Assessment 2: Case Study on Subcutaneous Insulin Medication Order

This assessment discusses the components of a valid routine subcutaneous insulin medication order, the rationale behind prescribing Novo Rapid insulin, and the appropriate insulin pen needle length for Ben. It also covers the potential impact of type 1 diabetes on Ben, including daily physical and emotional challenges.

RUNNING HEAD: ASSESSMENT 2
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Assessment 2
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401209 Health Variations 2
Assessment 2: Case study
Assessment Questions
Part A (60 marks, suggested 800 words)
1. Explain the 11 components of a valid routine subcutaneous insulin medication order
and why this is important. Support your answer with academic or clinical guideline
references. (5 marks)
The components of a valid routine subcutaneous insulin medication for the case of Ben
include name of the medicine, the route of administration, signature of the nurse, time of
administration, frequency of administration, date of order, the dose rate, the side effects
(Brashers, Jones & Huether, 2017).The importance of this components is to ensure proper
medication to the right patient and incidences of where the wrong or expired medicine is given
to the wrong patient.
2. Explain why Ben has been prescribed this medication. Relate to pathophysiology of
type 1 diabetes and the mechanism of action of Novo Rapid insulin. Support your
answer with academic references. (10 marks)
Diabetes, a condition which Ben is suffering from, is a condition in which the body fails to
produce insulin hormone and as a result, there is excess glucose in blood. Diabetes Mellitus is
an autoimmune disease which means it is the immune system that destroys its own body. The
immune system responds to chemical stimuli which in return destroys the B cells in the islets
of Langerhans that are responsible for the production of insulin hormone (Hoy & Hethrington,
2013). Lack of production of insulin then leads to accumulation of excess glucose in the blood
since it is insulin that breaks down the excess glucose to glycogen. The rationale as to why Ben
has been prescribed the Novo Rapid drug is because this is a modern day insulin of the
synthetic origin that acts quickly as compared to other drugs. This is simply to say that it has
been preferred to other drugs because it acts faster in reducing the level of glucose in blood.
The mechanism of action of the drug is simply breaking down of excess glucose to less
harmful substances like the glycogen.

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3. What is the onset, peak and duration of action for Novo Rapid insulin according to
Bullock and Manias (2017)? Explain when Novo Rapid should be administered in
relation to food intake and why. Support your answer with academic references. (5
marks)
According to studies, it has been established that Novo Rapid is one of the best modern day
insulin that can be used to treat Ben. (Bullock & Manias 2017). The studies have as well found
out that the onset of working is immediately after injection in the subcutaneous. It is estimated
that the peak is 10 minutes after injection and the duration for action is about 20 minutes. It is
recommended that the drug should be administered before any meal to avoid hypoglycaemia.
4. Discuss the definition, causes, symptoms and treatment of hypoglycaemia, a common
adverse effect of Novo Rapid. Support your answer with academic references. (5
marks)
Hypoglycaemia is a condition in which there is a low level of glucose in the blood. The
normal levels of blood glucose are either 70 mg/dl or 3.9 mmol/L (Arcus & New South
Wales, 2013).Therefore, whenever the glucose level is below those values, that is
hypoglycaemia and there should be immediate treatment for Ben who is the patient. The signs
and symptoms for the condition include fatigue, anxiety, hunger, irritability, sweating, an
irregular heart rhythm, pale skin and tingling sensation. The leading cause of hypoglycaemia
is as a side effect to drugs that are used to treat diabetes such as Novo Rapid. The treatment
option in hypoglycaemia involves consumption of fasting acting carbohydrates that are
between 15-20 grams in weight. The most common adverse effect of the Novo Rapid drug is
low blood glucose since it breaks down excess glucose in the body to form glycogen.
5. Discuss the importance of understanding the medication prior to administration.
Support your answer with academic references. (5 marks)
Before any drug is administered to the patient who is Ben in this scenario, the nurse should
understand the medication properly .It is important for the nurse to understand the dosage, the
mechanisms of action, the side effects, and the route of administration and time of
administering (Arcus & New South Wales, 2013). All this is just to ensure that the desired
medication acts in the best interest to the patient to promote wellness with very minimal

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effects to the patient .The right route for example assists the nurse to avoid using the wrong
route so that the medicine acts quickly.
6. Discuss the 5 rights of medication administration and why it is important for nurses to
follow this procedure. Support your answer with academic references. (5 marks)
At the moment, there are seven rights of medication administration of drugs to Ben. They
include right client, right dose, right time, right route, the right reason, and the right dose and
finally the right documentation (Canberra, 2015). The importance of this rights is to ensure
maximum benefits to the patient and avoid legal lawsuits in the future. The nurses are always
advised to adhere to the seven rights to avoid entanglements with the law or the court.
7. What is the most appropriate insulin pen needle length for Ben and why? Support your
answer with academic references. (5 marks)
Studies have shown that the needle length may affect the process of recovery as well as how
effective the drug acts. For the purposes of insulin, it has been established that the appropriate
or the best length for injection is that of between 25 and 28 gauge while the length should be
between 3/8 to 5/8 (Canberra, 2015). The importance of adhering to this measurements is to
avoid harm of other components of the skin to Ben like the melanin. This might lead to
ulcerations.
8. What diabetes specific nursing assessment would you conduct prior to administration
of Novo Rapid insulin to Ben and why? Support your answer with academic references.
(5 marks)
Before Novo Rapid is administered to Ben, the nursing interventions include asking if he has
any allergies for Novo Rapid medication (Brashers, Jones & Huether, 2017). The nurse should
also explain the importance of the treatment regimen that Ben is being subjected to .Inquiry on
how the patient adheres to medication is the final assessment.
9. Identify the site and angle you would inject the NovoRapid insulin and explain why
this was selected for Ben. Discuss infection control considerations. Support your
answer with academic references. (5 marks)

