Subcutaneous Insulin Administration: A Comprehensive Guide for Nurses
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This document provides a comprehensive guide for nurses on the administration of subcutaneous insulin, focusing on the 11 components of a routine order, the rationale for using NovoRapid, the onset of action, potential complications like hypoglycemia, and essential safety measures. It also delves into the nursing assessment required before administration, including diabetes-specific considerations, and outlines the appropriate documentation and patient education. The document further explores the physical and emotional challenges faced by individuals with Type 1 diabetes, emphasizing the importance of providing comprehensive support.
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Nursing - 401209 - Assignment 2
Contents
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2.................................................................................................................................................................. 1
3.................................................................................................................................................................. 2
4.................................................................................................................................................................. 2
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1.................................................................................................................................................................. 5
2.................................................................................................................................................................. 6
REFERENCES................................................................................................................................................ 7
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Contents
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6.................................................................................................................................................................. 3
7.................................................................................................................................................................. 4
8.................................................................................................................................................................. 4
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11................................................................................................................................................................ 5
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REFERENCES................................................................................................................................................ 7
1
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1.
The 11 components of routine subcutaneous insulin order are:
ď‚· The Date record (Garber, et al. 2016).
ď‚· Drug name
ď‚· Dosage strength (American Diabetes Association, 2015).
ď‚· Dosage form
ď‚· Preferred route of administration
ď‚· Frequency of administration
ď‚· Duration of drug therapy (Barnard, et al. 2014).
ď‚· Special instructions for drug administration
ď‚· Time when the last drug dose was given so as to compare and administer the
drug dose at an appropriate time (Bell, et al. 2015).
ď‚· Signature of the person who has prescribed the drug dose
ď‚· Initials of the person who has administered the last drug dose (Powers, et al.
2017).
2.
Ben has been advised to take NovoRapid because it is a replacement that is very
similar to the normal insulin made by the body and is also absorbed faster within the
body (Chiang, et al. 2014). This enables NovoRapid to work faster than the normal
insulin. It also works in the same way as normal insulin and helps glucose to enter the
body cells (Garber, et al. 2016).
2
The 11 components of routine subcutaneous insulin order are:
ď‚· The Date record (Garber, et al. 2016).
ď‚· Drug name
ď‚· Dosage strength (American Diabetes Association, 2015).
ď‚· Dosage form
ď‚· Preferred route of administration
ď‚· Frequency of administration
ď‚· Duration of drug therapy (Barnard, et al. 2014).
ď‚· Special instructions for drug administration
ď‚· Time when the last drug dose was given so as to compare and administer the
drug dose at an appropriate time (Bell, et al. 2015).
ď‚· Signature of the person who has prescribed the drug dose
ď‚· Initials of the person who has administered the last drug dose (Powers, et al.
2017).
2.
Ben has been advised to take NovoRapid because it is a replacement that is very
similar to the normal insulin made by the body and is also absorbed faster within the
body (Chiang, et al. 2014). This enables NovoRapid to work faster than the normal
insulin. It also works in the same way as normal insulin and helps glucose to enter the
body cells (Garber, et al. 2016).
2
As Ben had Type 1 diabetes where there is a deficiency if insulin production by the
body, it was required for him to have subcutaneous injections of insulin which can
control the blood glucose levels (Inzucchi, et al. 2015). Therefore, the insulin injections
of NovoRapid would act as a replacement for the natural insulin that will help people
with diabetes in achieving normal blood glucose levels (Inzucchi, et al. 2015).
3.
The onset of action for this drug occurs within 15-20 minutes of the subcutaneous
injection (Barnard, et al. 2014). The peak effects are obtained within a time period of 1-3
hours after injection and the effect of the drug stays for 3-5 hours (Bell, et al. 2015). This
is a solution of insulin aspart which needs to be given immediately before any meal or
after the meal is started (Chiang, et al. 2014). This is because the drug would initiate its
effect in the body after a time of 15 minutes and reach its utmost potential once the
glucose levels are high in the bloodstream (after meals).
4.
Hypoglycemia refers to an abnormally low level of glucose in the blood (Bell, et al.
