Transcript ADDITIONAL SLIDES FOR ASSIST WITH STUDYING

ADDITIONAL SLIDES FOR ASSIST
WITH COMPREHENSION OF LAB
CONTENT-MODULE FIVE-DM
DENISE TURNER, MS-N.ED, RN, CCRN
DIABETES MELLITUS (CONT’D)
• SIGNS AND SYMPTOMS
• ELEVATED FASTING BLOOD GLUCOSE (HIGHER THAN 126 MG/DL) OR A HEMOGLOBIN
A1C (A1C) LEVEL GREATER THAN OR EQUAL TO 6.5% 515
• POLYURIA
• POLYDIPSIA
• POLYPHAGIA
• GLYCOSURIA
• UNEXPLAINED WEIGHT LOSS
• FATIGUE
• BLURRED VISION
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TREATMENT FOR DM
• TYPE 1
• INSULIN THERAPY
• TYPE 2
• LIFESTYLE CHANGES
• ORAL DRUG THERAPY
• INSULIN WHEN THE ABOVE NO LONGER PROVIDE GLYCEMIC CONTROL
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TYPES OF ANTIDIABETIC DRUGS
• INSULINS
• ORAL HYPOGLYCEMIC DRUGS
• BOTH AIM TO PRODUCE NORMAL BLOOD GLUCOSE STATES
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INSULINS
• FUNCTION AS A SUBSTITUTE FOR THE ENDOGENOUS HORMONE
• EFFECTS ARE THE SAME AS NORMAL ENDOGENOUS INSULIN
• RESTORES THE DIABETIC PATIENT’S ABILITY TO:
• METABOLIZE CARBOHYDRATES, FATS, AND PROTEINS
• STORE GLUCOSE IN THE LIVER
• CONVERT GLYCOGEN TO FAT STORES
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INSULINS (CONT’D)
• HUMAN INSULIN
• DERIVED USING RECOMBINANT DNA TECHNOLOGIES
• RECOMBINANT INSULIN PRODUCED BY BACTERIA AND YEAST
• GOAL: TIGHT GLUCOSE CONTROL
• TO REDUCE THE INCIDENCE OF LONG-TERM COMPLICATIONS
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INSULINS (CONT’D)
• RAPID-ACTING
• MOST RAPID ONSET OF ACTION (5 TO 15 MINUTES)
• SHORTER DURATION
• PATIENT MUST EAT A MEAL AFTER INJECTION
• INSULIN LISPRO (HUMALOG)
• SIMILAR ACTION TO ENDOGENOUS INSULIN
• INSULIN ASPART (NOVOLOG)
• INSULIN GLULISINE (APIDRA)
• MAY BE GIVEN SUBCUTANEOUSLY OR VIA CONTINUOUS SUBCUTANEOUS INFUSION
PUMP (BUT NOT IV)
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INSULINS (CONT’D)
• SHORT-ACTING
• REGULAR INSULIN (HUMULIN R)
• ONSET 30 TO 60 MINUTES
• THE ONLY INSULIN PRODUCT THAT CAN BE GIVEN BY IV BOLUS,
IV INFUSION, OR EVEN IM
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INSULINS (CONT’D)
• INTERMEDIATE-ACTING
• INSULIN ISOPHANE SUSPENSION (ALSO CALLED NPH)
• CLOUDY APPEARANCE
• SLOWER IN ONSET AND MORE PROLONGED IN DURATION THAN ENDOGENOUS INSULIN
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INSULINS (CONT’D)
• LONG-ACTING
• GLARGINE (LANTUS), DETEMIR (LEVEMIR)
• CLEAR, COLORLESS SOLUTION
• USUALLY DOSED ONCE DAILY
• REFERRED TO AS BASAL INSULIN
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SLIDING-SCALE INSULIN DOSING
• SUBCUTANEOUS SHORT-ACTING OR REGULAR INSULIN
DOSES ADJUSTED ACCORDING TO BLOOD GLUCOSE TEST
RESULTS
• TYPICALLY USED IN HOSPITALIZED DIABETIC PATIENTS OR
THOSE ON TOTAL PARENTERAL NUTRITION (TPN) OR ENTERAL
TUBE FEEDINGS
• SUBCUTANEOUS INSULIN IS ORDERED IN AN AMOUNT THAT
INCREASES AS THE BLOOD GLUCOSE INCREASES
• DISADVANTAGE: DELAYS INSULIN ADMINISTRATION UNTIL
HYPERGLYCEMIA OCCURS; RESULTS IN LARGE SWINGS IN
GLUCOSE CONTROL
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GLUCOSE-ELEVATING DRUGS
• ORAL FORMS OF CONCENTRATED GLUCOSE
• BUCCAL TABLETS, SEMISOLID GEL
• 50% DEXTROSE IN WATER (D50W)
• GLUCAGON
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NURSING IMPLICATIONS (CONT’D)
• WHEN INSULIN IS ORDERED, ENSURE:
• CORRECT ROUTE
• CORRECT TYPE OF INSULIN
• TIMING OF THE DOSE
• CORRECT DOSAGE
• INSULIN ORDER AND PREPARED DOSAGES ARE SECOND-CHECKED WITH
ANOTHER NURSE
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NURSING IMPLICATIONS (CONT’D)
• INSULIN
• CHECK BLOOD GLUCOSE LEVEL BEFORE GIVING INSULIN
• ROLL VIALS BETWEEN HANDS INSTEAD OF SHAKING THEM TO MIX
SUSPENSIONS
• ENSURE CORRECT STORAGE OF INSULIN VIALS
• ONLY USE INSULIN SYRINGES, CALIBRATED IN UNITS, TO MEASURE AND GIVE
INSULIN
• ENSURE CORRECT TIMING OF INSULIN DOSE WITH MEALS
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NURSING IMPLICATIONS (CONT’D)
• INSULIN (CONT’D)
• WHEN DRAWING UP TWO TYPES OF INSULIN IN ONE SYRINGE, ALWAYS
WITHDRAW THE REGULAR OR RAPID-ACTING INSULIN FIRST (CLEAR)
• PROVIDE THOROUGH PATIENT EDUCATION REGARDING SELF-ADMINISTRATION
OF INSULIN INJECTIONS, INCLUDING TIMING OF DOSES, MONITORING BLOOD
GLUCOSE LEVELS, AND INJECTION SITE ROTATIONS
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