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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


insulin aspart NovoLog antidiabetics, 0.5 units / SQ Immediately following
hormones 15 g ingestion of
carbohydrat carbohydrates.
es
Peak Onset Duration Normal dosage range
1-3 hours Rapid 3-5 hrs Determined by needs of the patients; generally 0.5-1
units/kg/day.
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or
Diabetes mellitus solutions
N/A (Administer insulin aspart subcut in the abdominal
wall, thigh, or upper arm within 5-10 min before a meal.
Rotate injection sites. Do not administer IV).
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
Lowers blood glucose by stimulating glucose uptake Allergy or hypersensitivity to insulin
in skeletal muscle and fat and inhibiting hepatic aspart.
glucose production. Insulin also inhibits lipolysis
and proteolysis and enhances protein synthesis. A Use Cautiously in:
rapid-acting insulin with more rapid onset and Stress, and infection (temporarily increase insulin
shorter duration than human regular insulin; should requirements).
be used with an intermediate- or long-acting insulin. Common side effects
Lipodystrophy, HYPOGLYCEMIA, ALLERGIC
REACTIONS INCLUDING ANAPHYLAXIS.
Interactions with other patient drugs, OTC or Lab value alterations caused by medicine
herbal medicines (ask patient specifically) Monitor blood glucose and ketones every 6 hr during
Beta blockers may block some of the signs and therapy, more frequently in ketoacidosis and times of
symptoms of hypoglycemia and delay recovery from stress. Glycosylated hemoglobin may also be monitored to
hypoglycemia (Lopressor). Alcohol may ↓ insulin determine effectiveness.
requirements. 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,
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. Demonstrate
technique for mixing insulins by drawing up insulin aspart
first and rolling intermediate-acting insulin vial between
palms to mix, rather than shaking (may cause inaccurate
dose). Explain to patient that this medication controls
hyperglycemia but does not cure diabetes. Therapy is long
term. Instruct patient in proper testing of serum glucose
and ketones. These tests should be closely monitored
during periods of stress or illness and health care
professional notified of significant changes. Emphasize the
importance of compliance with nutritional guidelines and
regular exercise as directed by health care professional.
Advise patient to consult health care professional prior to
using alcohol or other Rx, OTC, or herbal products
concurrently with insulin. 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 sugar levels are not
controlled. Instruct patient on signs and symptoms of
hypoglycemia and hyperglycemia and what to do if they
occur. Advise patient to notify health care professional if
pregnancy is planned or suspected. 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.
Nursing Process- Assessment Assessment Evaluation
(Pre-administration assessment) Why would you hold or not give this Check after giving
Assess patient periodically for symptoms med? Control of blood glucose
of hypoglycemia (anxiety; restlessness; Overdose is manifested by symptoms levels without the
mood changes; tingling in hands, feet, of hypoglycemia. Mild hypoglycemia appearance of hypoglycemic
lips, or tongue; chills; cold sweats; may be treated by ingestion of oral or hyperglycemic episodes.
confusion; cool, pale skin; difficulty in glucose. Severe hypoglycemia is a
concentration; drowsiness; excessive life-threatening emergency; treatment
hunger; headache; irritability; nausea; consists of IV glucose, glucagon, or
nervousness; rapid pulse; shakiness; epinephrine. Blood glucose < 150
unusual tiredness or weakness) and mg/dL and >60 mg/dL. Medication
hyperglycemia (confusion, drowsiness; errors involving insulins have resulted
flushed, dry skin; fruit-like breath odor; in serious patient harm and death.
rapid, deep breathing, frequent urination; Clarify all ambiguous orders and do
loss of appetite; tiredness; unusual thirst) not accept orders using the
during therapy. Monitor body weight abbreviation "u" for units, which can
periodically. Changes in weight may be misread as a zero or the numeral 4
necessitate changes in insulin dose. 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.