NURS 1566 Clinical Form 3: Clinical Medications Worksheets(You will need to make additional copies of these forms)

Generic Nameinsulin aspart

Trade NameNovoLog

Classificationantidiabetics, hormones

Dose0.5 units / 15 g carbohydrates

RouteSQ

Time/frequencyImmediately following ingestion of carbohydrates.

Peak1-3 hours

OnsetRapid

Duration3-5 hrs

Normal dosage rangeDetermined by needs of the patients; generally 0.5-1 units/kg/day.

Why is your patient getting this medicationDiabetes mellitus

For IV meds, compatibility with IV drips and/or solutionsN/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(Why med ordered)Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat and inhibiting hepatic glucose production. Insulin also inhibits lipolysis and proteolysis and enhances protein synthesis. A rapid-acting insulin with more rapid onset and shorter duration than human regular insulin; should be used with an intermediate- or long-acting insulin.

Nursing Implications (what to focus on) Contraindications/warnings/interactionsAllergy or hypersensitivity to insulin aspart.Use Cautiously in: Stress, and infection (temporarily increase insulin requirements).Common side effectsLipodystrophy, HYPOGLYCEMIA, ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS.

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)Beta blockers may block some of the signs and symptoms of hypoglycemia and delay recovery from hypoglycemia (Lopressor). Alcohol may ↓ insulin requirements.

Lab value alterations caused by medicineMonitor blood glucose and ketones every 6 hr during therapy, more frequently in ketoacidosis and times of stress. Glycosylated hemoglobin may also be monitored to determine effectiveness.Be sure to teach the patient the following about this medicationInstruct 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(Pre-administration assessment)Assess patient periodically for symptoms of hypoglycemia (anxiety; restlessness; mood changes; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nausea; nervousness; rapid pulse; shakiness; unusual tiredness or weakness) and hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, frequent urination; loss of appetite; tiredness; unusual thirst) during therapy. Monitor body weight periodically. Changes in weight may necessitate changes in insulin dose.

AssessmentWhy would you hold or not give this med?Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated by ingestion of oral glucose. Severe hypoglycemia is a life-threatening emergency; treatment consists of IV glucose, glucagon, or epinephrine. Blood glucose < 150 mg/dL and >60 mg/dL. Medication errors involving insulins have resulted in serious patient harm and death. Clarify all ambiguous orders and do not accept orders using the abbreviation "u" for units, which can be misread as a zero or the numeral 4 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.

EvaluationCheck after givingControl of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes.