Podcast
Questions and Answers
Why is it important for the nurse to review the client's medical record prior to administering insulin?
Why is it important for the nurse to review the client's medical record prior to administering insulin?
- To schedule the client's next doctor's appointment.
- To identify potential allergies and conditions that may affect the technique or results. (correct)
- To ensure the client is aware of the cost of the insulin.
- To determine the client's preferred insulin brand.
What is the primary rationale for performing hand hygiene before preparing and administering insulin?
What is the primary rationale for performing hand hygiene before preparing and administering insulin?
- To reduce the client's anxiety.
- To decrease the risk of infection transmission. (correct)
- To improve the nurse-client relationship.
- To comply with facility policy.
Why is it important to use two unique identifiers before administering insulin?
Why is it important to use two unique identifiers before administering insulin?
- To ensure the client's insurance will cover the cost of the insulin.
- To update the client's contact information.
- To verify that the correct procedure is performed on the right client. (correct)
- To document the number of visitors the client has had.
What is the purpose of gently rolling a vial of NPH insulin before drawing up the medication?
What is the purpose of gently rolling a vial of NPH insulin before drawing up the medication?
Why does the nurse inject air into the insulin vial before withdrawing the medication?
Why does the nurse inject air into the insulin vial before withdrawing the medication?
When mixing two types of insulin in one syringe, why should the nurse draw up the unmodified (clear) insulin first?
When mixing two types of insulin in one syringe, why should the nurse draw up the unmodified (clear) insulin first?
What is the primary reason for verifying the dose of insulin with another nurse before administration?
What is the primary reason for verifying the dose of insulin with another nurse before administration?
Why is it important to label multidose insulin vials with the date and time they were opened?
Why is it important to label multidose insulin vials with the date and time they were opened?
What action should the nurse take after drawing up the modified insulin into the syringe containing unmodified insulin?
What action should the nurse take after drawing up the modified insulin into the syringe containing unmodified insulin?
What is the purpose of using the one-handed scoop method when recapping a needle?
What is the purpose of using the one-handed scoop method when recapping a needle?
An RN delegates the task of checking blood glucose levels to assistive personnel (AP). Which additional task related to insulin administration can the RN delegate to the AP?
An RN delegates the task of checking blood glucose levels to assistive personnel (AP). Which additional task related to insulin administration can the RN delegate to the AP?
A client questions why both air and insulin need to be drawn into the syringe, stating, 'Isn't that too much liquid?' What is the best response?
A client questions why both air and insulin need to be drawn into the syringe, stating, 'Isn't that too much liquid?' What is the best response?
The nurse is preparing to administer insulin to a client with a known latex allergy. What immediate action should the nurse take after reviewing the client's medical record?
The nurse is preparing to administer insulin to a client with a known latex allergy. What immediate action should the nurse take after reviewing the client's medical record?
A nurse is interrupted during the process of drawing up insulin but remembers having already injected air into both vials. What is the most appropriate next step?
A nurse is interrupted during the process of drawing up insulin but remembers having already injected air into both vials. What is the most appropriate next step?
What is the priority nursing intervention prior to insulin administration?
What is the priority nursing intervention prior to insulin administration?
The nurse notes that the client's prescribed insulin dose is unusually high, significantly different from the previous days. What is the most appropriate initial action?
The nurse notes that the client's prescribed insulin dose is unusually high, significantly different from the previous days. What is the most appropriate initial action?
A client receiving insulin reports feeling anxious about potential side effects. What is the most appropriate nursing response?
A client receiving insulin reports feeling anxious about potential side effects. What is the most appropriate nursing response?
What does the term 'range of function' mean in the context of delegating tasks to assistive personnel (AP)?
What does the term 'range of function' mean in the context of delegating tasks to assistive personnel (AP)?
Prior to administering insulin, the nurse assesses the client's skin for signs of lipohypertrophy. What is the significance of this assessment?
Prior to administering insulin, the nurse assesses the client's skin for signs of lipohypertrophy. What is the significance of this assessment?
A nurse administered the wrong dose of insulin to a client. After ensuring the client's safety, what is the next essential action?
A nurse administered the wrong dose of insulin to a client. After ensuring the client's safety, what is the next essential action?
While preparing an insulin injection, the nurse accidentally touches the needle to the counter. What is the appropriate course of action?
While preparing an insulin injection, the nurse accidentally touches the needle to the counter. What is the appropriate course of action?
