IV insulin

Question 1

when giving insulin Iv what do you use to tell you how to give

Answer 1

the order set not the monograph

Question 2

early s/s of hypoglycemia

Answer 2

shaking
sweaty
confused

Question 3

long term s/s hyperglycemia

Answer 3

PVD, neuropathies, inc BUN, inc creatinine

Question 4

ST s/s hyperglycemia

Answer 4

polyuria
polydipsia
polyphagia

Question 5

can you stop a pts IV insulin suddenly

Answer 5

no may cause rebound effect

Question 6

what assessments do you do on diabetic pt (maybe before giving IV insulin??not sure)

Answer 6

blood glucose 
fluids
lytes
dysrhythmias
VS
Abgs

Question 7

when giving IV insulin what must you know the location of

Answer 7

where the hypoglycemic protocol is

Question 8

can you calculate drip factor for IV insulin

Answer 8

not recommended. Should be given by infusion pump for tight control
c

Question 9

can yiu gve insulin through line with med in it

Answer 9

no. incompatible

Question 10

after giving insulin where would you document

Answer 10

fluid balance (its given in 250ml or some small volume)
MAR
diabetic record

Question 11

youve mixed the insulin with the soln what next

Answer 11

flush line with 50ml soln as some insulin will stick to the line and alter the dose reching the pt

Question 12

how is the acidosis in DKA reversed

Answer 12

by insulin admin

Question 13

how often to do BG when pt has DKA

Answer 13

hourly

Question 14

how to give insulin if pt has DKA

Answer 14

at slow continuous rate eg 5 units/h

Question 15

if pt has a high BG should that be dropped really quickly

Answer 15

no. IV fluid solnds w higher conc of glucose eg D5Ns

Question 16

should Iv rehydration be givn through same line as insulin

Answer 16

often theyre given through separate lines. The rehydration soln can then have its rate adjusted frequently

Question 17

when can you stop giving insulin IV

Answer 17

when pt has resumed subcut insulin (or maybe when their BG is normal and they no longer have ketone bodies??)

Question 18

what occurs first after DKA normal pH of body or normal BG

Answer 18

normal BG (therefore may need to continue with BG admin)

Question 19

is bicarb infusion used often for DKA

Answer 19

no because it precipitates sudden dec in K levels

Question 20

what are concerning complic of DKA that must be managed

Answer 20

fluid
lytes
BG monitoring
urine output must be ascertained (if none pt may get hyperkalemic)
ECG
give fluids, insulin, other meds

Question 21

which types of insulin are regular insulin

aka

Answer 21

humulin R

aka short acting insulin

Question 22

which kind of insulin should NOT be given IV

Answer 22

intermediate acting NPH
humulin N

lon acting
lantus

premixed insulin

Question 23

s/s of hyperglycemia

Answer 23

BG > 7.0 mmol/L
Polyuria – excessive urination
Polyphagia – increased hunger
Polydipsia – increased thirst
Glucosuria – high levels of glucose in the urine
Weight loss
Fatigue

Question 24

s/s of hypoglycemia autonomic symptoms

Answer 24

Trembling
Palpitations
Sweating
Anxiety
Hunger
Nausea
Tingling

Question 25

what are worse than just autonomic syptoms

Answer 25

neuroglycopenic

Question 26

hypo neuroglycopenic symptoms

Answer 26

``` Difficulty concentrating Confusion Weakness Drowsiness Vision changes Difficulty speaking Headache Dizziness Tiredness ```

Question 27

when to initiate hypoglycemic protocol and what to do if BG

Answer 27

``` mild to moderate and autonomic symp with BG of 2.8-3.9 Give 15 g carbohydrate (3 tablets) If the patient has medical issues (dysphagia, dentition issues) that prevent tolerance of glucose tablets, 1 tube of glucose gel (provides approx. 20 g of carbohydrate) can be administered and must be swallowed. 2. Repeat BG in 15 min. 3. Repeat steps 1 and 2 until pt has BG of >4.0 mmol 4. Give meal or snack If next meal is more than 1 hr away, give a snack in the form of diabetes reaction food kit * 5. inform dr If patient has had 3 or more incidents of hypoglycemia during a hospital stay, physician must be informed verbally by telephone or in person. 6. Document incident of hypoglycemia ```

Question 28

what is diff about severe autonomic neurogycopenic but pt is conscious symptoms in terms of tx protocol? what is BG?

Answer 28

if BG is

Question 29

tx of unconscious pt w BG of

Answer 29

IV glucose , 25 g given as 50mL of D50W over 1-3 minutes OR S/C or IM OR 1 mg glucagon ``` Wait 10 minutes; retest blood glucose and retreat with either the 25 g of IV glucose given as 50 ml of D50W or 1 mg glucagon if the blood glucose remains less than 4.0 mmoL/L (maximum glucagon injections is 2). ``` 3. As soon as possible, physician must be informed verbally (telephone or in person) ``` 4.Document incident of hypoglycemia IV glucose 1 mg glucagon call 911 ```