IV insulin Flashcards
when giving insulin Iv what do you use to tell you how to give
the order set not the monograph
early s/s of hypoglycemia
shaking
sweaty
confused
long term s/s hyperglycemia
PVD, neuropathies, inc BUN, inc creatinine
ST s/s hyperglycemia
polyuria
polydipsia
polyphagia
can you stop a pts IV insulin suddenly
no may cause rebound effect
what assessments do you do on diabetic pt (maybe before giving IV insulin??not sure)
blood glucose fluids lytes dysrhythmias VS Abgs
when giving IV insulin what must you know the location of
where the hypoglycemic protocol is
can you calculate drip factor for IV insulin
not recommended. Should be given by infusion pump for tight control
c
can yiu gve insulin through line with med in it
no. incompatible
after giving insulin where would you document
fluid balance (its given in 250ml or some small volume)
MAR
diabetic record
youve mixed the insulin with the soln what next
flush line with 50ml soln as some insulin will stick to the line and alter the dose reching the pt
how is the acidosis in DKA reversed
by insulin admin
how often to do BG when pt has DKA
hourly
how to give insulin if pt has DKA
at slow continuous rate eg 5 units/h
if pt has a high BG should that be dropped really quickly
no. IV fluid solnds w higher conc of glucose eg D5Ns
should Iv rehydration be givn through same line as insulin
often theyre given through separate lines. The rehydration soln can then have its rate adjusted frequently
when can you stop giving insulin IV
when pt has resumed subcut insulin (or maybe when their BG is normal and they no longer have ketone bodies??)
what occurs first after DKA normal pH of body or normal BG
normal BG (therefore may need to continue with BG admin)
is bicarb infusion used often for DKA
no because it precipitates sudden dec in K levels
what are concerning complic of DKA that must be managed
fluid lytes BG monitoring urine output must be ascertained (if none pt may get hyperkalemic) ECG give fluids, insulin, other meds
which types of insulin are regular insulin
aka
humulin R
aka short acting insulin
which kind of insulin should NOT be given IV
intermediate acting NPH
humulin N
lon acting
lantus
premixed insulin
s/s of hyperglycemia
BG > 7.0 mmol/L Polyuria – excessive urination Polyphagia – increased hunger Polydipsia – increased thirst Glucosuria – high levels of glucose in the urine Weight loss Fatigue
s/s of hypoglycemia autonomic symptoms
Trembling Palpitations Sweating Anxiety Hunger Nausea Tingling
what are worse than just autonomic syptoms
neuroglycopenic
hypo neuroglycopenic symptoms
Difficulty concentrating Confusion Weakness Drowsiness Vision changes Difficulty speaking Headache Dizziness Tiredness
when to initiate hypoglycemic protocol and what to do if BG
mild to moderate and autonomic symp with BG of 2.8-3.9 Give 15 g carbohydrate (3 tablets) If the patient has medical issues (dysphagia, dentition issues) that prevent tolerance of glucose tablets, 1 tube of glucose gel (provides approx. 20 g of carbohydrate) can be administered and must be swallowed. 2. Repeat BG in 15 min. 3. Repeat steps 1 and 2 until pt has BG of >4.0 mmol 4. Give meal or snack If next meal is more than 1 hr away, give a snack in the form of diabetes reaction food kit * 5. inform dr If patient has had 3 or more incidents of hypoglycemia during a hospital stay, physician must be informed verbally by telephone or in person. 6. Document incident of hypoglycemia
what is diff about severe autonomic neurogycopenic but pt is conscious symptoms in terms of tx protocol?
what is BG?
if BG is
tx of unconscious pt w BG of
IV glucose , 25 g
given as 50mL
of D50W over
1-3 minutes
OR
S/C or IM
OR
1 mg glucagon
Wait 10 minutes; retest blood glucose and retreat with either the 25 g of IV glucose given as 50 ml of D50W or 1 mg glucagon if the blood glucose remains less than 4.0 mmoL/L (maximum glucagon injections is 2).
- As soon as possible,
physician must be
informed verbally
(telephone or in person)
4.Document incident of hypoglycemia IV glucose 1 mg glucagon call 911
