Comprehensive Nursing Case Study: NovoRapid Insulin & Type 1 Diabetes

This nursing assignment presents a case study involving a 19-year-old patient, Ben, diagnosed with type 1 diabetes and prescribed NovoRapid insulin. The assignment delves into the essential components of a valid medication order, explaining their significance and supporting the information with academic and clinical guideline references. It explores the rationale behind Ben's prescription, relating it to the pathophysiology of type 1 diabetes and the mechanism of action of NovoRapid insulin. The assignment also covers the onset, peak, and duration of action for NovoRapid insulin, including the optimal timing of administration in relation to food intake, supported by academic references. Furthermore, it discusses the definition, causes, symptoms, and treatment of hypoglycaemia, a potential adverse effect of NovoRapid. The importance of understanding medication before administration and the five rights of medication administration are also discussed. The assignment addresses the selection of the most appropriate insulin pen needle length for Ben and the rationale behind it. It outlines the diabetes-specific nursing assessments to be conducted before and after NovoRapid administration, along with the rationale, site, and angle of injection, including infection control considerations. Documentation protocols are also addressed. Part B of the assignment explores the daily physical and potential emotional challenges Ben may face living with type 1 diabetes.

Running head: NURSING ASSIGNMENT 1
Nursing Assignment
Student’s Name
Institutional Affiliation

NURSING ASSIGNMENT 2
Part A
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.
The components of a medication order include; client’s name, client’s gender, date of birth,
medical record number, date of order, name of medication, medication dosage, route of dosage
administration, time of administration and frequency of medication administration, signature of
the health practitioner (Tierney, McLurg & Macmillan, 2018). The medical order elements are
vital to the pharmacy for correct dispensing of medication.
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. Support your
answer with academic references.
The work of NovoRapid insulin is to lower blood sugar levels (Russell-Jones et al., 2017).
Since Ben's blood glucose level is too high, that is the reason the medication was prescribed to
him. Apart from it reducing the level of blood sugar, it has a rapid onset of action than soluble
human or cattle insulin. Also, the impact happens within 10-20 minutes although the utmost
impact takes place from 1-3 hours and ends for up to 5 hours (Russell-Jones et al., 2017).
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.
The onset of NovoRapid insulin is 15 minutes after the administration, the peak is about 1
hour, and the duration of action is 2-4 hours. NovoRapid insulin should be given before a meal
such that it takes less than 5-10 minutes to the meal due to its rapid onset of action (Bullock &
Manias, 2017). The reason why the medication should be administered before a meal is to manage
the blood sugar level after taking food.
4. Discuss the definition, causes, symptoms and treatment of hypoglycaemia, a common
adverse effect of NovoRapid. Support your answer with academic references. (5
marks)

NURSING ASSIGNMENT 3
Hypoglycaemia can be defined as the deficiency of glucose in the bloodstream (Cryer, 2016).
It can occur when an individual with diabetes takes much of insulin. Several symptoms are
associated with hypoglycaemia, and some are increased appetite, frequent urination, feeling tired
and excessive thirst (Cryer, 2016). To treat hypoglycaemia, an individual with diabetes should
take 15 to 20 grams of rapid-acting carbohydrates that include fruit juice, fizzy drinks and glucose
tablets. The terrible impact of NovoRapid is hypoglycaemia.
5. Discuss the importance of understanding the medication before administration.
Support your answer with academic references.
The importance of understanding a medication before it is given is that medical practitioners
are assisted in striving to meet any medicine related need of their clients (Sluggett, Ilomäki,
Seaman, Corlis & Bell, 2017).
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.
The five rights of medication administration are the right patient, the right drug, the right dose,
the right route and the right time. Nurses have to administer to the right patient by checking his or
her name, date of birth and make sure the patient is aware of all the side effects of the medication
and understands it (Pirinen et al., 2015). They should also examine the prescription and the expiry
date of the medicine to ensure it is the correct medication. However, the right drug should have the
correct dosage be administered via checking and confirming the appropriateness of the medication
together with using the right route by verifying if the client can take the medication via the
prescribed path. Finally, while administering a drug should be done at the right time. Nurses
examine the ordered drug frequency, checks whether he or she is delivering at the right time and
confirm when the last dose was given (Pirinen et al., 2015). Therefore, it is essential that these
rights are followed so that medication errors are reduced.
7. What is the most appropriate insulin pen needle length for Ben and why? Support
your answer with academic references.
The range of insulin pen needle length is 4-12.7 mm, and a pen needle with a broad gauge is
preferred for small doses of insulin of 30 units and below (Hirsch, Byron & Gibney, 2014). Ben
would be preferred to an insulin pen needle of 5 mm because it is injected in the subcutaneous
layer and needs short needles so that it cannot extend to the muscles.