2015). The patients may experience early warning signs of hypoglycemia where the
complication may occur owing to an excess of insulin as compared to the food intake or
after excessive exercise or both (American Diabetes Association, 2015). The signs and
symptoms of hypoglycemia include sweating, fatigue, hunger, confusion, blurred vision,
nausea, and vomiting (Chiang, et al. 2014). The treatment of mild hypoglycemia is by
administration of oral glucose.
3
body, it was required for him to have subcutaneous injections of insulin which can
control the blood glucose levels (Inzucchi, et al. 2015). Therefore, the insulin injections
of NovoRapid would act as a replacement for the natural insulin that will help people
with diabetes in achieving normal blood glucose levels (Inzucchi, et al. 2015).
3.
The onset of action for this drug occurs within 15-20 minutes of the subcutaneous
injection (Barnard, et al. 2014). The peak effects are obtained within a time period of 1-3
hours after injection and the effect of the drug stays for 3-5 hours (Bell, et al. 2015). This
is a solution of insulin aspart which needs to be given immediately before any meal or
after the meal is started (Chiang, et al. 2014). This is because the drug would initiate its
effect in the body after a time of 15 minutes and reach its utmost potential once the
glucose levels are high in the bloodstream (after meals).
4.
Hypoglycemia refers to an abnormally low level of glucose in the blood (Bell, et al.
2015). The patients may experience early warning signs of hypoglycemia where the
complication may occur owing to an excess of insulin as compared to the food intake or
after excessive exercise or both (American Diabetes Association, 2015). The signs and
symptoms of hypoglycemia include sweating, fatigue, hunger, confusion, blurred vision,
nausea, and vomiting (Chiang, et al. 2014). The treatment of mild hypoglycemia is by
administration of oral glucose.
3
5.
Understanding the medication prior to its administration is important as it helps the
medical practitioner or the nursing staff to analyze the risks, precautions, side effects
and important details about any drug (Barnard, et al. 2014). This is also done to avoid
any possible errors that may occur due to staff mistakes or drug side effects (Bell, et al.
2015).
6.
The nurses currently use a safety measure for preventing any possible medication
errors such as
• The Right Patient – which lets the nurse identify the right patient
• The Right Drug – which helps to identify the correct drug
• The Right Dose – which identifies the appropriate drug dose
• The Right Route - which identifies the correct route of drug administration
• The Right time and Administration frequency – which determines the correct time and
frequency of drug dose (Barnard, et al. 2014)
This is to be followed by the nurses as the goal of medication safety rather than blaming
the nurses for any medication errors done (Bell, et al. 2015).
7.
The most appropriate length of insulin pen needle is up to 8 mm. Research proves that
the length of insulin needle up to 4-8 mm is highly effective while delivering the insulin
drug dose (Bell, et al. 2015). Further, it is found that the needles of shorter length are
4
Understanding the medication prior to its administration is important as it helps the
medical practitioner or the nursing staff to analyze the risks, precautions, side effects
and important details about any drug (Barnard, et al. 2014). This is also done to avoid
any possible errors that may occur due to staff mistakes or drug side effects (Bell, et al.
2015).
6.
The nurses currently use a safety measure for preventing any possible medication
errors such as
• The Right Patient – which lets the nurse identify the right patient
• The Right Drug – which helps to identify the correct drug
• The Right Dose – which identifies the appropriate drug dose
• The Right Route - which identifies the correct route of drug administration
• The Right time and Administration frequency – which determines the correct time and
frequency of drug dose (Barnard, et al. 2014)
This is to be followed by the nurses as the goal of medication safety rather than blaming
the nurses for any medication errors done (Bell, et al. 2015).
7.
The most appropriate length of insulin pen needle is up to 8 mm. Research proves that
the length of insulin needle up to 4-8 mm is highly effective while delivering the insulin
drug dose (Bell, et al. 2015). Further, it is found that the needles of shorter length are
4
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practically pain-free and does not show variation in terms of the patient’s age, gender
and body mass (Garber, et al. 2016).
8.
The diabetes-specific nursing assessment that should be done prior to insulin drug
administration for Ben would include the possibility of ketoacidosis, along with any
possibility of a positive family history of any autoimmune diseases such as Grave’s
disease (American Diabetes Association, 2015). This is because the presence of these
health conditions might cause interference with the action of the NovoRapid drug.
9.
