401209 Health Variations 2: Insulin Administration Case Study Analysis

This case study analyzes the nursing care of a 19-year-old patient, Ben, diagnosed with type 1 diabetes. It explores the components of a valid subcutaneous insulin medication order, the pathophysiology of type 1 diabetes, and the mechanism of action of NovoRapid insulin. The assignment details the onset, peak, and duration of NovoRapid, its administration in relation to food intake, and the adverse effect of hypoglycemia. It emphasizes the importance of medication understanding, the five rights of medication administration, and appropriate insulin pen needle selection. Furthermore, it covers pre- and post-administration nursing assessments, injection site and angle selection, and documentation practices. The case study concludes by discussing the daily physical and emotional challenges faced by individuals living with type 1 diabetes.

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 routine subcutaneous insulin medication order are -
 Understand and interpret the insulin prescription correctly. Confirm the name of
the patient, dosage and time of injection. Confirm whether someone else has
not given insulin before.
 Measure the correct dose of the insulin into the syringe or pen.
 Have thorough knowledge about injection sites.
 Examine the chosen site for lipodystrophy.
 Administer the subcutaneous injection.
 Disposal of sharps after use should be done following the safety protocol.
 Monitoring of blood glucose level after administration of insulin.
 Interpret the results correctly and take corrective action if required.
 Mention the time, dose of injection and initial.
 Recognise to hypo- or hyperglycemia.
 Maintain record of the blood glucose levels (NHS).
It is important to follow the above guidelines because insulin administration
affects blood glucose levels and any mistake or oversight when doing so can
put the patient's life to danger.
2. Explain why Ben has been prescribed this medication. Relate to
pathophysiology of type 1 diabetes and the mechanism of action of NovoRapid
insulin. Support your answer with academic references. (10 marks)
Ben's complaints were increased thirst and weight loss. His appetite had also
increased. Type 1 diabetes occurs due to the autoimmune destruction of the beta
cells of the endocrine pancreas. Individuals have to be genetically pre-disposed and
some environmental , genetic or immunologic factors begin to destroy the beta cells.
Once the cells are destroyed and insulin production stops completely the type 1
diabetes manifests itself. The autoantibodies that begin to circulate in the system take
considerable time before all the bet cells are killed by the immune system. It is while
before the symptoms begin to show up in the patient (Paschou, Papadopoulou-
Marketou, Chrousos, & Kanaka-Gantenbein, 2018).
When given subcutaneously, the NovoRapid insulin is quickly absorbed and
can begin acting by lowering blood glucose levels. Because it is administered before
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meals it successfully controls postprandial blood glucose levels rather effectively and
avoids hyperglycemia in patients. Its duration of action is short. It has an additional
aspartic acid at position 28 on the B chain, this helps its rapid absorption when
injected subcutaneously. It lowers blood glucose levels by binding to insulin receptors
on cells so that uptake of glucose by cells occurs. This leads to a lower hepatic
glucose output (Novonordisk).
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. Support your answer with
academic references. (5 marks)
NovoRapid is a recombinant insulin produced using the Saccharomyces. It is a rapid-
acting insulin and begins acting 10-20 minutes after it has been injected. Its effect
lasts for 1 to 3 hours and it stops working after 3 to 5 hours. It is also called insulin
aspart and gives good postprandial control of blood sugar. Since it is a rapid acting
insulin it is usually administered before meals (Bullock & Manias, 2016).
4. Discuss the definition, causes, symptoms and treatment of hypoglycaemia, a
common adverse effect of NovoRapid. Support your answer with academic
references. (5 marks)
Hypoglycemia is defined as ''the occurrence of a wide variety of symptoms in
association with a plasma glucose concentration of 50 mg per dl or less'' (Field,
1989). Hypoglycemia is a complication that occurs due to medication used to control
blood sugar levels. Hypoglycemia increases the risk of mortality among patients with
diabetes. 92% patients perceived autonomic symptoms of hypoglycemia whereas
88% patients experience neuroglycopenic symptoms (Hendrieckx, et al., 2017). It is
possible to reduce the risk of diabetes by checking blood glucose levels more
frequently. Hypoglycemia can be treated by taking oral glucose to restore the blood
sugar levels. It occurs in diabetes patients irrespective of age, gender, and duration
since onset of diabetes (Hendrieckx, et al., 2017).
5. Discuss the importance of understanding the medication prior to administration.
Support your answer with academic references. (5 marks)
It is important to understand the medication and schedule of administration before
administering so that the correct dosage, timing and effects of the medication are
understood in advance. In case of an adverse effect of the drug the nurse is prepared
with follow up action (NHS).
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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)
The five rights of medication use and administration should be followed by all health
practitioners including nurses because the rights ensure safe medication of patient
and if followed correctly will avoid errors in medication (Grissinger, 2010). The rights
include- the right patient, followed by the right drug at the right time in the right dose
through the right route.
7. What is the most appropriate insulin pen needle length for Ben and why?
Support your answer with academic references. (5 marks)
A 4 mm insulin pen needle is adequate for Ben irrespective of his BMI (O’Neal,
Johnson, & Swar, 2015).
