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. (5 marks)
Answer: A medication order is valid only when authorised prescriber enters all the details of the 11 components of a valid routine subcutaneous insulin medication. The 11 components are
- patient’s URN, family and given names, address, DOB, sex on the address level
- First prescriber ID label checked
- National Inpatient Medication Chart (NIMC) has been marked
- Hospital details
- Doctor to notify
- Printed name and signature of prescriber
- Date
- Name of Insulin
- Dose
- Meal or time
- Doctor’s initials
These components are important to be filled up in order to assess the patient before proceeding towards further medication process (LeMone et al., 2014).
- Explain why Ben has been prescribed this medication.Relate to pathophysiology of type 1 diabetes and the mechanism of action of NovoRapid insulin. Support your answer with academic references. (10 marks)
Answer: Ben has been prescribed for NovoRapid Insulin which is related to pathophysiology of type 1 diabetes as his gene can interact and apart from that the environment can also interact for viral infections. The impact of disease is the autoimmune destruction of the beta cells which can reduce the secretion of insulin hormone. It also breaks down the body fats and protein which in turn forms ketosis as insulin hormone promotes the protein synthesis and fat storage. Insulin breaks down the glycogen to form glucose in the body. The mechanism of action of NovoRapid insulin is it stimulates amino acid intake into the blood cells, and inhibits glycogenolysis and also gluconeogenesis in the liver to stimulate glycogenesis (Bullock & Manias, 2013).
- What is the onset, peak and durationof action for NovoRapid insulin according to Bullock and Manias (2017)? Explain when NovoRapid should be administeredin relation to food intake and why.Support your answer with academic references. (5 marks)
Answer: The onset for NovoRapid is 0-0.25 hours which means 15 minutes, the peak is 1 hour and the duration is 3-5 hours. Generally, if insulin is given before the meal, and if somehow the meal is skipped then it can cause hypoglycaemia which is very dangerous and even can lead to death. So, the NovoRapid insulin should always be given after meal or breakfast to prevent the risk of hypoglycaemia among the patients (American Diabetes Association, 2015).
- Discussthe definition, causes, symptoms and treatmentof hypoglycaemia, a common adverse effect of NovoRapid.Support your answer with academic references. (5 marks)
Answer: If the glucose level in blood comes less than 4mmol/L when tested via blood glucose meter, then that is called hypoglycaemia. The symptoms are hunger, restlessness, tremor, pallor, sweating, mild trachycardia and in some serious cases it can lead to seizures, coma and death also. Immediate replace of glucose is the main treatment using some quick-acting carbohydrate such as sugar, honey, fruit juice etc. and slow-acting carbohydrates such as piece of fruit, sandwich etc (Choudhary et al., 2015).
- Discuss the importance ofunderstanding the medication prior to administration.Support your answer with academic references. (5 marks)
Answer: Supporting the medication administration may not be the role of nurse, but if it is involved then the nurse should have a clear understanding about the medication prior to the administration. Sometimes nurses need to make a judgement about the medication in order to find the side effects of using any medicines. So, a registered nurse with appropriate qualification should have an understanding of medication while dealing with any particular patient (Maruthur et al., 2016).
- Discuss the 5 rights of medication administration and why it isimportant for nurses to follow this procedure.Support your answer with academic references. (5 marks)
Mechanism of Action of NovoRapid Insulin and Its Prescription to Ben
Answer: The 5 rights of medication administration are
- The right medication
- The right dose
- The right time
- The right route
- The right medication
All the rights are important for nurses to follow as if they are properly obeyed and observed then the potential for doing mistakes in professional area will be reduced. In order to improve the medication process by reducing errors, all the nurses are bound to follow these rights (Truitt, Thompson, Blazey-Martin, Nisai & Salem, 2016).
- What isthe most appropriateinsulin pen needle lengthfor Ben and why?Support your answer with academic references. (5 marks)
Answer: The insulin pen needle length must be appropriate in order to decrease the risks of having any error in the medication process. If the length is not ideal, the insulin may not be delivered where required. So, the appropriate needle length for Ben should from 4mm to 6mm in order to ensure that the insulin has been delivered to the SC route not the intramuscular as per the medication order (O’Neal, Johnson & Swar, 2015).
- What diabetes specific nursing assessment would you conduct prior to administration of NovoRapid insulin to Ben and why?Support your answer with academic references. (5 marks)
Answer: NovoRapid insulin requires prior checking before the administration to the patient. In this case, before the administration of NovoRapid insulin to Ben, it is important to check if he has completed his meal or breakfast otherwise it can lead to serious hypoglycaemia. So, the timing of insulin with respect to the meal is very much crucial to keep the glucose level of blood under control. Nurses should also assess if Ben is allergy prone or not (Passarelli et al., 2016).
