Nursing Case Study: NovoRapid Insulin Administration

This nursing case study discusses the administration of NovoRapid insulin for a patient with type 1 diabetes. It covers the components of a valid routine subcutaneous insulin medication order, the pathophysiology of type 1 diabetes, NovoRapid insulin's onset, peak and duration of action, potential adverse effects, and diabetes-specific nursing assessments.

Running head: NURSING CASE STUDY
Nursing Case Study
Name of the student
Name of the university
Author note

1NURSING CASE STUDY
PART- I
1. Explain the 11 components of a valid routine subcutaneous
insulin medication order and why this is important.
The components of a valid routine subcutaneous insulin medication order are:
 Following the state drug legislations
 Reviewing orders
 The National Subcutaneous Insulin Chart must be used for subcutaneous
insulin administration
 A chart, different from the previous one, should be used for intravenous
insulin orders
 Entries should be clearly written in ink
 Water-resistant black ink is preferred
 The order is valid only when the required items are entered
 Information must be printed
 No use of erasers
 One chart must be used for five days
 A new chart must be introduced after five days
 The current hospital and ward number of the patient should be clearly
mentioned on the chart
These regulations are important for proper ordering, administration and
utilization of the insulin medication (Cleland et al., 2013). The chart helps the

2NURSING CASE STUDY
authorized prescribers to maintain a detailed documentation of the medication
ordered.
2. Explain why Ben has been prescribed this medication. Relate to
the pathophysiology of type 1 diabetes and the mechanism of
action of NovoRapid insulin.
Type 1 diabetes (T1D) is an autoimmune disorder that leads to the destruction
of the pancreatic beta cells resulting in deficiency of insulin and thus hyperglycaemia
(Zaccardi et al., 2015). Absolute insulin reduction results in osmotic diuresis,
dehydration and diabetic ketoacidosis. In the absence of the inhibitory effects of
insulin on lipolysis and protein degradation, muscle wasting and breakdown of body
fats is observed in the T1D patients. Ben displayed all the symptoms of T1D such as
increased appetite, excessive thirst, fatigue, sudden weight loss and frequent
urination. His blood glucose level was 25.0 mmol/L which is extremely high, and his
blood ketone level was 1.5 mmol/L which is moderate ketone level in blood. Based
on these symptoms and his genetic history of autoimmune disease from his mother
who suffers from hyperthyroidism, Ben was prescribed 10 units of the NovoRapid
Flexpen which is a rapid-acting insulin analog (Stankov, Benc & Draskovic, 2013).
NovoRapid works almost immediately after administration and its effects wear off
within 3-5 hours of administration.

3NURSING CASE STUDY
3. What is the onset, peak and duration of action for NovoRapid
insulin according to Bullock and Manias (2017)? Explain when
NovoRapid should be administered in relation to food intake and
why.
According to Bullock and Manias (2017), the followings are found for
NovoRapid:
Onset: 0-15 minutes
Peak: 1 hour
Duration of action: 3-5 hours
NovoRapid should be administered immediately before or after food
consumption. The blood glucose level rises after the patient intakes food. This is the
optimum time of action for the medicine.
4. Discuss the definition, causes, symptoms and treatment of
hypoglycaemia, a common adverse effect of NovoRapid.
Hypoglycaemia, is the most common adverse effect of insulin therapy. It is the
condition of decrease in blood sugar levels, below 4 mmol/L. Overdose of insulin,
reduced carbohydrate intake, strenuous activity are the common causes of
hypoglycaemia (Ozougwu et al., 2013). Symptoms include trembling, dizziness,
headache, sweating and hunger. Consuming foods and drinks rich in glucose and
hormonal medications can help treat hypoglycaemia.

4NURSING CASE STUDY
5. Discuss the importance of understanding the medication prior to
administration.
It is important to develop an understanding of the NovoRapid before
administering the medication. NovoRapid lowers the blood glucose levels by
promoting glucose transport inside the membranes. Along with this, it also inhibits
glycogen breakdown and promotes protein synthesis and fat storage. If the mode of
action is not perceived properly, the dosage of the medication cannot be decided
(Ozougwu et al., 2013).
6. Discuss the 5 rights of medication administration and why it is
important for nurses to follow this procedure.
The five rights of medication administration includes: the right patient, the right
drug, the right dose, the right route and the right time. It is of utmost importance for
nurses to follow these rights while caring for a patient for properly administering the
medication, leading to a better patient outcome (Lind et al., 2014).
7. What is the most appropriate insulin pen needle length for Ben
and why?
The appropriate insulin pen needle length for Ben would be 4-6 mm. Ben has
lost a lot of weight in the past two weeks. Therefore, his subcutaneous fat layer has
thinned and a 4-6 mm of needle length should ensure subcutaneous delivery of the
medication (Cleland et al., 2013).

