Unit 12: Nursing care of clients with endocrine disorders
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| Insulin Regimens for type 1 DM: types of insulin | Rapid, short, intermediate & long-acting
-Given 1 or more x a day based on glucose results
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| Other ways to administer insulin? | Pump (con't), pens
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| Rapid acting insulin: (Pg. 915) | Lispro insulin (Humalog), Aspart insulin (Novolog), Glulisine insulin (Apidra)
-Administer before meals
-Onset is rapid: 10-30 mins (<15)
-Administer in conjunction w intermediate or long-acting insulins = glycemic control between meals & at nights
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| Short acting insulin: | Regular insulin (Humulin R, Novolin R)
-Administer 30-60 min before meals
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| Short-acting insulin is available in 2 concentrations: U-500 U-100 | U-500; for complete insulin resistance, NEVER administered IV
U-100; for most clients; can be given IV
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| Intermediate-acting Insulin: | NPH insulin (Humulin N), detemir insulin (Levemir)
-For glycemic control between meals & at nights
NOT administered before meals
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| Intermediate-acting insulin contains ____ ? | Protamine (a protein), causes a delay in the insulin absorption or onset and extends the duration of action of the insulin
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| How is NPH insulin administered? | SUB Q
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| What is the only insulin that can mix w short-acting insulin? | NPH insulin (Humulin N) .. immediate-acting insulin
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| How is determir insulin (Levemir) administered? | SUB Q
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| Can you mix determir insulin (Levemir) with other insulin? | No
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| Long-acting insulin: | Glargine insulin (Lantus)
Peak-less, trough-less
Administered once daily, anytime during the day but always at same time
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| How does Lantus work? | Microprecipitates; dissolves slowly over 24 hours & maintains a steady blood sugar level
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| How is lantus administered? | SUB q, never IV
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| At what angle do you inject insulin? | 90 degree; 45 if thin
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| When mixing a rapid or short-acting insulin w a longer-acting insulin which one do you draw up first? | Draw up the shorter-acting insulin first (regular) & then the longer-acting insulin
-reduces risk of introducing the longer acting insulin into the short-acting vial
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| S/S of hypoglycemia: | Mild shakiness, mental confusion, sweating, palpitations, headache, lack of coordination, blurred vision, seizures & coma
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| How can you avoid hypoglycemia: | Avoid excess insulin, extreme exercise, alcohol on an empty stomach
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| Hypoglycemia level? | 70 or less
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| What should we give a hypoglycemic client? | 15-20g of a readily absorbable carb (4-6oz of fruit juice or regular soft drink, 3-4 glucose tablets, 8-10 hard candies, or 1 tbsp of honey)
-recheck glucose in 15 min
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| If carbs are given and still not in NL? | Give 15-20 more and recheck in 15
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| How much does BG increase over 30 mins following ingestion of 10g of carbs? | 40mg/dl
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| What if hypoglycemic patient is unconscious or unable to swallow? | Administer glucagon subq or IM (repeat if 10 minutes) & notify provider
-In acute care, nurse gives IV 50% dextrose, conscious in 20
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| S/S of hyperglycemia? | Hot, dry skin, fruity breath
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| If pt is hyperglycemic? fluids, insulin, BG, urine | oral fluid/nonsugary prevent dehydration, administer insulin, restrict exercise w BG >250, test urine for ketones
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| Oral hypoglycemics: 1. Metformin HCI (Glucophage) action- | Reduces production of glucose by the liver (gluconeogenesis)
-Increases tissue sensitivity of insulin
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| S/e of metformin? | (Glucophage)
-GI effects (gas, anorexia, nausea/vomit), lactic acidosis
* stop med for 48hr before radio test w iodinated contrast dye
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| Education on metformin? food? supplements? pregnancy? crush or chew? | Take w food, take vit b & folic acid supplements
can take during pregnancy
never crush or chew med
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| What are.. Glipizide (Glucotrol), Glimepiride (Amaryl), Glyburide (Diabeta, glynase prestab) | Second-generation sulfonlyureas
-Stimulate insulin release from the pancreas = decrease in BG levels
-increase tissue sensitivity to insulin
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| S/e of second generation sulfonylureas (oral anti diabetics) | Monitor for hypoglycemia
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| Education for second generation? | Administer 30 mins before a meal
-avoid alcohol
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| What is lipohypertrophy? and lipoatrophy? and how can you prevent it? | Increased swelling of fat
Loss of fat tissue
-Rotate injection sites within one anatomic site; prevents day to day changes in absorption rate
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| Foot care: -wash feet how often and with what? -how do you dry & what to avoid | Daily w mild soap & warm water (test w hands)
-Pat dry, especially in-between the toes, avoid lotions between toes
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| What should you use on sweaty feet? Should you use commercial remedies for callouses & corns? | Mild foot powder (w cornstarch)
NO
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| When is the best time to perform nail care? How should you separate overlapping toes? | After a bath/shower when toenails are soft & easier to trim
w cotton & lamb wool
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| Avoid what kind of shoes? | Open-toe, open-heal, slippers w/o souls, plastic shoes
NO barefoot
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| What kind of stockings? Heating pads okay? | Clean, absorbent stockings, cotton/wool (better absorption)
NO, wear socks for warmth
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| Should you avoid prolonged sitting, standing or crossing legs? | Yes
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| Nail cutting recommendations or filing? | Straight across
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| Nutritional guidelines: (Pg.920) | Meals should be similar each day; eat at regular intervals, don't skip meals
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| Why include fiber in the diet? | To increase carb metabolism & to help control cholesterol levels
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| What kind of sweeteners should you use? Keep saturated fats w/in __ % of caloric intake | Artificial
7
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| When sick.. monitor BG q __ hrs Consume what for fluids & how often? What kind of carbs? | 3-4
4oz of sugar-free, non caffeinated liquid q30min to prevent dehydration
Softer carbs recommended 6-8x/day
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| Call provider during sick days if; BG >___ ketones Fever >__ | 240, test for ketones
fever= >101.5 (38.6), doesn't respond to tylenol or lasts >24hrs
disoriented, confused, rapid breathing, vomit/diarrhea, illness >2 days
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