endocrine lecture 2 l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Endocrine Lecture 2 PowerPoint Presentation
Download Presentation
Endocrine Lecture 2

Loading in 2 Seconds...

play fullscreen
1 / 62

Endocrine Lecture 2 - PowerPoint PPT Presentation


  • 143 Views
  • Uploaded on

Endocrine Lecture 2. Part 3. Mixing Insulin – How it. #1 Assemble equipment Insulin Syringe Alcohol swab MD order. Mixing insulin – How it. #2 Check MD order for dose and types. Mixing insulin – How it. #3 Roll the bottle of intermediate acting insulin (DO NOT SHAKE).

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Endocrine Lecture 2' - adamdaniel


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
mixing insulin how it
Mixing Insulin – How it

#1 Assemble equipment

  • Insulin
  • Syringe
  • Alcohol swab
  • MD order
mixing insulin how it3
Mixing insulin – How it

#2 Check MD order for dose and types

mixing insulin how it4
Mixing insulin – How it

#3 Roll the bottle of intermediate acting insulin (DO NOT SHAKE)

mixing insulin how it5
Mixing insulin – How it

#4 Wipe the top of both vials with alcohol swab

mixing insulin how it6
Mixing insulin – How it

#5 Draw up and inject an amount of air equal to the dose of intermediate acting insulin vial. Then remove syringe from the vial

mixing insulin how it7
Mixing insulin – How it

#6 Draw up and inject an amount of air equal to the amount of short-acting insulin into the clear vial. *Leave syringe in the vial

mixing insulin how it8
Mixing insulin – How it

#7 Draw up the correct amount of clear/regular insulin.

mixing insulin how it9
Mixing insulin – How it

#8 Double check with another nurse if this is the institutions policy.

mixing insulin how it10
Mixing insulin – How it

#9 Remove the syringe and insert into the cloudy vial. Carefully draw up the correct amount of insulin.

mixing insulin how it11
Mixing insulin – How it

#10 Double check with another nurse before removing the syringe from the vial

what do you do if you draw up too much intermediate acting insulin with mixing
What do you do if you draw up too much intermediate acting insulin with mixing?
  • Push it back into the vial and re-draw up the correct amount.
  • Waste the med and start over with the same syringe.
  • Waste the med and start over with a clean syringe.
  • Who cares, a little extra never hurt anyone! Just give it to the patient.
what do you do if you draw up too much regular clear insulin when mixing
What do you do if you draw up too much Regular/clear insulin when mixing?
  • Push it back into the vial and re-draw up the correct amount.
  • Waste the med and start over with the same syringe.
  • Waste the med and start over with a clean syringe.
  • Who cares, a little extra never hurt anyone! Just give it to the patient.
how would you do it
How would you do it?

Give 8u Humulin R and 12u NPH sub-q, qAM.

