Nursing Management Of Type 1 Diabetes: NovoRapid Insulin Administration

Components of a Valid Routine Subcutaneous Insulin Medication Order

Explain the 11 components of a valid routine subcutaneous insulin medication order and why this is important. Support your answer with academic or clinical guideline references.

The components of a medication order include; client’s name, client’s gender, date of birth, medical record number, date of order, name of medication, medication dosage, route of dosage administration, time of administration and frequency of medication administration, signature of the health practitioner (Tierney, McLurg & Macmillan, 2018). The medical order elements are vital to the pharmacy for correct dispensing of medication.

Explain why Ben has been prescribed this medication. Relate to the pathophysiology of type 1 diabetes and the mechanism of action of NovoRapid insulin. Support your answer with academic references.

The work of NovoRapid insulin is to lower blood sugar levels (Russell-Jones et al., 2017). Since Ben’s blood glucose level is too high, that is the reason the medication was prescribed to him. Apart from it reducing the level of blood sugar, it has a rapid onset of action than soluble human or cattle insulin. Also, the impact happens within 10-20 minutes although the utmost impact takes place from 1-3 hours and ends for up to 5 hours (Russell-Jones et al., 2017).

What is the onset, peak and duration of action for NovoRapid insulin according to Bullock and Manias (2017)? Explain when NovoRapid should be administered in relation to food intake and why. Support your answer with academic references.

The onset of NovoRapid insulin is 15 minutes after the administration, the peak is about 1 hour, and the duration of action is 2-4 hours. NovoRapid insulin should be given before a meal such that it takes less than 5-10 minutes to the meal due to its rapid onset of action (Bullock & Manias, 2017). The reason why the medication should be administered before a meal is to manage the blood sugar level after taking food.

Discuss the definition, causes, symptoms and treatment of hypoglycaemia, a common adverse effect of NovoRapid. Support your answer with academic references. (5 marks)

Hypoglycaemia can be defined as the deficiency of glucose in the bloodstream (Cryer, 2016). It can occur when an individual with diabetes takes much of insulin. Several symptoms are associated with hypoglycaemia, and some are increased appetite, frequent urination, feeling tired and excessive thirst (Cryer, 2016). To treat hypoglycaemia, an individual with diabetes should take 15 to 20 grams of rapid-acting carbohydrates that include fruit juice, fizzy drinks and glucose tablets. The terrible impact of NovoRapid is hypoglycaemia.

Why NovoRapid Insulin is Prescribed and Its Mechanism of Action

Discuss the importance of understanding the medication before administration. Support your answer with academic references.

The importance of understanding a medication before it is given is that medical practitioners are assisted in striving to meet any medicine related need of their clients (Sluggett, Ilomäki, Seaman, Corlis & Bell, 2017).

Discuss the 5 rights of medication administration and why it is important for nurses to follow this procedure. Support your answer with academic references.

The five rights of medication administration are the right patient, the right drug, the right dose, the right route and the right time. Nurses have to administer to the right patient by checking his or her name, date of birth and make sure the patient is aware of all the side effects of the medication and understands it (Pirinen et al., 2015). They should also examine the prescription and the expiry date of the medicine to ensure it is the correct medication. However, the right drug should have the correct dosage be administered via checking and confirming the appropriateness of the medication together with using the right route by verifying if the client can take the medication via the prescribed path. Finally, while administering a drug should be done at the right time. Nurses examine the ordered drug frequency, checks whether he or she is delivering at the right time and confirm when the last dose was given (Pirinen et al., 2015). Therefore, it is essential that these rights are followed so that medication errors are reduced.

What is the most appropriate insulin pen needle length for Ben and why? Support your answer with academic references.

The range of insulin pen needle length is 4-12.7 mm, and a pen needle with a broad gauge is preferred for small doses of insulin of 30 units and below (Hirsch, Byron & Gibney, 2014). Ben would be preferred to an insulin pen needle of 5 mm because it is injected in the subcutaneous layer and needs short needles so that it cannot extend to the muscles.

What diabetes-specific nursing assessment would you conduct prior to administration of NovoRapid insulin to Ben and why? Support your answer with academic references.

I would evaluate the patient’s vital signs, blood glucose level, appetite and presence of any symptoms that show that the patient will not be able to take or retain the next meal (Vallerand, 2018). Also, the subcutaneous areas for lipodystrophies and the other regions with potential insulin injection sites will be evaluated together with the knowledge of insulin and insulin administration by the patient. Medication is examined for the expiration date, physical damage and deterioration. The patient will also be assessed for the potential drug or drug interactions, food or drug interactions and drug or drug class allergies (Vallerand, 2018). For Ben, the evaluations are essential to ensure the medication he uses is the right one and for the proper purpose.

Dosage Administration of NovoRapid Insulin

Identify the site and angle you would inject the NovoRapid insulin and explain why this was selected for Ben. Discuss infection control considerations. Support your answer with academic references.

