Endocrine, DM, & Critical Care

Question 1

Regular Insulin

Answer 1

Trade Names: Humulin R

Classification: Anti-diabetic

Common Use: type 1 and 2 DM, gestational diabetes, DKA

Common side/adverse effects: redness, swelling, or itching at injection site; severe hypoglycemia

Nursing Interventions: Assess for hypoglycemia (cool, wet skin, tremors, dizziness, anxiety, headache, anxiety, tachycardia, diplopia). Assess pt’s sleeping pattern for restlessness, diaphoresis. Be alert to situations that may change the need for glucose (sick days)

Teaching Points: Wear or carry medical alert identification. Parts of therapy includes weight control, exercise, smoking cessation, and hygiene. Avoid delaying/skipping meals.

Question 2

Metformin

Black Box Alert

Answer 2

Trade Names: Glucophage

Classification: Antihyperglycemic; antidiabetic

Common Use: type 2 diabetes

Common side/adverse effects: diarrhea, n&v, lactic acidosis

Black Box Warning: Risk for lactic acidosis

Nursing Interventions: Monitor serum glucose, Hgb, A1c, renal function, CBC, folic acid. Assess for hypoglycemia. Be alert to situations that may alter glucose requirement.

Teaching Points: Discontinue med if evidence of lactic acidosis (muscle aches, extreme fatigue, unexplained hyperventilation, unusual drowsiness) and report to provider. Don’t take if receiving IV contrast dye. Avoid alcohol.

Question 3

Levothyroxine

Answer 3

Trade Names: Synthroid

Classification: Thyroid hormone (T4)

Common Use: hypothyroidism, TSH

Common side/adverse effects: s/s of hyperthyroidism, dry skin, GI intolerance

Nursing Interventions:Monitor pulse rate and rhythm. Watch for tremors or anxiety. Assess appetite, sleep pattern.

Teaching Points: Don’t discontinue drug regimen; it’s lifelong therapy. Take med at same time each day. Monitor pulse for rate and rhythm; report if rate is over 100 bpm or rhythm is irregular.

Question 4

Gabapentin

Answer 4

Trade Name: Neurotin, Gralise, Horizant

Classification: anticonvulsant, antineuralgic

Common use: To reduce seizure activity and neuropathic pain

Common Side/Adverse Effects: Fatigue, drowsiness, dizziness, ataxia

Nursing Interventions: Seizure precautions. Monitor seizure duration/frequency, kidney function, weight. Monitor for s/s of depression, suicidal ideation, or unusual behavior.

Teaching points: Do not abruptly stop taking drug. Avoid tasks that require mental alertness, and alcohol. Carry and identification card/bracelet to indicate seizure disorder or anticonvulsant therapy.

Question 5

Glipizide

Answer 5

Trade Names: Glucotrol

Classification: Antidiabetic agent

Common Use: type 2 DM

Common side/adverse effects: Altered taste, dizziness, drowsiness, hypoglycemia

Nursing Interventions: Assess for hypoglycemia or hyperglycemia. Be aware to situations that may alter glucose needs.

Teaching Points: Prescribed diet is part of treatment; don’t skip or delay meals. Carry sugar packets, candy, or other sugar supplements to treat hypoglycemia. Check w/ provider when glucose demands are altered.