sliding scale
Sliding Scale
  • Used during
    • Surgery
    • Illness
    • Stress
  • Determines insulin dose based on FSBG
  • Usually regular insulin is used
  • FSBS check usually every 4-6 hrs
sample sliding scale
Sample Sliding Scale
  • Check FSBS before meals and at HS (2200)
  • 4u Humulin R insulin for glucose 151-200 mg/dL
  • 6u Humulin R insulin for glucose 201-250 mg/dL
  • 8u Humulin R insulin for glucose 251-300 mg/dL
  • 10u Humulin R insulin for glucose 301-350 mg/dL
  • Call MD for glucose >350 mg/dL
questions for sliding scale
Questions for sliding scale
  • Check FSBS before meals and at HS (2200)
  • 4u Humulin R insulin for glucose 151-200 mg/dL
  • 6u Humulin R insulin for glucose 201-250 mg/dL
  • 8u Humulin R insulin for glucose 251-300 mg/dL
  • 10u Humulin R insulin for glucose 301-350 mg/dL
  • Call MD for glucose >350 mg/dL
  • If FSBS 189 how much insulin would you give?
  • If FSBS 309, how much insulin would you give?
  • If FSBS 120, how much insulin would you give?
  • If FSBS 60, how much insulin would you give?
insulin injections
Insulin Injections -
  • In general the more frequent the injections the better the control.
  • Read and study pg. 1394-1395 of text book for different insulin regimens
insulin regiments
Insulin regiments
  • Vary
  • Usually combo
  • Goal is to mimic normal pancreas
  • Patient adjust
syringe types
Syringe Types
  • Insulin syringe
  • 27-29 gauge
  • Various units
    • Must match insulin concentrations
route self administration
Route (Self Administration)
  • Subcutaneous tissue
    • If you can “pinch an inch”
      • 90 degree angle
    • If you can’t “pinch an inch”
      • 45 degree angle
area s of injection
Area’s of injection
  • Abdomen
  • Arm
  • Thigh
  • Hips
factors affecting absorption rates
Factors affecting absorption rates
  • Quickest
    • Abdomen
  • Exercise
    • Increases absorption rate
lipodystrophy
Lipodystrophy
  • Atrophy of subcutaneous fat
  • Do not use these sites!
  • Causes
    • Non-human insulin
    • Alcohol
  • Rotate site
self injection techniques
Self-Injection Techniques
  • No need to aspirate
  • Through clothing  OK
  • Skin prep with alcohol not recommended
  • Reuse needles
  • Disposal
flocculation
Flocculation
  • Check for flocculation
    • Frosted, whitish coating inside the bottle)
    • Caused by extreme heat
    • Do not use
insulin storage
Insulin Storage
  • Vial NOT being used refrigerate
  • Vial in use  room temperature
  • Storage life un-refrigerated = 1 month
  • Remember: date all vials when opened
pre mixed insulin
Pre-mixed insulin
  • NPH + Regular
  • Novolin 70/30
    • 70% NPH
    • 30% regular
insulin pens advantages
Insulin Pens - Advantages
  • Portable, discreet, convenient
  • Save time (don’t draw up insulin)
    • Pre-filled insulin cartridge
  • Set accurate dose with the turn of a dial
insulin pens disadvantages
Insulin Pens - Disadvantages
  • $$$$
  • Some insulin wasted
  • Not all insulin's available
  • Can’t mix
  • Only for self-injection
nurses pre filled syringes
Nurses pre-filled syringes
  • Up to 3 weeks supply
  • Kept in frig
  • Store with needles in upright position
  • Mix thoroughly before injecting
what would you do
What would you do?

Which of the following is frequently best to teach / do first when doing initial diabetic training?

  • How & where to purchase insulin
  • Preparation & storage of insulin
  • Mixing insulin with return demonstration
  • Self-injection of insulin
  • Learning O-P-D of insulin types
insulin pumps
Insulin Pumps
  • Portable infusion pump
  • Subcutaneous needle
  • Continuous/basal rate
  • Additional bolus if needed
  • Change site q24-48 hours
insulin pumps34
Insulin Pumps
  • S/E - risks
    • Hypoglycemia
      • FSBG at 3AM /wk
    • Infection
    • Hyperglycemia
      • Occlusion
      • Battery
teacher mistakes insulin pump for cell phone ap october 5 2005
Teacher mistakes insulin pump for cell phoneAP: October 5, 2005

CLERMONT — A substitute teacher pulled out a student’s insulin pump after mistaking it for a cell phone, officials said.Cliffton Hassam told East Ridge High School officials that his insulin pump began beeping in class Friday.Before he could turn it off, substitute teacher Richard Maline ripped it from his leg, according to the written statement Hassam gave school officials on Tuesday.

slide36

Hassam, a junior, is diabetic and wears the insulin pump to regulate his blood sugar level.Maline pulled the pump because he thought the beeping came from a cell phone, said Russell Anderson, executive director of human resources for Lake County School District.“It fell to the floor,” Hassam wrote in his statement to school officials. “The second time he pulled it the tube came out of my leg.”