The most commonly used site for subcutaneous drug dose is abdomen due to the easy
possibility of injecting insulin solution along with a facilitated uptake of insulin in the
body (Powers, et al. 2017). Also, the buttocks, thighs, and arms may also be used for
this. The chosen angle of injection would be 90 degrees to the skin surface (Fisher, et
al. 2015). Also, the infection control procedures would include the use of gloves,
hygienic practices along with the ability and understanding of the complete job
responsibilities (Inzucchi, et al. 2015).
10.
The documentation would include the drug that has been administered along with the
dose and the route of administration. Along with this, the time of drug administration
should also be recorded (Fisher, et al. 2015). Further, any instances of adverse
reactions being observed should be recorded and the appropriate steps taken after that
5
and body mass (Garber, et al. 2016).
8.
The diabetes-specific nursing assessment that should be done prior to insulin drug
administration for Ben would include the possibility of ketoacidosis, along with any
possibility of a positive family history of any autoimmune diseases such as Grave’s
disease (American Diabetes Association, 2015). This is because the presence of these
health conditions might cause interference with the action of the NovoRapid drug.
9.
The most commonly used site for subcutaneous drug dose is abdomen due to the easy
possibility of injecting insulin solution along with a facilitated uptake of insulin in the
body (Powers, et al. 2017). Also, the buttocks, thighs, and arms may also be used for
this. The chosen angle of injection would be 90 degrees to the skin surface (Fisher, et
al. 2015). Also, the infection control procedures would include the use of gloves,
hygienic practices along with the ability and understanding of the complete job
responsibilities (Inzucchi, et al. 2015).
10.
The documentation would include the drug that has been administered along with the
dose and the route of administration. Along with this, the time of drug administration
should also be recorded (Fisher, et al. 2015). Further, any instances of adverse
reactions being observed should be recorded and the appropriate steps taken after that
5
must be noted (Garber, et al. 2016). Documentation is essential so as to validate that
the actions taken by the nursing staff are correct.
11.
The specific nursing assessment that should be provided to Ben would include the
recognizing signs of hypoglycemia (Fisher, et al. 2015). This should be informed to Ben
before insulin has to be administered due to which Ben would be aware of the
complications that may arise (American Diabetes Association, 2015). This will enable
the hospital staff to be prepared with the existing situation and take necessary steps for
action.
Part B
1.
There are different physical challenges which Ben will have to experience due to his
health condition such as he may develop an eating disorder which is commonly found in
diabetic individuals (Bell, et al. 2015). Also, the usual symptoms of diabetes may lead to
a feeling of an energy deficit in the body which may pose difficulties for him to carry out
the routine task (Inzucchi, et al. 2015). Diabetic ketoacidosis is another complication
that can cause damage to eyes and kidneys of the patient.
2.
Along with this, there are emotional challenges also which can make him feel like a
burden to the family (Powers, et al. 2017). He also has to constantly cope with the
insulin levels and the blood sugar levels in the body due to which he would feel
pressurized (Fisher, et al. 2015). Over time, he would also develop anxiety about the
6
the actions taken by the nursing staff are correct.
11.
The specific nursing assessment that should be provided to Ben would include the
recognizing signs of hypoglycemia (Fisher, et al. 2015). This should be informed to Ben
before insulin has to be administered due to which Ben would be aware of the
complications that may arise (American Diabetes Association, 2015). This will enable
the hospital staff to be prepared with the existing situation and take necessary steps for
action.
Part B
1.
There are different physical challenges which Ben will have to experience due to his
health condition such as he may develop an eating disorder which is commonly found in
diabetic individuals (Bell, et al. 2015). Also, the usual symptoms of diabetes may lead to
a feeling of an energy deficit in the body which may pose difficulties for him to carry out
the routine task (Inzucchi, et al. 2015). Diabetic ketoacidosis is another complication
that can cause damage to eyes and kidneys of the patient.
2.
Along with this, there are emotional challenges also which can make him feel like a
burden to the family (Powers, et al. 2017). He also has to constantly cope with the
insulin levels and the blood sugar levels in the body due to which he would feel
pressurized (Fisher, et al. 2015). Over time, he would also develop anxiety about the
6
health condition and may eventually develop a fear of needles along with a frustrating
feeling due to constantly fluctuating blood glucose levels (American Diabetes
Association, 2015).
7
feeling due to constantly fluctuating blood glucose levels (American Diabetes
Association, 2015).