5NURSING CASE STUDY
8. What diabetes specific nursing assessment would you conduct
prior to administration of NovoRapid insulin to Ben and why?
The nursing assessment for Ben would consist of identification of any issues
regarding the glycaemic control, diabetic complications or any coincidental illness
(Lind et al., 2014). Prior to administration of NovoRapid, I would ensure that the
prescription is correct and legible, check the drug name and dosage in the patient
record and finally confirm the identification of the patient Ben.
9. Identify the site and angle you would inject the NovoRapid
insulin and explain why this was selected for Ben. Discuss
infection control considerations.
The NovoRapid would be injected to Ben at his abdominal wall at a 90 degree
angle. This would ensure the effective delivery of the medication to the
subcutaneous route and maintain patient comfort (Bernstein et al., 2013). The
essential precautions for infection control and prevention include the hand-hygiene
maintenance, safe handling and disposal of sharps and wastes, spillage
management and using personal protective equipment.
10. What would you document and where? Why is documentation
important?
All the details of the medication order and the patient progress would be
documented in the National Subcutaneous Insulin Chart. The blood glucose level of
Ben and the NovoRapid administration record including the name of the drug, dose
given and the time of administration: all must be clearly mentioned in the chart.

6NURSING CASE STUDY
Documentation helps to keep track of the medication administered and note the
patient progress. Without documenting all these details, the nurses would not be
able to maintain a healthy patient outcome (Cleland et al., 2013).
11. Explain the diabetes specific nursing assessment you would
provide for Ben post administration of insulin, when you would
provide it and why.
One hour after the administration of the NovoRapid insulin, Ben’s blood
glucose level should be assessed. The one hour gap is provided, since NovoRapid
takes an hour to reach its peak action (Purnell, Zinman & Brunzell, 2013). Along with
this, Ben would be assessed for any issues with the glycaemic control or
complications as done previously.
PART- II
1. Discuss the daily physical challenges of living with type 1
diabetes that Ben may face.
The issues of diabetes type 1 that 19 year old Ben has to face are quite
challenging for him. He plays football, but due to his illness, he has not been able to
perform his best in the field. He has been feeling very tired to do any strenuous
activity. His thirst and appetite has increased despite a 10 kgs weight loss over just
two weeks. Despite of his excessive fatigue, he is unable to sleep at night due to his
problem of frequent urination (Atkinson, Eisenbarth & Michels, 2014). If a few days

7NURSING CASE STUDY
had passed without the diagnosis, Ben would have developed diabetic ketoacidosis
since his blood ketone level was almost at the verge of becoming high from its
moderate value of 1.6 mmol/L.
2. Discuss potential emotional impacts of living with type 1
diabetes that Ben may face.
Having diabetes may lead to some unpleasant and uncomfortable emotions in
Ben. Diabetes may challenge Ben’s relationships with his family and friends. Stress
and surge of negative emotions may lead to complications in his personal
relationships. If the situation worsens, he may require expert advice regarding his
mental health issues as well (Bernstein et al., 2013). Inability to lead his previous
usual lifestyle may lead to severe depression in Ben. Therefore, the impacts of type
1diabetes is far more widespread than just the physical complications.

8NURSING CASE STUDY
References
Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1 diabetes. The
Lancet, 383(9911), 69-82. doi: 10.1016/S0140-6736(13)60591-7
Bernstein, C. M., Stockwell, M. S., Gallagher, M. P., Rosenthal, S. L., & Soren, K.
(2013). Mental health issues in adolescents and young adults with type 1
diabetes: prevalence and impact on glycemic control. Clinical
pediatrics, 52(1), 10-15. doi: 10.1177/0009922812459950
Cleland, S. J., Fisher, B. M., Colhoun, H. M., Sattar, N., & Petrie, J. R. (2013). Insulin
resistance in type 1 diabetes: what is ‘double diabetes’ and what are the
risks?. Diabetologia, 56(7), 1462-1470. Retrieved from:
https://link.springer.com/article/10.1007/s00125-013-2904-2
Lind, M., Svensson, A. M., Kosiborod, M., Gudbjörnsdottir, S., Pivodic, A., Wedel, H.,
... & Rosengren, A. (2014). Glycemic control and excess mortality in type 1
diabetes. New England Journal of Medicine, 371(21), 1972-1982. doi:
10.1056/NEJMoa1408214
Ozougwu, J. C., Obimba, K. C., Belonwu, C. D., & Unakalamba, C. B. (2013). The
pathogenesis and pathophysiology of type 1 and type 2 diabetes
mellitus. Journal of Physiology and Pathophysiology, 4(4), 46-57. doi:
10.5897/JPAP2013.0001
Purnell, J. Q., Zinman, B., & Brunzell, J. D. (2013). The effect of excess weight gain
with intensive diabetes mellitus treatment on cardiovascular disease risk
factors and atherosclerosis in type 1 diabetes mellitus: results from the

9NURSING CASE STUDY
Diabetes Control and Complications Trial/Epidemiology of Diabetes
Interventions and Complications Study (DCCT/EDIC)
study. Circulation, 127(2), 180-187. doi:
10.1161/CIRCULATIONAHA.111.077487
Stankov, K., Benc, D., & Draskovic, D. (2013). Genetic and epigenetic factors in
etiology of diabetes mellitus type 1. Pediatrics, peds-2013. Retrieved from:
http://pediatrics.aappublications.org/content/early/2013/10/30/peds.2013-
1652.short
Zaccardi, F., Webb, D. R., Yates, T., & Davies, M. J. (2015). Pathophysiology of type
1 and type 2 diabetes mellitus: a 90-year perspective. Postgraduate medical
journal, postgradmedj-2015. doi: 10.1136/postgradmedj-2015-133281