NURS 1566 Clinical Form 3: Clinical Medications Worksheets

(You will need to make additional copies of these forms)

Generic Name Trade Name Classification Dose Route Time/frequency

regular insulin Humulin R, antidiabetics 125 units IVPB Infuse per physician’s
Novolin R order, change daily at
1200
Peak Onset Duration Normal dosage range
2-4 hr 30-60 min 5-7 hr Dose depends on blood glucose, response, and many other
factors. 0.1 unit/kg/hr as a continuous infusion. Rate should
be ordered by physician, and infusion placed on an IV pump for
accurate administration.
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or solutions
Diabetes mellitus Medication errors involving insulins have resulted in serious
patient harm and death. Clarify all ambiguous orders and do
not accept orders using the abbreviation "u" for units, which
can be misread as a zero or the numeral 4 and has resulted in
tenfold overdoses. Insulins are available in different types
and strengths and from different species. Check type, species
source, dose, and expiration date with another licensed nurse.
Do not interchange insulins without consulting physician or
other health care professional. Do not confuse regular
concentrated (U-500) insulin with regular insulin. Regular
insulin is the only insulin that can be administered IV. Do not
use if cloudy, discolored, or unusually viscous. Do not
administer regular (concentrated) insulin U-500 IV. May be
diluted in commonly used IV solutions as an infusion;
however, insulin potency may be reduced by at least 20-80%
by the plastic or glass container or tubing before reaching the
venous system.
Y-Site Compatibility: amiodarone, ampicillin, ampicillin-
sulbactam, aztreonam, cefazolin, cefotetan, dobutamine,
esmolol, famotadine, gentamicin, heparin, imipenem-
cilastatin, indomethacin, magnesium sulfate, meperidine,
meropenem, midazolam, milrinone, morphine, nitroglycerin,
nitroprusside, oxytocin, potassium chloride, propofol,
ritodrine, sodium bicarbonate, tacrolimus, terbutaline,
ticarcillin, ticarcillin/clavulanate, tobramycin, vancomycin,
vitamin B complex with C.
Y-Site Incompatibility: dopamine, nafcillin, norepinephrine,
ranitidine.
Additivie Compatibility: May be added to total parenteral
nutrition (TPN) solutions.
Mechanism of action and indications
(Why med ordered)
Lower blood glucose by increasing transport into
cells and promoting the conversion of glucose to
glycogen. Promote the conversion of amino acids
to proteins in muscle and stimulate triglyceride
formation. Inhibit the release of free fatty acids.
Interactions with other patient drugs, OTC or
herbal medicines (ask patient specifically)
Beta blockers may block some of the signs and
symptoms of hypoglycemia and delay recovery
from hypoglycemia (Lopressor). Chronic use of
alcohol may increase insulin requirements. Acute
use of alcohol and beta blockers (nonselective)
may decrease insulin requirements.
Nursing Process- Assessment Assessment
(Pre-administration assessment) Why would you hold or not give this
Blood sugar monitoring. Assess for signs med?
and symptoms of hypoglycemia (anxiety; Hypoglycemia
chills; cold sweats; confusion; cool, pale
skin; difficulty in concentration;
drowsiness; excessive hunger; headache;
irritability; nausea; nervousness; rapid
Nursing Implications (what to focus on)
Contraindications/warnings/interactions
Allergy or hypersensitivity to a particular type of insulin,
preservatives, or other additives, Stress,
infection (temporarily increase insulin requirements).
Common side effects
Lipodystrophy, HYPOGLYCEMIA.
Lab value alterations caused by medicine
May cause ↓ serum inorganic phosphate, magnesium, and
potassium levels.
Be sure to teach the patient the following about this
medication
Instruct patient on proper technique for administration.
Include type of insulin, equipment (syringe, cartridge pens,
external pumps, alcohol swabs), storage, and place to discard
syringes. Discuss the importance of not changing brands of
insulin or syringes, selection and rotation of injection sites,
and compliance with therapeutic regimen
Explain to patient that this medication controls
hyperglycemia but does not cure diabetes. Therapy is long
term. Emphasize the importance of compliance with
nutritional guidelines and regular exercise as directed by
health care professional. Advise patient to notify health care
professional of medication regimen prior to treatment or
surgery. Advise patient to notify health care professional if
nausea, vomiting, or fever develops, if unable to eat regular
diet, or if blood glucose levels are not controlled. Instruct
patient on signs and symptoms of hypoglycemia and
hyperglycemia and what to do if they occur. Patients with
diabetes mellitus should carry a source of sugar (candy, sugar
packets) and identification describing their disease and
treatment regimen at all times. Emphasize the importance of
regular follow-up, especially during first few weeks of
therapy.
Evaluation
Check after giving
Control of blood glucose
levels without the
appearance of hypoglycemic
or hyperglycemic episodes.
pulse; shakiness; unusual tiredness or
weakness) and hyperglycemia
(drowsiness; flushed, dry skin; fruit-like
breath odor; frequent urination; loss of
appetite; tiredness; unusual thirst)
periodically during therapy. Monitor body
weight periodically. Changes in weight
may necessitate changes in insulin dose.