A patient states they prefer to have their insulin injection in their arm rather than their abdomen. What is the nurse's best response?
A patient states they prefer to have their insulin injection in their arm rather than their abdomen. What is the nurse's best response?
A nurse is teaching a client how to mix insulin. What statement indicates the client needs further instruction?
A nurse is teaching a client how to mix insulin. What statement indicates the client needs further instruction?
The nurse finds an unlabeled syringe filled with a clear liquid in the medication preparation area. What is the most appropriate immediate action?
The nurse finds an unlabeled syringe filled with a clear liquid in the medication preparation area. What is the most appropriate immediate action?
Prior to administering insulin, the client states, “My blood sugar was normal this morning. Do I still need the shot?” What action should the nurse take first?
Prior to administering insulin, the client states, “My blood sugar was normal this morning. Do I still need the shot?” What action should the nurse take first?
A nurse is reviewing the MAR (medication administration record) and notices that the client’s scheduled insulin dose was not administered. What is the priority nursing action?
A nurse is reviewing the MAR (medication administration record) and notices that the client’s scheduled insulin dose was not administered. What is the priority nursing action?
After administering insulin, the client develops signs of hypoglycemia (sweating, shakiness, confusion). What is the nurse's first action?
After administering insulin, the client develops signs of hypoglycemia (sweating, shakiness, confusion). What is the nurse's first action?
A client who self-administers insulin at home asks the nurse about proper disposal of used needles. The nurse should recommend:
A client who self-administers insulin at home asks the nurse about proper disposal of used needles. The nurse should recommend:
A new nurse is caring for an elderly client who has hearing loss and is visually impaired. What adjustments should the nurse do to effectively communicate directions about getting an insulin injection?
A new nurse is caring for an elderly client who has hearing loss and is visually impaired. What adjustments should the nurse do to effectively communicate directions about getting an insulin injection?
Flashcards
Insulin Injections for Diabetics
Insulin Injections for Diabetics
Clients with diabetes mellitus may need insulin injections to lower blood glucose, administered into subcutaneous tissue. Nurses may need to mix two types of insulin in one syringe.
Insulin Delegation
Insulin Delegation
The RN can delegate preparing and giving insulin to a PN or advanced practice clinician. AP can check blood glucose, but not mix insulin.
Allergy and ID Checks
Allergy and ID Checks
Determining allergies prevents allergic reactions. Verify client identity to ensure the correct procedure.
Infection Control and Record Review
Infection Control and Record Review
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Antiseptic Wipes
Antiseptic Wipes
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Check Medical Record
Check Medical Record
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Gather Supplies
Gather Supplies
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Provide Privacy
Provide Privacy
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Introduce Yourself
Introduce Yourself
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Perform Hand Hygiene
Perform Hand Hygiene
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Client Identification
Client Identification
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Confirm Allergy Status
Confirm Allergy Status
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Educate the Client
Educate the Client
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Evaluate Health Status
Evaluate Health Status
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Mixing Insulin
Mixing Insulin
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Aseptic Technique
Aseptic Technique
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Inject Air into Vial
Inject Air into Vial
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Draw Unmodified Insulin First
Draw Unmodified Insulin First
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Verify and Check for Air Bubbles
Verify and Check for Air Bubbles
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Calculate Total Units
Calculate Total Units
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Avoid Mixing in Vial
Avoid Mixing in Vial
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Eye-Level Withdrawal
Eye-Level Withdrawal
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One-Hand Scoop
One-Hand Scoop
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Verify with Another Nurse
Verify with Another Nurse
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Labeling Vials
Labeling Vials
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Return Unused Medication
Return Unused Medication
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Discuss Findings
Discuss Findings
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Ensure Client Safety
Ensure Client Safety
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Accurate Documentation
Accurate Documentation
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Study Notes
- Clients with diabetes mellitus often need insulin injections to lower blood glucose. These injections are given into the subcutaneous tissue. Sometimes, nurses must mix two types of insulin in one syringe.
- Registered nurses (RNs) can delegate insulin preparation and administration to practical nurses (PNs) or advanced practice clinicians. RNs can delegate blood glucose checks to assistive personnel (AP), but AP cannot mix insulin for administration.
Safety Considerations
- Check for client allergies to prevent allergic reactions.
- Verify client identification to ensure the procedure is performed on the correct client.