8. What diabetes specific nursing assessment would you conduct prior to
administration of NovoRapid insulin to Ben and why? Support your answer with
academic references. (5 marks)
Prior to administration of NovoRapid insulin to Ben it is important to check his blood
sugar level, confirm whether he is ready for a meal just after the administration,
because it is a fast acting insulin. The site for injection should be checked for
lipodystrophy (Theofanidis, 2017).
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)
The site for injecting insulin in Ben's case would be abdomen and the injection can be
given at an angle of 45 degree, because he has recently lost weight. The site will be
adequately rubbed with alcohol for disinfection (Theofanidis, 2017).
10. What would you document and where? Why is documentation important?
Support your answer with academic or clinical guideline references. (5 marks)
The dose, timing and site of injection should be recorded soon after injecting insulin
and initialled. The documentation should be done on the patient chart (NHS).
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 it is important to remain alert for any signs of
hypoglycemia or hyperglycemia. Once blood glucose is checked and in case either
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hypoglycemia or hyperglycemia is observed it should be immediately reported to the
healthcare team by the nurse (McCall, 2012).
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)
Living with diabetes for a young person can be challenging. Although it is possible to
lead an active life, the patient has to be very punctual with regard to taking insulin.
Even if care is taken, a missed dose or slight variation in food can cause
hypoglycemia or hyperglycemia. The patient and the family have to remain alert for
such an eventuality. Initially the injection of insulin dose before every meal and
monitoring the blood glucose levels several times a day may cause concern.
Constantly watching one's own diet can also prove difficult. Issues with non-
adherence may cause poor glycemic control. This can lead to higher morbidity (Borus
& Laffel, 2010).
2. Discuss potential emotional impacts of living with type 1 diabetes that Ben
may face. Support your answer with academic references. (5 marks)
Controlling blood sugar levels for type 1 diabetes patients is a life-long challenge.
The constant need for medication, blood sugar monitoring, controlling diet and
balancing an exercise regime into the daily routine can affect the patient
psychologically and cause emotional distress. If the patient suffers from emotional
stress, it can also affect the control of blood sugar. In such cases counseling or
cognitive behavior therapy can help the patient to resolve emotional distress
(Ashraff, Siddiqui, & Carline, 2013).
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Reference list
Ashraff, S., Siddiqui, M. A., & Carline, T. E. (2013). The Psychosocial Impact of Diabetes in
Adolescents: A Review. Oman Medical Journal, 28(3):159–162.
Borus, J. S., & Laffel, L. (2010). Adherence challenges in the management of type 1
diabetes in adolescents: prevention and intervention. Current Opinion in
Pediatrics, 22(4): 405–411.
Bullock, S., & Manias, E. (2016). Fundamentals of Pharmacology, 8th Edition. Pearson.
Field, J. (1989). Hypoglycemia. Definition, clinical presentations, classification, and
laboratory tests. Endocrinology and Metabolic Clinics of North America, 18(1):27-
43.
Grissinger, M. (2010). The Five Rights: A Destination Without a Map. Pharmacy and
Therapeutics, 35(10):542.
Hendrieckx, C., Hagger, V., Jenkins, A., Skinner, T., Pouwer, F., & Speight, J. (2017).
Severe hypoglycemia, impaired awareness of hypoglycemia, and self-monitoring
in adults with type 1 diabetes: Results from Diabetes MILES-Australia. Journal of
diabetes and its complications, 31(3):577-582.
McCall, A. L. (2012). Insulin Therapy and Hypoglycemia. Endocrinology and Metabolism
Clinics of North America, 41(1):57–87.
NHS. (n.d.). Diabetes%20Clinical%20Guidelines/Documents/Guideline%20for%20the
%20Administration%20of%20Insulin%20by%20Nursing%20Staff%20final
%20May14.pdf. Retrieved from http://www.nhslanarkshire.org.uk:
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%20Guidelines/Documents/Guideline%20for%20the%20Administration%20of
%20Insulin%20by%20Nursing%20Staff%20final%20May14.pdf
Novonordisk. (n.d.).
www-novonordisk-au/Health%20Care%20Professionals/Documents/NovoRapid-
NovoMix%20pi4a_MarketingVersion.pdf. Retrieved from
http://www.novonordisk.com.au:
http://www.novonordisk.com.au/content/dam/australia/affiliate/www-novonordisk-
au/Health%20Care%20Professionals/Documents/NovoRapid-NovoMix
%20pi4a_MarketingVersion.pdf
O’Neal, K. S., Johnson, J., & Swar, S. (2015). Nontraditional Considerations With Insulin
Needle Length Selection. . Diabetes Spectrum : A Publication of the American
Diabetes Association, 28(4):264–267.
Paschou, S. A., Papadopoulou-Marketou, N., Chrousos, G. P., & Kanaka-Gantenbein, C.
(2018). On type 1 diabetes mellitus pathogenesis. Endocrine Connections,
7(1):R38–R46.
Theofanidis, D. (2017). In-Hospital Administration of Insulin by Nurses in Northern
Greece: An Observational Study. Diabetes Spectrum : A Publication of the
American Diabetes Association, 30(3):175–181.
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