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Novo Rapid is the modern insulin. However, the insulin should be injected at the correct site
and angle to Ben who is the patient. According to studies, it has been established that Novo
Rapid should be injected into the subcutaneous and not the muscles as it causes a lot of pain
and the benefits may not be long lasting (Canberra, 2015).It is recommended therefore that the
nurse should pinch a fold of the skin and inject the needle at 90 degrees.
The best site for injection of Novo Rapid to Ben according to studies is the abdomen. It has
been established that the onset of reaction of novo rapid is much faster at the abdomen than
any other site. However, there should initial sterilization before injection to prevent infections
at the site of injection.
10. What would you document and where? Why is documentation important? Support your
answer with academic or clinical guideline references. (5 marks)
Documentation in nursing is the process or recording whatever happened or was done to the
patient who is Ben in this case. There are different components that are usually documented
during nursing intervention. Name of the patient, Date of admission, drugs used, side effects,
dosage of the drugs (Craig ME et al., 2014). Documentation is very important since it ensures
accountability and prevents confusion. This is because in the event there is no documentation,
a nurse might confuse and administer the wrong drug to the wrong patient and this complicates
the patient’s situation .Documenting side effects on the other hand assists the nurses to change
the treatment regimen in case the side effects are adverse.
11. Explain the diabetes specific nursing assessment you would provide for Ben post
administration of insulin, when you would provide it and why. Support your answer
with academic references. (5 marks)
After administration of insulin, there are usually specific nursing assessment to prevent
exercabations of the condition that Ben is suffering from. The specific nursing assessments to
Ben include reviewing the client’s current diet as well as the nutritional needs (Craig ME et al.,
2014). Educating the client about proper wound care is another important nursing assessment
and finally educating the patient on the importance of adhering diabetic treatment on a
consistent basis. The rationale behind this nursing assessment is to ensure efficient flow of
blood and reduce the risks for delayed wound healing.

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Part B (10 marks, suggested 200 words)
Discuss the potential impact of type 1 diabetes on Ben.
1. Discuss the daily physical challenges of living with type 1 diabetes that Ben may face.
Support your answer with academic references. (5 marks)
Diabetes comes with a lot of physical challenges. Ben may encounter a lot of these challenges.
One such challenge is the inability to engage in any physical activities since he will be feeling
fatigued nearly most of the time (Ambler, Cameron & Gillbank, 2010).This is brought about
by the attempts of the body to breakdown excess glucose while excreting the waste products at
the same time.
Another important physical challenge that might affect Ben is inability to move around freely.
In the event that the diabetes is not managed well, Ben may develop wounds especially on the
foot. These wounds normally take time to heal and will therefore restrict Ben from moving
from one place to another .Impairment in vision also restricts the patients from engaging in
different physical activities like reading. Blurred vision is a symptom of diabetes and affects
how well the patient carries out his or her daily life.
2. Discuss potential emotional impacts of living with type 1 diabetes that Ben may face.
Support your answer with academic references. (5 marks)
Diabetes is a condition in which the level of blood glucose is extremely high. This is caused
by the defects in the production of insulin. This condition is associated with emotional impacts
.One such impact that Ben is likely to encounter is stress. Diabetes leads to stress among the
patients since they have to go through strenuous medications frequently. Another emotional
impact to Ben is anxiety (Ambler, Cameron & Gillbank, 2010). The patients are always
anxious if the condition will ever get better. Depression is another emotional impact which can
affect Ben since it comes along with type 1 diabetes. The idea of being subjected to
medication frequently makes the patients to be depressed

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References
Hoy,A, & Hethrington,J. (2013). Alterations of endocrine function across the life span.
Arcus, J., & New South Wales. (2013). Medication Handling in NSW Public Health
Facilities. Gladesville, N.S.W: NSW Health Dept.
Bullock, S., & Manias, E. (2002). The educational preparation of undergraduate nursing
students in pharmacology: a survey of lecturers' perceptions and experiences.
Journal of Advanced Nursing, 40(1), 7-16. doi:10.1046/j.1365-2648.2002.02335.x
Canberra. (2015). Clinical Guiding Principles for Subcutaneous Injection Technique.
Craig ME, Jefferies C, Dabalea D, Balde N, Seth A, & Donaghue KC. (2014).
Definition,epidemiology ,and classification of diabetes in children and
adolescents.
Ambler,G, Cameron,F,, & Gillbank,J. (2010). Caring for Diabetes in Children and
Adolescents (3rd ed.).
Tracy Parrish. (2013). Nursing Care of People with Diabetes Mellitus.
Brashers, V.L,, Jones,R.E, & Huether,S.E,. (2017). Chapter 22. In Alterations of
Hormonal Regulation.