NURSING ASSIGNMENT 4
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.
I would evaluate the patient’s vital signs, blood glucose level, appetite and presence of any
symptoms that show that the patient will not be able to take or retain the next meal (Vallerand,
2018). Also, the subcutaneous areas for lipodystrophies and the other regions with potential
insulin injection sites will be evaluated together with the knowledge of insulin and insulin
administration by the patient. Medication is examined for the expiration date, physical damage and
deterioration. The patient will also be assessed for the potential drug or drug interactions, food or
drug interactions and drug or drug class allergies (Vallerand, 2018). For Ben, the evaluations are
essential to ensure the medication he uses is the right one and for the proper purpose.
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.
I would inject the NovoRapid insulin into the abdomen at an angle of 90 degrees (Tandon et
al., 2015). This site was selected for Ben because the insulin will be absorbed faster and the action
will last long. Considerations in infection control are that for those clients transferred from other
types of insulin to NovoRapid insulin should be appropriated as directed by the health practitioner.
Also, individuals who were initiated on insulin may be similarly started on NovoRapid to if they
were on cattle insulin.
10. What would you document and where? Why is documentation important? Support
your answer with academic or clinical guideline references.
What I would document is the medication name, the given dose, route and site for injection,
time of administration, initials and signature. This is recorded in category E 10 of ICD-10 which is
for type 1 diabetes, and it is essential to help in the treatment of the chronic condition (American
Diabetes Association, 2015).
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.
The post administration assessments provided for Ben are; the evaluation for any unfavourable
side impacts, assessment for the effectiveness of the medication, comparing his prior condition

NURSING ASSIGNMENT 5
with post medication condition and documenting the response of Ben to medication (Vallerand,
2018). The evaluations are conducted after 10-20 minutes of the administration, and it is done to
put him on track so that the right procedures can be undertaken to control the disease.
Part B
1. Discuss the daily physical challenges of living with type 1 diabetes that Ben may face.
Support your answer with academic references.
Counting carbohydrates is a challenge to Ben because in each food he takes he has to
approximate the grams of carbs in it and sum up the total number of carbohydrate grams he takes
daily. Also, he has to have enough supply of foods daily that do not increase his blood sugar level
and also consider foods that will change his diet (Engström, Leksell, Johansson &
Gudbjörnsdottir, 2016). Ben will face difficulties when administering the NovoRapid insulin
since he has to buy the insulin and acquire a glucose meter to estimate the glucose concentration
in the blood.
2. Discuss the potential emotional impacts of living with type 1 diabetes that Ben may
face. Support your answer with academic references.
When Ben thinks too hard about his condition, he develops some stress that results in the
release of stress hormones hence raising the blood sugar level. In his relationship with his
girlfriend, he might experience adverse effects on quality of life of male sexual dysfunction
(Jones, Olsen, Perrild & Willaing, 2016). Depression is another psychological effect impacting
his mental health making him not to enjoy while doing his daily activities. Furthermore, due to
the everyday demands of managing his condition, he will become tired and in the end, ignore the
diabetes management.

NURSING ASSIGNMENT 6
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.
Bullock, S. & Manias, E. (2017). Fundamentals of pharmacology. Melbourne, Vic: Pearson
Australia.
Cryer, P. E. (2016). Management of hypoglycemia during treatment of diabetes
mellitus. UpToDate, Waltham, MA. (Accessed on March 25th, 2014.) Retrieved from
http://www. Update. com/contents/management-of-hypoglycemia-during-treatment-of-
diabetes-mellitus.
Engström, M. S., Leksell, J., Johansson, U. B., & Gudbjörnsdottir, S. (2016). What is important
to you? A qualitative interview study of living with diabetes and experiences of diabetes
care to establish a basis for a tailored Patient-Reported Outcome Measure for the Swedish
National Diabetes Register. BMJ Open, 6(3), e010249.
Hirsch, L., Byron, K., & Gibney, M. (2014). Intramuscular risk at insulin injection sites—
measurement of the distance from skin to muscle and rationale for shorter-length needles
for subcutaneous insulin therapy. Diabetes Technology & Therapeutics, 16(12), 867-873.
Jones, A., Olsen, M. Z., Perrild, H. J., & Willaing, I. (2016). The psychological impact of living
with diabetes: descriptive findings from the DAWN2 study in Denmark. Primary care
diabetes, 10(1), 83-86.
Pirinen, H., Kauhanen, L., Danielsson-Ojala, R., Lilius, J., Tuominen, I., Díaz Rodríguez, N., &
Salanterä, S. (2015). Registered Nurses’ experiences with the medication administration
process. Advances in Nursing, 2015.
Russell-Jones, D., Bode, B. W., De Block, C., Franek, E., Heller, S. R., Mathieu, C., ... &
Graungaard, T. (2017). Fast-acting insulin as part improves glycemic control in basal-
bolus treatment for type 1 diabetes: results of a 26-week multicenter, active-controlled,
treat-to-target, randomized, parallel-group trial (onset 1). Diabetes Care, dc161771.

NURSING ASSIGNMENT 7
Sluggett, J. K., Ilomäki, J., Seaman, K. L., Corlis, M., & Bell, J. S. (2017). Medication
management policy, practice and research in Australian residential aged care: current and
future directions. Pharmacological research, 116, 20-28.
Tandon, N., Kalra, S., Balhara, Y. P., Baruah, M., Chadha, M., Chandalia, H., ... & Mithal, A.
(2015). Forum for injection technique (FIT), India: The Indian recommendations 2.0, for
best practice in insulin injection technique, 2015. Indian journal of endocrinology and
metabolism, 19(3).
Tierney, M., McLurg, D., & Macmillan, C. (2018). Transferring medication order entry from
pharmacists to pharmacy technicians. The Canadian Journal of Hospital
Pharmacy, 52(4).
Vallerand, A. H. (2018). Davis's drug guide for nurses. FA Davis.