- Use standard and infection control precautions to prevent transmission of infectious organisms.
- Review the client's medical record to be aware of their health status and prevent complications.
Equipment
- Nonsterile gloves and other personal protective equipment (PPE) are needed as indicated.
- Standard precautions require nonsterile gloves and PPE if contact with blood or body fluids is possible.
- A facility-approved cleansing antiseptic wipe is needed.
- Cleansing the vial top and skin before injection reduces infection risk.
- Insulin vial(s) are needed as the insulin source.
- An insulin needle and syringe are needed to access the client’s subcutaneous tissue.
Step-by-Step Guide
- Step 1: Review the client's medical record.
- This includes allergies, medical history, medications, previous vital signs, and lab values.
- Rationale: To identify allergies or conditions that may affect the technique or results.
- Step 2: Obtain supplies.
- Rationale: Ensures preparedness for the procedure.
- Step 3: Provide privacy.
- Rationale: Maintains client confidentiality.
- Step 4: Introduce yourself.
- Rationale: Promotes a therapeutic nurse-client relationship.
- Step 5: Perform hand hygiene and put on PPE if indicated.
- Rationale: Important infection control measure.
- Step 6: Identify the client using two unique identifiers.
- Rationale: Ensures the correct procedure is performed on the correct client.
- Step 7: Confirm the client’s allergy status.
- Rationale: Prevents allergic reactions.
- Step 8: Provide client education.
- Rationale: Decreases client anxiety and promotes the nurse-client relationship.
- Step 9: Evaluate the client’s health status.
- Assess skin integrity and blood glucose level.
- Rationale: Identifies baseline data to prevent client harm.
- Step 10: Remove vial caps. If using NPH insulin, gently roll the vial to mix.
- Rationale: Rolling mixes the solution.
- Step 11: Scrub vial tops with antiseptic wipes; allow drying.
- Rationale: Aseptic technique ensures equipment sterility.
- Step 12: Draw back air equal to the dose of modified (cloudy) insulin.
- Rationale: Adding air facilitates medication removal due to vial pressure.
- Step 13: Inject air into the modified insulin vial above the solution; remove the needle.
- Rationale: Adding air facilitates medication removal due to vial pressure.
- Step 14: Draw back air equal to the dose of unmodified (clear) insulin.
- Rationale: Adding air facilitates medication removal due to vial pressure.
- Step 15: Inject air into the unmodified insulin vial above the solution.
- Rationale: Adding air facilitates medication removal due to vial pressure.
- Step 16: Invert the unmodified vial and withdraw the prescribed amount of unmodified insulin. Remove the needle.
- Rationale: Prevents contamination of the unmodified insulin vial.
- Step 17: Verify the amount of unmodified insulin in the syringe and check for air bubbles.
- Rationale: Ensures correct medication amount and removes air.
- Step 18: Calculate the total units for the full dose.
- Rationale: Ensures the correct dose is withdrawn
- Step 19: Pierce the modified insulin vial with the needle; do not inject medication into the vial.
- Rationale: Avoids contaminating the unmodified insulin.
- Step 20: Invert the modified insulin vial and withdraw the prescribed amount. Remove the needle.
- Rationale: Ensures accurate measurement.
- Step 21: Recap the syringe using the one-hand scoop method.
- Rationale: Reduces the risk of accidental needlesticks.
- Step 22: Confirm the total amount of insulin in the syringe matches the prescribed dose.
- Rationale: Ensures safe medication administration.
- Step 23: Label multi-dose vials with the date and time opened, and the beyond-use date.
- Rationale: Prevents the use of expired medications.
- Step 24: Return any unused medication per facility policy.
- Rationale: Follow facility guidelines.
- Step 25: Discuss findings with the client.
- Rationale: Decreases anxiety and promotes the nurse-client relationship.
- Step 26: Ensure client safety before leaving the room.
- This includes placing the call light within reach, lowering the bed, and placing needed items within reach.
- Rationale: Reduces the risk of falls and injury.
Documentation
- Accurately document relevant information in the client’s medical record, including date, time, and amount used.
- Rationale: Allows immediate access to client data by the healthcare team.
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Description
This lesson covers insulin injections into subcutaneous tissue and the mixing of two types of insulin in one syringe. It also explains the delegation of insulin preparation and administration by registered nurses (RNs) to practical nurses (PNs) or advanced practice clinicians. Safety considerations and necessary equipment are also discussed.
