IV Insulin
How long can you hang a bag of insulin for?
what is 24 hours
These clinical markers indicate DKA, Name two :)
What is:
Blood glucose of greater than 11 mmol/L*
Bicarbonate of less than 18 mmol/L.
Anion Gap of greater that 12 mmol/L.
The anion gap measures the difference—or gap—between the negatively charged and positively charged electrolytes in your blood.
Ketone screen positive.
pH of 7.3 or less.
This protocol is initiated when your blood sugar is less than 4mmol/L.
Bonus: What are the parameters for mild-moderate and severe blood sugars
What is the hypoglycemia initial emergency treatment (adult) decision support tool
Bonus: mild to moderate 2.8-3.9
severe: <2.9
In this condition the body cannot properly use the insulin it makes.
What is Type 2 Diabetes - The body cannot properly use the insulin it makes as a result blood sugar is higher than normal.
Do you need a Doctors order for a DNE referral?
Bonus: how do you do a DNE referral?
No
Bonus: Phone the phone number on the GAL and leave a detailed message or complete an order through powerchart
You'll find our unit stock pre mixed insulin bags here: _____
What is the medication fridge
These are the two phases of DKA treatment
What are:
Phase 1 - Initial 3 bag infusion
Phase 2 - transition to subcutaneous insulin
You have a DYSPHAGIC patient who is able to swallow has a blood sugar of 2.0. Using the hypoglycemic protocol what SPECIFICALLY should be administered?
What is give 20 g fast-acting carbohydrate:
e.g. for dysphagic patients 2 packages of honey or 1 tube of glucose gel
You know your diabetic patient's glycemic control is sufficent/healthy when their blood sugar is within this range.
What is between 4-7 mmol/L
Increased thirst, Nausea/Vomiting, Abdominal Pain, and confusion are symptoms of what medical emergency?
What is Diabetic Ketoacidosis
This needs to be done when the insulin rate needs to be decreased to less than 0.5 unit/h
Stop infusion
Recheck bedside blood glucose Q2H
Once blood glucose is 6mmol/L or greater resume insulin infusion at previous rate or at 1 unit/h, whichever is lower
These three infusions are used in phase 1 of DKA
What are:
1. Crystalloid fluid - to restore fluids
2. Insulin - to treat the acidosis
3. Dextrose (D10W) - to prevent hypoglycemia
You have a patient who is NPO and has pulled out their enteral tube and IV and their OT is 2.8. These nursing actions should be taken as per the hypoglycemic protocol.
What is you may attempt to insert an IV for no more than 2 mins and give IV dextrose 50% 12.5g/25ml (1/2 a pre-filled syringe)
OR
give glucagon 3 mg intranasal (1push/dose)
**glucagon may cause vomiting**
OR
1mg glucagon IM/SC (1 unit dose syringe)
This lab value measures how much glucose has adhered to RBCs and the average blood glucose for the previous 3 months.
What is hemoglobin A1C.
This body part should never be neglected during head to toe assessments of your diabetic patients
What is check their feet.
Diabetic patients are at a high risk of feet infections/amputations. Always take off their socks!
This nursing action needs to be done for the IV insulin if your patients TPN or tube feed has been stopped for greater than 1 hour
What is notify the MRP ordering insulin for further orders
This nursing action can be taken when the potassium is greater than 3.3 in DKA
What is start the insulin infusion
Patient is NPO and on TPN with a blood sugar of 1.9 and have IV access.
What do we give and for over how many mins?
BONUS: When do we check the next BG?
give IV dextrose 50% 12.5g/25ml (1/2 a pre-filled syringe) X2 over 1-3 mins
BONUS: Re check in 15 mins
Work through the rest:
Next BG is 2.3
Check BG again and BG is 2.9
Notify MRP urgently
Medication safety suggests insulin pens are not to be shared among patients for this reason.
What is increased risk of blood backflow into the pen during injection.
These are 3 preferred areas to teach a patient to self inject insulin into.
What are abdomen, thigh, buttocks
This IV infusion should be started if you get blood back flowing up the IV during the insulin administration
What is: phone the MRP and receive and order for a driver fluid
Connect to the Y site as close to the patient as possible
Ensure drive fluid is compatible with insulin
Required rate depends on vessel size, IV gauge, etc. recommended rate is 10-20ml//hr
You'll know that acidosis has resolved when this happens...
What is anion gap is less than 11mmol/L and bicarbonate is greater than 18 mmol/L
Your patient has an established Tube feed with blood glucose 3.0. What nursing actions should be taken? What should SPECIFICALLY be given?
Bonus: BG 6.2 after 15min and the next tube feed is more than an hour away. What should you do now?
What is give 15G of fast acting carbohydrate
(Admin 150-170mls apple juice and flush with water pre/post)
Bonus: Ensure the MRP is notified. Collaborate with MRP, dietician & Pharmacist to identify cause(s) of hypoglycemic event, implement a nutritional plan, and re-evaluate medications
Give protein and carbohydrate (due to the feed being more than an hour away we would need to discuss with the MRP and check BG after 1 hour
This is device allows patients to monitor blood glucose levels and independently administer continuous subcutaneous insulin infusions.
Bonus: What do these patients need when they're a patient in the hospital?
What is an insulin pump.
Bonus: Insulin pump order set
Patient or caregiver eligibility criteria
patient handout to self-manage insulin
insulin and glucose log sheet
Lipohypertrophy (raised, red, hard areas on the skin) can be avoided by doing this when injecting insulin.
What is rotating injection sites