401209 Health Variations 2: NovoRapid Insulin and Type 1 Diabetes

This case study focuses on the nursing management of a 19-year-old patient, Ben Summer, diagnosed with Type 1 Diabetes and prescribed NovoRapid insulin. It addresses the essential components of a valid subcutaneous insulin medication order, explaining the rationale behind each element for ensuring patient safety. The study delves into the pathophysiology of Type 1 Diabetes, elucidating why NovoRapid is prescribed and its mechanism of action, onset, peak, and duration, and the importance of timing administration with food intake. It further discusses hypoglycemia, a common adverse effect, covering its definition, causes, symptoms, and treatment. The importance of understanding medication properties and adhering to the 5 rights of medication administration are emphasized. The case study also specifies the appropriate insulin pen needle length for Ben, recommended injection sites, and the significance of proper injection techniques to prevent infection. Finally, it outlines the essential documentation required post-administration and the importance of assessing potential side effects like hyperglycemia and hypoglycemia. The case study also touches upon the psychological impact of Type 1 Diabetes on the patient's lifestyle and emotional well-being.

Running Head: ASSESSMENT 2 CASE STUDY
Assessment 2 case study
Student’s Name
Institution
Date

ASSESSMENT 2 CASE STUDY 2
Part A
Question 1
Firstly, the nurse will need to Ben’s name in full and the date he received the insulin dose. The
nurse will also specify the insulin name (NovoRapid insulin) and the dosage. The time and
frequency of medication administration should also appear in the medication order. In addition,
Ben’s residence and his contact information should be indicated. Lastly, the nurse should write
his or her name. All these components, according to Rossetti, Porcellati, Bolli & Fanelli (2008)
enhance Ben’s safety.
Question 2
Ben was prescribed NovoRapid because his beta cells cannot synthesize enough insulin and
hence his system needs to be supplemented with artificial insulin that can perform similar
function as normal insulin. Novorapid is almost similar to the insulin released by the pancreas of
a person without diabetes (Goldman-Levine & Lee, 2005). They begin to be active 10-15
minutes after being punctured. Its activity peak is at 30-90 minutes and last between 3 and 4
hours.
Question 3
Novorapid insulin has a shorter duration of action compared to human soluble insulin after
subcutaneous injection. According to Bullock & Manias (2017), NovoRapid begin to be active
10-15 minutes after being punctured. Its activity peak is at 30-90 minutes and last between 3 and
4 hours. NovoRapid ® has a faster onset of action and a shorter duration than soluble human
insulin. Because of the faster onset of action, NovoRapid ® should usually be administered
immediately before a meal (Rossetti, Porcellati, Bolli & Fanelli, 2008).

ASSESSMENT 2 CASE STUDY 3
Question 4
Hypoglycemia in an adult is defined as a blood glucose level below 40 mg / dl, even in the
absence of symptoms (Skyler, 2004). It is caused by inadequate intake of glucose or food rich in
glucose. The common symptoms include sweating, palpitations, anxiety, changes in the pupillary
size and increase in the secretion of saliva by the parotid. Hypoglycemia is treated by
intravenous administration of glucose. It is not advisable to administer NovoRapid to
hypoglycemic individuals because NovoRapid increase the uptake of blood glucose yet
hypoglycemic patients have low level of blood glucose.
Question 5
Since Ben is suffering from type 1 diabetes, it is important to choose medication whose
pharmacodynamic properties fit’s Ben’s condition. Ben needs medication that act first. Different
medications have different pharmacodynamic properties (Goldman-Levine & Lee, 2005). These
properties dictate the time, dosage and frequency. For example, NovoRapid ® produces a faster
onset of action compared and hence stands out as the best replacement for insulin deficiency
(Florence, 2015). The replacement insulin acts in the same way as naturally produced insulin and
helps glucose to enter the blood in the cells (Bullock & Manias, 2013).
Question 6
The first right is the right patient, for our case, Ben is the right patient. The second right is right
drug, for this case, NovoRapid. The third right is right of medication. Right of medication
describes the right for Ben to be treated. Another right is the right route. For Ben’s case, the right
route is subcutaneous route because NovoRapid can be absorbed immediately into blood vessels

ASSESSMENT 2 CASE STUDY 4
located in subcutaneous layer. Lastly, the right dose is another key right of medication (Fogarty
& McKeon 2006).
Question 7
Needles of 5 and 6 mm in length for an insulin pen or injector are recommended for Ben. This is
because Ben can be categorized as an adult patient with reduced body weight or for standard
injection into a reduced layer of subcutaneous tissue (Gibney, Arce, Byron & Hirsch 2010). The
needles of 5 to 6 mm will ensure that the insulin is delivered to the right point where it can get
into blood stream as soon as possible.
Question 8
Some of the assessment to conduct before administering insulin is to determine whether Ben
could be having other illness. If it is determined that Ben have another condition, then nurse will
have to evaluate the effectiveness of medication and determine the right dosage (Wallace &
Matthews 2004). In addition, nurse will have to assess whether Ben is agitated or stressed,
whether he is taking various medications, and his level of physical activity. These assessments
will enable nurses choose the best medication and determine the right dosage.
Question 9
The recommended injection sites for Ben is the anterior wall of the abdomen and the external
surface of the thigh. The angle of the injection should be 45 °, and a skin fold should be formed
(Gibney, Arce, Byron & Hirsch 2010). Pathogens can enter through the broken skin. Hence it is
advisable to use sterilize cotton, sterilized needle and remove the needle in the angle at which it
penetrated the injection site in order to avoid infections (Gibney, Arce, Byron & Hirsch 2010).

