NURS 1566 Clinical Form 3: Clinical Medications Worksheets

(You will need to make additional copies of these forms)

Generic Name Trade Name Classification Dose Route Time/frequency

regular insulin Humulin R, Novolin R antidiabetics (BS -100)/40 = SQ Fingerstick blood sugar
units of insulin checks q AC & HS
Peak Onset Duration Normal dosage range
2-4 hr 30-60 min 5-7 hr 0.5-1 unit/kg/day
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or
Diabetes mellitus solutions
Medication errors involving insulins have resulted in
serious patient harm and death. Clarify all ambiguous
orders and do not accept orders using the abbreviation "u"
for units, which can be misread as a zero or the numeral 4
and has resulted in tenfold overdoses. Insulins are available
in different types and strengths and from different species.
Check type, species source, dose, and expiration date with
another licensed nurse. Do not interchange insulins without
consulting physician or other health care professional. Do
not confuse regular concentrated (U-500) insulin with
regular insulin. Use only insulin syringes to draw up dose.
The unit markings on the insulin syringe must match the
insulin's units/ml. Special syringes for doses <50 units are
available. Prior to withdrawing dose, rotate vial between
palms to ensure uniform solution; do not shake. When
mixing insulins, draw regular insulin or insulin lispro into
syringe first to avoid contamination of regular insulin vial.
Insulin should be stored in a cool place but does not need
to be refrigerated. If unable to refrigerate, the 10- ml vial
can be kept in a cool place unrefrigerated for up to 28 days,
and the 5-ml vial, up to 14 days.
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
Lower blood glucose by increasing transport into Allergy or hypersensitivity to a particular type of insulin,
cells and promoting the conversion of glucose to preservatives, or other additives, stress,
glycogen. Promote the conversion of amino acids to infection (temporarily increase insulin requirements).
proteins in muscle and stimulate triglyceride Common side effects
formation. Inhibit the release of free fatty acids. Lipodystrophy, HYPOGLYCEMIA.
Interactions with other patient drugs, OTC or
herbal medicines (ask patient specifically)
Beta blockers may block some of the signs and
symptoms of hypoglycemia and delay recovery from
hypoglycemia (Coreg). Chronic use of alcohol may
increase insulin requirements. Acute use of alcohol
and beta blockers (nonselective) may decrease
insulin requirements. Oral hypoglycemic agents
(Glucophage) may ↓ insulin requirements.
Nursing Process- Assessment Assessment
(Pre-administration assessment) Why would you hold or not give this
Blood sugar monitoring. Assess for signs med?
and symptoms of hypoglycemia (anxiety; Hypoglycemia, blood sugar within
chills; cold sweats; confusion; cool, pale normal range.
skin; difficulty in concentration;
drowsiness; excessive hunger; headache;
irritability; nausea; nervousness; rapid
pulse; shakiness; unusual tiredness or
weakness) and hyperglycemia
(drowsiness; flushed, dry skin; fruit-like
breath odor; frequent urination; loss of
appetite; tiredness; unusual thirst)
periodically during therapy. Monitor body
weight periodically. Changes in weight
may necessitate changes in insulin dose.
Lab value alterations caused by medicine
May cause ↓ serum inorganic phosphate, magnesium, and
potassium levels.
Be sure to teach the patient the following about this
medication
Instruct patient on proper technique for administration.
Include type of insulin, equipment (syringe, cartridge pens,
external pumps, alcohol swabs), storage, and place to
discard syringes. Discuss the importance of not changing
brands of insulin or syringes, selection and rotation of
injection sites, and compliance with therapeutic regimen.
Explain to patient that this medication controls
hyperglycemia but does not cure diabetes. Therapy is long
term. Emphasize the importance of compliance with
nutritional guidelines and regular exercise as directed by
health care professional. Advise patient to notify health
care professional of medication regimen prior to treatment
or surgery. Advise patient to notify health care
professional if nausea, vomiting, or fever develops, if
unable to eat regular diet, or if blood glucose levels are not
controlled. Instruct patient on signs and symptoms of
hypoglycemia and hyperglycemia and what to do if they
occur. Patients with diabetes mellitus should carry a source
of sugar (candy, sugar packets) and identification
describing their disease and treatment regimen at all times.
Emphasize the importance of regular follow-up, especially
during first few weeks of therapy.
Evaluation
Check after giving
Control of blood glucose
levels without the
appearance of hypoglycemic
or hyperglycemic episodes.