Insulin administration is a crucial component of managing diabetes, particularly in patients with new onset DM and hyperglycemia. In this case study, we are dealing with Mr. Eduardo Alvarez, a 64-year-old male admitted to the hospital with new onset DM and a blood glucose level of 800 in the Emergency Department. Mr. Alvarez is experiencing symptoms of lethargy and dehydration. His past medical history includes hypertension (HTN), and he has not seen a doctor in the past year. Mr. Alvarez reports gaining 50 pounds in the past six months and feeling fatigued. He also complains of frequent urination in large amounts, drinking a quart of orange juice per week, and consuming 3-4 cans of Dr. Pepper daily. Mr. Alvarez is a non-smoker, married, works 8-10 hours a day, and attends business school three nights a week.
The provider has discontinued the insulin gtt and ordered a new insulin regimen for Mr. Alvarez. The order reads NPH 30 units and Humalog insulin 6 units every 12 hours. Accuchecks are to be done four times a day before meals and at bedtime. Mr. Alvarez’s vital signs and laboratory values are within normal range.
As the nurse assigned to Mr. Alvarez on the day shift, your role is to ensure the safe and accurate administration of insulin. Let’s go through the steps needed to administer NPH and Humalog insulin as per the order.
1. Gather the necessary equipment: To administer insulin, you will need insulin syringes, alcohol swabs, and a sharps container. Ensure that the insulin syringe is appropriate for the dose ordered.
2. Perform hand hygiene: Before administering any medication, it is essential to perform hand hygiene to prevent the spread of infection.
3. Identify the patient: Verify the patient’s identity using two unique identifiers, such as their name and date of birth. This step is crucial to ensure that you are administering the medication to the correct patient.
4. Explain the procedure to the patient: Before administering insulin, inform Mr. Alvarez about the medication, its purpose, and potential side effects. Address any concerns or questions he may have.
5. Prepare the NPH insulin: NPH insulin should be gently rolled between the palms to ensure uniform mixing of the suspension. Check the expiration date and appearance of the insulin. Insulin should be clear and free from particles or discoloration. Using an insulin syringe, draw up 30 units of NPH insulin.
6. Prepare the Humalog insulin: As with the NPH insulin, gently roll the Humalog vial between the palms to mix the solution. Check the expiration date and appearance of the insulin. Insulin should be clear and free from particles or discoloration. Using a separate insulin syringe, draw up 6 units of Humalog insulin.
7. Administering the insulin: Choose an appropriate injection site, such as the abdomen, thigh, or upper arm. Cleanse the skin with an alcohol swab and allow it to dry. Pinch about an inch of skin at the chosen site, insert the needle into a 90-degree angle, and inject the NPH insulin. Repeat the same procedure with the Humalog insulin, using a different injection site.
8. Discard the used syringes and needles: Immediately after administration, dispose of the used syringes and needles in a sharps container following appropriate safe disposal protocols.
9. Document the insulin administration: Record the administration of NPH and Humalog insulin in Mr. Alvarez’s medication administration record (MAR). Include the date, time, dosage, injection site, and any relevant observations.
10. Monitor blood glucose levels: Perform Accuchecks as ordered, four times a day before meals and at bedtime. Document the blood glucose readings and report any significant findings to the healthcare provider.
In summary, the administration of NPH and Humalog insulin plays a crucial role in managing hyperglycemia in patients with new onset DM. As Mr. Alvarez’s nurse, it is vital to follow the steps outlined above to ensure safe and accurate administration of insulin. Regular monitoring of blood glucose levels will help evaluate the effectiveness of the insulin regimen and guide further management.