ASSESSMENT 2 CASE STUDY 5
Question 10
The first thing to document is the name of medication. Based on the diagnosis made, Ben should
receive NovoRapid insulin, medication designed to address insulin deficiency (Masse, et al
2018).. NovoRapid is an insulin replacement that is very close to insulin produced by the body.
The second thing to document is the amount of dose given (In Qureshi & In Maxwell, 2014).
The usual dose is between 0.5 and 1.0 units per kilogram of body weight per day. The third thing
to document is route used and site for injection. NovoRapid is given by subcutaneous injection
into the abdominal wall, thighs, arms, shoulder or shoulder. Other aspects to document include
time administered, initials and signature. Documentations help in ensuring ongoing care is done
efficiently (Aitken, Manias & Dunning 2006).
Question 11
One of the post administration assessment is to determine potential side effects. Improper dosing,
in most cases, may lead to hyperglycaemia and diabetic ketoacidosis. Ketoacidosis does not
occur immediately (George, Byun & Howard-Thompson, 2018). The first symptoms develop
slowly over hours or days. Consequently, it is a role of nurse to follow up and assess the effects
of every drug administered so as to intervene accordingly in case of contraindication. It is also
important to note that the NovoRapid may cause hypoglycaemia (low blood sugar). The nurse
should therefore be ready to assess Ben in order to determine whether he developed
hypoglycemia or hyperglycemia (Skyler, 2004).
Part 2
Question 1

ASSESSMENT 2 CASE STUDY 6
Firstly, it is important to note that the common symptoms of type 1 diabetes include constant
thirst, frequent urge to urinate, weakness and drowsiness, blurred vision, sensation of
goosebumps, numbness and tingling in the palms and soles, skin problems, poorly healing cuts
and scratches, sudden weight loss and severe hunger with proper and full nutrition (Brazeau,
Rabasa-Lhoret & Strychar et al. (2008). These symptoms may make it inconvenient for Ben to
engage in daily activities. If Ben used to go out the whole day, he will have to change his
behavior and schedule. In other words, diabetes type 1 will force Ben to live relatively restricted
lifestyle.
Question 2
Diabetes mellitus is a physical illness, but it puts our psychological world in check. After the
diagnosis can appear compatible pictures with: anxiety, social withdrawal, depression, anger,
feelings of guilt and disability and a series of feelings and situations that can worsen the general
state of mind of the patient (Wallace & Matthews 2004). Ben has a risk of social isolation or
emotional disorders that affect their more social sphere, so it is important to address these
aspects. This is why psychologists stress the importance of taking care of internal emotional
world by supporting our loved ones, going to group therapy with people suffering from the same
condition and / or asking for advice from psychologists who are experts in chronic diseases.

ASSESSMENT 2 CASE STUDY 7
References
Aitken R., Manias E. & Dunning T. (2006). Documentation of medication management by
graduate nurses in patient progress notes: a way forward for patient
safety. Collegian. 13(4):5–11
Brazeau A. S., Rabasa-Lhoret R. & Strychar I, et al. (2008). Barriers to physical activity among
patients with type 1 diabetes. Diabetes Care. 31:2108–9. [PMC free article] [PubMed]
Bullock, S & Manias, E. (2017). Fundamentals of Pharmacology (8e). Pearson.
Bullock, S., & Manias, E. (2013). Fundamentals of Pharmacology. Melbourne: P.Ed Australia.
Florence, A. T. (2015). Physicochemical principles of pharmacy: In manufacture, formulation
and clinical use. London: Pharmaceutical Press.
Fogarty G. J. & McKeon C. M. (2006). Patient safety during medication administration: the
influence of organizational and individual variables on unsafe work practices and
medication errors. Ergonomics. 49:444–56.
George, C. M., Byun, A., & Howard-Thompson, A. (2018). New Injectable Agents for the
Treatment of Type 2 Diabetes Part 1 - Injectable Insulins. The American Journal Of
Medicine, 131(7), 752-754. doi:10.1016/j.amjmed.2018.01.049
Gibney M. A., Arce C. H., Byron K. J. & Hirsch L. J. (2010). Skin and subcutaneous adipose
layer thickness in adults with diabetes at sites used for insulin injections: Implications for
needle length recommendations. Curr Med Res Opin. 26(6):1519-1530. 3.
Goldman-Levine, J. D. & Lee, K. W (2005). Insulin Detemir--A New Basal Insulin Analog. The
Annals of Pharmacotherapy 39: 502-507.
In Qureshi, Z., & In Maxwell, S. R. J. (2014). The Unofficial Guide to Prescribing e-book.
Churchill Livingstone

ASSESSMENT 2 CASE STUDY 8
Masse, M., Maton, M., Genay, S., Blanchemain, N., Barthélémy, C., Décaudin, B., & Odou, P.
(2018). In vitro assessment of the influence of intravenous extension set materials on
insulin aspart drug delivery. Plos One, 13(8), e0201623.
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Rossetti, P., Porcellati, F., Bolli, G. B., Fanelli, C. G. (2008). Prevention of Hypoglycemia While
Achieving Good Glycemic Control in Type 1 Diabetes: The role of insulin analogs.
Diabetes Care 31: S113-S120 .
Skyler, J. S. (2004). Effects of Glycemic Control on Diabetes Complications and on the
Prevention of Diabetes. Clin. Diabetes 22: 162-166
Wallace T. M. & Matthews D. R. (2004). Recent advances in the monitoring and management of
diabetic ketoacidosis. QJM. 97:773–80. [PubMed]