inhaled insulin
Inhaled insulin
  • “Exubera”
    • Type 2 DM
    • Pre-meal dose
    • Not basal insulin
insulin therapy complications
Insulin Therapy Complications
  • Hypoglycemia
    • Insulin Shock
  • Causes
    • Too much insulin
    • Too little food
    • Extreme exercise
s s of hypoglycemia
S&S of Hypoglycemia
  • Neuro
    • Dizzy / faint
    • Nervous
    • Irritability
    • Blurred vision
    • Numb tongue or lips
    • C/O Headache
    • Stupor
s s of hypoglycemia40
S&S of Hypoglycemia
  • Cardiovascular
    • Full bounding pulse
  • Respiratory
    • Shallow breathing
  • Gastro-intestinal
    • Polyphagia
s s of hypoglycemia41
S&S of Hypoglycemia
  • Genital-urinary
    • No polydipsia
  • Skeletal/muscular
    • Weak
    • Trembling / tremor
  • Integumentary
    • Perspiring
    • Moist
    • Pale
hyper or hypoglycemia
Hyper or Hypoglycemia???
  • How come they are not all opposite S&S?
  • Why are some so similar?
  • Which symptoms are different?
insulin therapy complications43
Insulin Therapy Complications
  • Local allergic reaction
    • Redness, swelling, tenderness, induration
    • First start taking insulin
    • No alcohol prep
insulin therapy complications44
Insulin Therapy Complications
  • Insulin Resistance
    • Decreases sensitivity to insulin
    • d/t obesity
  • Lypodystrophy
    • Do not use site
small group questions
Small group Questions
  • When is a sliding scale commonly used?
  • A tuberculin syringe is also calibrated in units. Is it OK to use a TB syringe to draw up insulin?
  • What route is insulin administered?
  • Compare the signs and symptoms of hyper and hypoglycemia
slide46

How come they are not all opposite signs and symptoms?

  • Why are some so similar?
  • Which symptoms can you look for to tell the difference between hyper and hypoglycemia? (*)
  • Identify the components of a complete endocrine physical assessment
slide47

What type of insulin is used in an insulin pump?

  • What is the biggest risk factor in using an insulin pump?
  • What qualifications would you look for in recommending a client for using an insulin pump?
insulin therapy complication insulin waning
Insulin Therapy ComplicationInsulin waning
  • Progressive rise in blood glucose from bedtime to morning
insulin therapy complication insulin waning49
Insulin Therapy ComplicationInsulin waning
  • Progressive rise in blood glucose from bedtime to morning
insulin therapy complication insulin waning treatment
Insulin Therapy ComplicationInsulin waning - Treatment
  • Increase evening dose of intermediate insulin
  • Or institute a dose of insulin before evening meal
insulin therapy complication dawn phenomenon
Insulin Therapy ComplicationDawn Phenomenon
  • Relatively normal glucose level until about 3:00 AM, when the level begins to rise
insulin therapy complication dawn phenomenon52
Insulin Therapy ComplicationDawn Phenomenon
  • Relatively normal glucose level until about 3:00 AM, when the level begins to rise
insulin therapy complication dawn phenomenon tx
Insulin Therapy ComplicationDawn Phenomenon - TX
  • Change time of injection of evening intermediate acting insulin from dinnertime to bedtime
insulin therapy complication somogyi effect
Insulin Therapy ComplicationSomogyi Effect
  • Normal or elevated glucose level at bedtime, a decrease at 2-3AM (hypoglycemic), increase BS levels due to “counter-regulatory” hormones
insulin therapy complication somogyi effect55
Insulin Therapy ComplicationSomogyi Effect
  • Normal or elevated glucose level at bedtime, a decrease at 2-3AM (hypoglycemic), increase BS levels due to “counter-regulatory” hormones
insulin therapy complication somogyi effect tx
Insulin Therapy ComplicationSomogyi Effect - TX
  • Decrease evening or bedtime dose of intermediate acting insulin
  • Or increase bedtime snack
ms sunshine
Ms. Sunshine:

Ms. Sunshine in waking up in the morning with hyperglycemia. She is taking insulin to control her diabetes. She takes 15 units of NPH qAM before breakfast and 15 units q PM before dinner. She is told to check her blood sugar every hour through the night. The results are as follows. What would you expect the doctor to diagnose as the cause? What changes do you expect the doctor to make in Ms. Sunshine’s management of diabetes?

mrs small
Mrs. Small:

Mrs. Small in waking up in the morning with hyperglycemia. She is taking insulin to control her diabetes. She takes 15 units of NPH qAM before breakfast and 15 units q PM before dinner. She is told to check her blood sugar every hour through the night. The results are as follows. What would you expect the doctor to diagnose as the cause? What changes do you expect the doctor to make in Mrs. Small management of diabetes?

mr flush
Mr. Flush:

Mr. Flush in waking up in the morning with hyperglycemia. She is taking insulin to control her diabetes. She takes 15 units of NPH qAM before breakfast and 15 units q PM before dinner. She is told to check her blood sugar every hour through the night. The results are as follows. What would you expect the doctor to diagnose as the cause? What changes do you expect the doctor to make in Mr. Flush management of diabetes?