Insulin case studies

Insulin case studies

NUR 311

A patient receives 4 units of regular insulin SQ at 0800.     

Multiple Choice

What time will the regular insulin PEAK?

• 0815

• 1000

• 1200

• 1400

Fill in the Blank

The patient is also ordered glargine (Lantus) at 0900. Can you mix the two and administer them at 0830? Why or why not?

Multiple Choice

What is the benefit of giving the regular insulin at 0800 if the breakfast tray arrives at 0830?

• Insulin will be at peak levels when breakfast arrives

• Insulin begins taking effect as breakfast arrives

• Insulin's effect will be over once breakfast arrives

• Insulin should not be given until breakfast arrives

Multiple Choice

The patient is ordered regular insulin (Humulin R), 3 units SQ at 0800 and 1200. Also ordered is NPH 15 units at 0800. What time will the REGULAR insulin reach peak effect?

• 0900

• 1000

• 1200

• 1600

Multiple Choice

The patient is ordered regular insulin (Humulin R), 3 units SQ at 0800 and 1200. Also ordered is NPH 15 units at 0800. What time will the NPH insulin reach peak effect?

• 1200

• 1400

• 1600

• 1800

Fill in the Blank

Why are two different insulins being ordered for the patient?

Multiple Choice

The Humulin Regular Insulin and NPH insulin __________________ (can/cannot) be mixed and administered together.

• CAN

• CANNOT

Multiple Choice

How are these insulins properly drawn into the syringe?

• Regular first, then NPH

• NPH first, then Regular

Discuss the appearance of these two insulins

Clear to Cloudy!

Fill in the Blank

The patient is ordered insulin Lispro 5 units SQ with breakfast (0800), lunch(1200) and dinner (1700).

What is the benefit of giving the insulin at all of these times?

From American Association of Diabetes Educators (2017)

Fill in the Blank

The patient is also ordered glargine daily at 0900.

Why is the glargine given?

Multiple Choice

The patient asks why he does not need a snack ½ hour after the glargine is administered. How should the nurse respond?

• Glargine does not reach peak levels until 4 hours later.

• You do not need a snack as long as you eat lunch.

• The onset for Glargine is one hour and it remains consistent.

• If you would like a snack you can certainly have one.

Multiple Choice

The client is ordered rapid-acting lispro SQ at 0800 and 1200. The client is also ordered a dose of NPH to be given at 0800.

What time will the 0800 dose of lispro PEAK? ____

• 0900

• 1200

• 1400

• 1600

Multiple Choice

NPH is also administered at 0800. When will the NPH insulin peak?

• 0900

• 1200

• 1400

• 1600

Multiple Choice

The patient is ordered lispro and NPH SQ at 0800 and lispro again at 1200.

When the NPH is peaking, is the FIRST dose of lispro still exerting an effect on the blood sugar?

• Yes

• No

Regular vs. NPH vs. Glargine

Onset?

Peak?

Duration?

Formulation

Mixing

What if the patient is NPO?

Memorize: Onset, Peak, Duration

Multiple Choice

If the patient receives lispro again tomorrow at 0800, will today’s glargine still be exerting an effect on the blood sugar?

• Yes

• No

The patient is ordered regular insulin SQ at breakfast (0800), lunch (1200) and dinner (1700).  The patient is also ordered a dose of NPH at bedtime (2200).  

Multiple Choice

If the blood glucose is 205, how much insulin will the nurse give? ___ units

• 1 units

• 2 units

• 3 units

• 4 units

Multiple Select

Why are the three doses of regular insulin given with meals? Select all that apply.

• Insulin needs to be given every time that the patient eats.

• Insulin must be injected in three different locations.

• Insulin works in response to the carbohydrates eaten at meals.

• Giving insulin with meals reduces risk of GI upset.

• The risk of hypoglycemia is increased when given with meals.

Fill in the Blank

After the 0800 dose of regular insulin, what time will the patient be at HIGHEST risk for hypoglycemia? {enter time only, i.e. 0800}

Multiple Choice

The patient is ordered regular insulin SQ at breakfast (0800), lunch (1200) and dinner (1700). The patient is also ordered a dose of NPH at bedtime (2200).

What time will the NPH be peaking?

• 0200

• 0400

• 0600

• 0800

Multiple Choice

If the blood glucose is 300, how mauch insulin will the nurse give? ___ units

• 2 units

• 4 units

• 5 units

• recheck before giving any units

Fill in the Blank

BONUS: What is the antidote for insulin?

(What would you administer in response to a hypoglycemic crisis)

information from the American Diabetes Association (diabetes.org)