hormones, etc…

44
Q

Names of rapid-acting insulins?

A

Aspart (Novorapid)
Glulisine (Apidra)
Lispro (Humalog)

45
Q

Peak, onset + duration of:

1) Rapid acting insulins
2) Humulin R (human regular)
3) Human NPH (Humulin N, NPH)
4) Lantus

A

1) Onset = 10-15mins
Peak = 60-90mins
Duration = 305hrs

2) 30 mins
Peak = 2-3hrs
Duration = 6.5hrs

3) Onset 1-3hrs
Peak = 5-8hrs
Duration = up to 18hrs

4) Onset = 90 mins
Peak = None
Duration = 24hrs

46
Q

Common adverse effects of insulin?

A

Tachycardia, palpitations
Headache, lethargy, tremors, weakness, fatgue, delirium, sweating
Hypoglycemia
Blurred vision, dry mouth, hunger, nausea, flushing, rash, urticaria, anaphylaxis

47
Q

Primary treatment for gestational diabetes?

A

Insulin

48
Q

4 major classifications of insulins?

A

1) Rapid-acting
2) Short-acting
3) Intermediate-acting
4) Long-acting

49
Q

When are porcine products used?

A

(not typically d/t risk of allergy)

May be used if have intolerance to other insulins or achieve better glycemic control with them

50
Q

Which insulins are clear?

A 
regular insulin
insulin glulisine (Apidra)
Lispro (Humalog)
Glargine (Lantus)
* All rapid or short-acting + Lantus (long)
51
Q

Which insulins are cloudy/opaque?

A

NPH (Humulin N, Novolin ge NPH)

*ALl intermediate acting

52
Q

For which two groups are insulin calculated based on weight?

A

Pregnant + children

53
Q

Insulin protocol for BG of 2.8-3.9mmol/L (mild-moderate)

A

1) Give 15mg CHO (3 tablets)
2) Repeat BG in 15 mins
3) Repeat 1 and 2 until BG >4.0mmol/L
4) Give snack or meal
5) Inform physician
6) Document incidence of hypoglycemia

54
Q

If a meal is more than 1 hour away when responding with hypoglycemic protocol (mild-moderate or sever conscious), what should you do?

A

Give snack in form of diabetes reaction kit

***Snack should include 15g CHO and a protein sources

55
Q

Insulin protocol for BG of

A

1) Give 20mg CHO (4 tablets)
2) Repeat BG in 15 mins
3) Repeat 1 and 2 until BG >4.0mmol/L
4) Give snack or meal
5) Inform physician
6) Document incidence of hypoglycemia

56
Q

Insulin protocol for BG of

A

1) IV glucose 25g given as 50mL of D50W over 1-3minutes
OR
1mg glucagon subcut or IM
(Call 911 if in community)

2) IV or glucagon can be repeated after 10min (if BG less than 4.0mmol/L)
3) Inform physician ASAP
4) Document

57
Q

How many glucagon injections can be given?

A

2 max

58
Q

Where are diabetes reaction food kits available?

A

In nursing medication fridge (regular and dysphagia versions)

59
Q

In order to make glucose tablets more tolerable, what can you do?

A

Cut into quarters or crush and mix with water

60
Q

For VIHA, what are you supposed to do (according to subcut insulin clinical order set) if patient becomes NPO or develops nausea and vomitting?

A

Call the doctor

61
Q

What is a requirement of subcut insulin clinical order set for VIHA? (Which patients can be taking s/c insulin?

A

Must be taking solid food orally or intermittend tube feeding. May be on TPN

62
Q

How often does blood glucose monitoring take place?

A

QID

63
Q

If BBG is less than 4mmol/L, what to do for VIHA?

A

Initiate glycemic protocol

64
Q

If BBG is

A

Call the physician managing diabetes

65
Q

If new to insulin, what is the usual starting daily insulin requirement according to VIHA protocol?

A

0.5 unit/kg/day

66
Q

Suggested daily initial insulin radio is:

A

1 (prandial breakfast), 1 (prandial lunch), 1 (prandial supper), 2 (basal bedtime)

67
Q

What is the “prandial insulin”?

A

Short acting (given before meals)

68
Q

What is “basal insulin”

A

Long acting

69
Q

When are basal insulin doses typically given?

A

Breakast, supper, and/or bedtime (not typically at lunch)

70
Q

When is prandial insulin typically not given?

A

bedtime

71
Q

What kind of symptoms occur with mild hypoglycemia according to VIHA?

A 
autonomic syntoms (trembling, palpitations, sweating, anxiety, hunger, nausea, tingling)
\+ person has ability to self treat
72
Q

What kind of symptoms occur with moderate hypoglycemia according to VIHA?

A

autonomic and neuroglycopenic symptoms (includes difficulty [ ]ing, confusion, weakness, drowsiness, vision changes, difficulty speaking, headache, dizziness, tiredness )
+ person has ability to self-treat

73
Q

What constitutes “severe” hypoglycemia according to VIHA?

A

Person requires the assistance of another person and may be unconscious

74
Q

If a patient has had ____ or more incidents of hypoglycemia during their hospitalization, ____ should happen.

A

3

Phyisician must be informed verbally or by telephone

75
Q

How much fruit juice/drink makes up 10-15g CHO?

A

4 oz

76
Q

If a patient has issues (dysphagia, dentition issues) that prevents intolerance to glucose tablets, what can be given?

A

1 tube glucose gel (provides approx 20g CHO) can be administered and MUST BE SWALLOWED

77
Q

A snack (of 15g CHO and protein) is recommended if? (in hypoglycemic protocol)

A

Next meal is more than 1 hour away and in the absence of complications.

78
Q

What should be given to an emaciated or undernourished pt’s or those with uremia, or hepatic disease in severe (unconscious) hypoglycemic protocol? Why?

A

Glucagon NOT effective in these patients

Give IV glucose (50mL of D50W)

79
Q

Does taking glucose tablets or glucose gel compromise NPO status?

A

No, even with small amount of water.

80
Q

In patient that is NPO with naso-gastric tube, admin what?

A

1 tube glucose gel orally

81
Q

In pre=op patients who are NPO, how should hypoglycemia be treated?

A

Eitehr with glucose tablets or gel (if dysphagia)

Nursing 242 (6 decks)

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