I would inject the NovoRapid insulin into the abdomen at an angle of 90 degrees (Tandon et al., 2015). This site was selected for Ben because the insulin will be absorbed faster and the action will last long. Considerations in infection control are that for those clients transferred from other types of insulin to NovoRapid insulin should be appropriated as directed by the health practitioner. Also, individuals who were initiated on insulin may be similarly started on NovoRapid to if they were on cattle insulin.

What would you document and where? Why is documentation important? Support your answer with academic or clinical guideline references.

What I would document is the medication name, the given dose, route and site for injection, time of administration, initials and signature. This is recorded in category E 10 of ICD-10 which is for type 1 diabetes, and it is essential to help in the treatment of the chronic condition (American Diabetes Association, 2015).

Explain the diabetes specific nursing assessment you would provide for Ben post administration of insulin, when you would provide it and why. Support your answer with academic references.

The post administration assessments provided for Ben are; the evaluation for any unfavourable side impacts, assessment for the effectiveness of the medication, comparing his prior condition with post medication condition and documenting the response of Ben to medication (Vallerand, 2018). The evaluations are conducted after 10-20 minutes of the administration, and it is done to put him on track so that the right procedures can be undertaken to control the disease.

Discuss the daily physical challenges of living with type 1 diabetes that Ben may face. Support your answer with academic references.

Counting carbohydrates is a challenge to Ben because in each food he takes he has to approximate the grams of carbs in it and sum up the total number of carbohydrate grams he takes daily. Also, he has to have enough supply of foods daily that do not increase his blood sugar level and also consider foods that will change his diet (Engström, Leksell, Johansson & Gudbjörnsdottir, 2016). Ben will face difficulties when administering the NovoRapid insulin since he has to buy the insulin and acquire a glucose meter to estimate the glucose concentration in the blood.

Management of Hypoglycaemia

Discuss the potential emotional impacts of living with type 1 diabetes that Ben may face. Support your answer with academic references.

When Ben thinks too hard about his condition, he develops some stress that results in the release of stress hormones hence raising the blood sugar level. In his relationship with his girlfriend, he might experience adverse effects on quality of life of male sexual dysfunction (Jones, Olsen, Perrild & Willaing, 2016). Depression is another psychological effect impacting his mental health making him not to enjoy while doing his daily activities. Furthermore, due to the everyday demands of managing his condition, he will become tired and in the end, ignore the diabetes management.

References

American Diabetes Association. (2015). Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association, 33(2), 97.

Bullock, S. & Manias, E. (2017). Fundamentals of pharmacology. Melbourne, Vic: Pearson Australia.

Cryer, P. E. (2016). Management of hypoglycemia during treatment of diabetes mellitus. UpToDate, Waltham, MA. (Accessed on March 25th, 2014.) Retrieved from https://www. Update. com/contents/management-of-hypoglycemia-during-treatment-of-diabetes-mellitus.

Engström, M. S., Leksell, J., Johansson, U. B., & Gudbjörnsdottir, S. (2016). What is important to you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored Patient-Reported Outcome Measure for the Swedish National Diabetes Register. BMJ Open, 6(3), e010249.

Hirsch, L., Byron, K., & Gibney, M. (2014). Intramuscular risk at insulin injection sites—measurement of the distance from skin to muscle and rationale for shorter-length needles for subcutaneous insulin therapy. Diabetes Technology & Therapeutics, 16(12), 867-873.

Jones, A., Olsen, M. Z., Perrild, H. J., & Willaing, I. (2016). The psychological impact of living with diabetes: descriptive findings from the DAWN2 study in Denmark. Primary care diabetes, 10(1), 83-86.

Pirinen, H., Kauhanen, L., Danielsson-Ojala, R., Lilius, J., Tuominen, I., Díaz Rodríguez, N., & Salanterä, S. (2015). Registered Nurses’ experiences with the medication administration process. Advances in Nursing, 2015.

Russell-Jones, D., Bode, B. W., De Block, C., Franek, E., Heller, S. R., Mathieu, C., … & Graungaard, T. (2017). Fast-acting insulin as part improves glycemic control in basal-bolus treatment for type 1 diabetes: results of a 26-week multicenter, active-controlled, treat-to-target, randomized, parallel-group trial (onset 1). Diabetes Care, dc161771.

Sluggett, J. K., Ilomäki, J., Seaman, K. L., Corlis, M., & Bell, J. S. (2017). Medication management policy, practice and research in Australian residential aged care: current and future directions. Pharmacological research, 116, 20-28.

Tandon, N., Kalra, S., Balhara, Y. P., Baruah, M., Chadha, M., Chandalia, H., … & Mithal, A. (2015). Forum for injection technique (FIT), India: The Indian recommendations 2.0, for best practice in insulin injection technique, 2015. Indian journal of endocrinology and metabolism, 19(3).

Tierney, M., McLurg, D., & Macmillan, C. (2018). Transferring medication order entry from pharmacists to pharmacy technicians. The Canadian Journal of Hospital Pharmacy, 52(4).

Vallerand, A. H. (2018). Davis’s drug guide for nurses. FA Davis.