- Identify the site and angle you would inject the NovoRapid insulin and explain why this was selected for Ben. Discussinfection controlconsiderations.Support your answer with academic references. (5 marks)
Answer: The appropriate injection site for the patient should be the abdominal wall in order to ensure the comfort of the patient so that it effectively gets delivered to the SC route and the insulin also gets absorbed consistently. To ensure the SC delivery, the angle should also be 90 degree for Ben. In order to control the infection some considerations must be taken such as the disposal of the syringe after use and no sharing of blood glucose meter etc (Tandon et al., 2015).
- What would you document and where? Why is documentation important? Support your answer with academic or clinical guideline references. (5 marks)
Answer: Documentation is very much important while giving insulin injection to a patient of Type 1 diabetes. The food intake and the time of giving the insulin injection along with the site must be documented in order to prevent the risks of medication error. All the information and reports must be documented in the chart and routine medication order set for the particular patient. If all the data is not kept properly then it can endanger the life of the patient also (Kolltveit et al., 2016).
- 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. (5 marks)
Answer: It is to be checked if Ben is having any allergy or infection after the administration of insulin. His weight and blood glucose level should also be checked. From the record keeping documents, the last intake of meal should also be assessed. The dose, timing and the site of the insulin injection must be recorded in chart. It should also be assessed if Ben is bleeding from the injection site (Sarkar & Mani, 2018).
Onset, Peak, and Duration of Action of NovoRapid Insulin
Discuss the potential impact of type 1 diabetes on Ben.
- Discuss the daily physical challenges of living with type 1 diabetes that Ben may face.Support your answer with academic references. (5 marks)
Answer: Type 1 diabetes can affect the daily activities of the patients and as a result, young patients like Ben needs to face a lot of daily physical challenges in their life. Ben is young and an engineering student who works in McDonalds. Type 1 diabetes causes fatigue and weakness which may hamper his professional as well as academic career. He also plays football and symptoms of having blurred vision in Type 1 diabetes can create challenge while playing. Ben enjoys surfing on the beach which can also get hampered due to his weakness and other effects of Type 1 diabetes (Chiang, Kirkman, Laffel & Peters, 2014).
- Discuss potential emotional impacts of living with type 1 diabetes that Ben may face.Support your answer with academic references. (5 marks)
Answer: While living with Type 1 diabetes, a patient might face some emotional impacts too. Ben is very young and he is having an active personality who enjoys his life a lot. But, due to some physical struggles as a consequence of Type 1 diabetes, he will not be able to actively participate in various actions such as football, training and surfing as well. Even, this diabetes also creates mood swings which can affect his relationship with girlfriend and other family members. For the treatment he needs to visit hospital frequently which will make him feel disappointed as he will not be able to live his life like other young adults. So, all these can have an emotional affect on Ben (Lawton et al., 2015).
Reference list
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. (2013). Fundamentals of pharmacology (8th ed.). Pearson Higher Education AU.
Chiang, J. L., Kirkman, M. S., Laffel, L. M., & Peters, A. L. (2014). Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes care, 37(7), 2034-2054.
Choudhary, P., Rickels, M. R., Senior, P. A., Vantyghem, M. C., Maffi, P., Kay, T. W., … & Hering, B. J. (2015). Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia. Diabetes Care, 38(6), 1016-1029.
Kolltveit, B. C. H., Gjengedal, E., Graue, M., Iversen, M. M., Thorne, S., & Kirkevold, M. (2016). Telemedicine in diabetes foot care delivery: health care professionals’ experience. BMC health services research, 16(1), 134.
Lawton, J., Kirkham, J., White, D., Rankin, D., Cooper, C., & Heller, S. (2015). Uncovering the emotional aspects of working on a clinical trial: a qualitative study of the experiences and views of staff involved in a type 1 diabetes trial. Trials, 16(1), 3.
LeMone, P., Burke, K., Levett-Jones, T., Dwyer, T., Moxham, L., Reid-Searl, K., … & Luxford, Y. (2014). Medical-surgical Nursing: Critical Thinking for Person-centred Care (3rd ed.).
Maruthur, N. M., Tseng, E., Hutfless, S., Wilson, L. M., Suarez-Cuervo, C., Berger, Z., … & Bolen, S. (2016). Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: a systematic review and meta-analysis. Annals of internal medicine, 164(11), 740-751.
O’Neal, K. S., Johnson, J., & Swar, S. (2015). Nontraditional considerations with insulin needle length selection. Diabetes Spectrum, 28(4), 264-267.
Passarelli, A. J., Gibbs, H., Rowden, A. M., Efird, L., Zink, E., & Mathioudakis, N. (2016). Evaluation of a nurse-managed insulin infusion protocol. Diabetes technology & therapeutics, 18(2), 93-99.
Sarkar, P., & Mani, S. (2018). A study to assess the effectiveness of structured teaching programme on knowledge and practice regarding self-administration of insulin among insulin requiring diabetic patients. GLOBAL JOURNAL FOR RESEARCH ANALYSIS, 7(1).
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).
Truitt, E., Thompson, R., Blazey-Martin, D., Nisai, D., & Salem, D. (2016). Effect of the implementation of barcode technology and an electronic medication administration record on adverse drug events. Hospital pharmacy, 51(6), 474-483.
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