7
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REFERENCES
American Diabetes Association. (2015). Standards of medical care in diabetes—2015
abridged for primary care providers. Clinical diabetes: a publication of the American
Diabetes Association, 33(2), 97.
Barnard, K. D., Dyson, P., Sinclair, J. M. A., Lawton, J., Anthony, D., Cranston, M., &
Holt, R. I. G. (2014). Alcohol health literacy in young adults with type 1 diabetes and its
impact on diabetes management. Diabetic Medicine, 31(12), 1625-1630.
Bell, K. J., Smart, C. E., Steil, G. M., Brand-Miller, J. C., King, B., & Wolpert, H. A.
(2015). Impact of fat, protein, and glycemic index on postprandial glucose control in type
1 diabetes: implications for intensive diabetes management in the continuous glucose
monitoring era. Diabetes Care, 38(6), 1008-1015.
Chiang, J. L., Kirkman, M. S., Laffel, L. M., & Peters, A. L. (2014). Type 1 diabetes
through the life span: a position statement of the American Diabetes
Association. Diabetes care, 37(7), 2034-2054.
Fisher, L., Polonsky, W. H., Hessler, D. M., Masharani, U., Blumer, I., Peters, A. L., ... &
Bowyer, V. (2015). Understanding the sources of diabetes distress in adults with type 1
diabetes. Journal of Diabetes and its Complications, 29(4), 572-577.
Garber, A. J., Abrahamson, M. J., Barzilay, J. I., Blonde, L., Bloomgarden, Z. T., Bush,
M. A., ... & Garber, J. R. (2016). Consensus statement by the American Association of
Clinical Endocrinologists and American College of Endocrinology on the comprehensive
8
American Diabetes Association. (2015). Standards of medical care in diabetes—2015
abridged for primary care providers. Clinical diabetes: a publication of the American
Diabetes Association, 33(2), 97.
Barnard, K. D., Dyson, P., Sinclair, J. M. A., Lawton, J., Anthony, D., Cranston, M., &
Holt, R. I. G. (2014). Alcohol health literacy in young adults with type 1 diabetes and its
impact on diabetes management. Diabetic Medicine, 31(12), 1625-1630.
Bell, K. J., Smart, C. E., Steil, G. M., Brand-Miller, J. C., King, B., & Wolpert, H. A.
(2015). Impact of fat, protein, and glycemic index on postprandial glucose control in type
1 diabetes: implications for intensive diabetes management in the continuous glucose
monitoring era. Diabetes Care, 38(6), 1008-1015.
Chiang, J. L., Kirkman, M. S., Laffel, L. M., & Peters, A. L. (2014). Type 1 diabetes
through the life span: a position statement of the American Diabetes
Association. Diabetes care, 37(7), 2034-2054.
Fisher, L., Polonsky, W. H., Hessler, D. M., Masharani, U., Blumer, I., Peters, A. L., ... &
Bowyer, V. (2015). Understanding the sources of diabetes distress in adults with type 1
diabetes. Journal of Diabetes and its Complications, 29(4), 572-577.
Garber, A. J., Abrahamson, M. J., Barzilay, J. I., Blonde, L., Bloomgarden, Z. T., Bush,
M. A., ... & Garber, J. R. (2016). Consensus statement by the American Association of
Clinical Endocrinologists and American College of Endocrinology on the comprehensive
8
type 2 diabetes management algorithm–2016 executive summary. Endocrine
Practice, 22(1), 84-113.
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck,
M., ... & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes,
2015: a patient-centered approach: update to a position statement of the American
Diabetes Association and the European Association for the Study of Diabetes. Diabetes
care, 38(1), 140-149.
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., ... &
Vivian, E. (2017). Diabetes self-management education and support in type 2 diabetes:
a joint position statement of the American Diabetes Association, the American
Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The
Diabetes Educator, 43(1), 40-53.
9
Practice, 22(1), 84-113.
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck,
M., ... & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes,
2015: a patient-centered approach: update to a position statement of the American
Diabetes Association and the European Association for the Study of Diabetes. Diabetes
care, 38(1), 140-149.
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., ... &
Vivian, E. (2017). Diabetes self-management education and support in type 2 diabetes:
a joint position statement of the American Diabetes Association, the American
Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The
Diabetes Educator, 43(1), 40-53.
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