Patient Case Study

1. The eleven components of valid routine subcutaneous insulin order for medication need to be determined and evaluated.

Patient identification – It is done to by the set standards to identify the type of problem caused to the patient, it is the initial stage most important step to initiate the treatment.

• Cross-referencing of medication with the national standards is to be done.
• Hospital details should be notified during the insulin order.
• Any special instruction should be noted by the nurse.
• Diabetes treatment prior to admission should be noted for better diagnosis.
• Monitoring of the blood glucose level on a regular basis should be done
• The proper diet should be patient by the patient while taking insulin.
• Proper documentation of the time and dosage of insulin and blood glucose level should be done (SHIMIZU, 2012).
• Supplemental insulin orders must be taken to align the  blood glucose level with the dosage of Insulin
• If the blood glucose is out of order stat phone insulin orders are given for emergencies.

2. Ben has the symptoms of the type one diabetes. He has increased blood glucose level and ketone bodies in his blood. This is the reason he has been prescribed this medication. Since Bens Pancreas is not producing sufficient insulin Novo rapid insulin is used by the nurse.

The Novo rapid insulin acts rapidly to control the type 1 diabetes. The insulin receptors present binds with the muscle and fat cell and lowers the glucose level. It helps in increase in the cellular uptake of glucose which results in lowering of the overall blood sugar level. It has a basic difference than the other insulin it is absorbed in the body at a much fast pace than the regular insulin (Leal, Herrier & Soto, 2007).

3. The onset of the novo rapid insulin is ten to twenty minutes. After the onset of the insulin, it takes almost 1- 3 hours to go the peak of its action.  The duration of the action is 3-5 hours.

It is administered 0- 10 minutes before a meal so that after the initiation food is taken so that the patient will not suffer from a sudden fall in glucose level. The medicine will have the time to work properly (Iwasaki et al., 2017).

4. The hypoglycaemia is the condition when the blood glucose level falls below the normal range.

If the Novo rapid insulin is not balanced with proper diet then the patient can face hypoglycaemia.

Symptoms of Hypoglycaemia

• Hunger
• Dizziness
• Unusual sweating
• Sleepiness.

Proper balance meal with a right dose of insulin should be given to the patient. Immediately glucose should be given to the patient so that the blood glucose level can be stabilized (Choudhary et al., 2010).

5. Medication administration helps to explain the tasks that are needed to be done before medication. Moreover, it helps individuals to be involved in the treatment process at the earliest period in order to get an effective outcome. As per the case study, the medication administration has been done through evidence-based nursing. The medication of ben was suggested after testing his blood ketone level and blood glucose level.

6. Five rights of medication administrations are as follows:

1. Right child
2. Right Medication
3. Right Dose
4. Right time
5. Right route

Right child helps the nurses to record all the details of the child patient. It includes his name, birth, residential and family details sand his picture. Right medication helps the nurses to recheck the medicine container and makes nurses in accordance with the medicine with the disease. Right dose helps to understand the required dose for the patients of the medicine. Right time helps to understand the proper timing of the medicine. Right route helps to understand the whether the medicine is properly given to the patient. As per the case study, the medical staffs provided sufficient care to Ben and provided him with insulin: As part and Novo Rapid (Kerr, Lu, Mill & McKinlay, 2012).

Diagnosis and Treatment

7. The appropriate needle length for Ben is 0.3ml. because Ben was given Aspart (NovoRapid)of amount 10units. A 0.3ml needle is always applicable to the units below 30.

8. The assessment would undergo a specific process prior to the administration of NovoRapid insulin to Bern. The process is as follows:

• Insurance of the prescription process
• Checking the dose of insulin NovoRapid
• Check blood glucose level
• Remove the needle from the syringe and put that in a safe disposal
• Report to a supervisor if bleeding
• Preparing insulin syringe by mixing insulin NovoRapid from downward with the premixed insulin.
• It should not be shaken before the use
• Attach pen needle of 0.3ml
• Ensure the insulin is available le in the needle
• Then, the insulin is provided to the patient

This diabetes-specific assessment of administration of Novio Rapid is important because safety measures must be maintained in order to provide perfect medication for treatment to Ben (Atkin & Aye, 2014).

9. The best place to inject NovoRapid injection into a place where skin lump cannot be developed easily. Thus, for Ben in front of his thighs or on his waist or on the upper arm is most suitable (Kwok et al., 2017).

NovoRapid infection can be controlled by :

• Stop talking Novorapid if it is found allergic
• A fresh injection syringe must be used every time
• Injection must not be provided in the fatty body part

10. The insulin dosages given to Ben by his nurse should be documented in the National subcutaneous insulin chart. The chart should contain the patient identification, a cross-reference of the NSMC, Hospital details, doctor to notify details, special instructions for the patient, history of diabetes treatment prior to admission (Kostev & Rathmann, 2016).

It is very important to document these details so that the doctor treating the patient can get a quick look at the details and the treatment being provided to the patient.

11. Nursing staff has certain responsibilities after the insulin administration:

1. Screening and making the patient understand the patient the early detection and prevention of type-2 diabetes.

2. Promote the ability of self-care.

3. Having an understanding of the mental health issues of the patient and bringing it to notice of the doctor.

4. The proper intake of diet by the patient.

5. Monitoring the urine and the glucose (Haugen & Musser, 2012).

6. Providing the oral and the inject-able therapies.

7. Prevention and treatment of hypoglycemia and hyperglycemia.

1. Children with type-1 diabetes need to balance their energy usage, insulin dosage, and food intake. Children have an unpredictable physical routine and the parents have a tendency of preventing physical activities of their children from the fear of hypoglycemia. Although studies show that children with type-1 diabetes should indulge themselves in more physical activities and exercises to ensure better health and quality of life in the future. Ben’s parents have to overcome their fears of hypoglycaemia and help Ben regularly practice his football. His parents can prevent any situation of hypoglycaemia by ensuring proper food intake and regular insulin intakes by Ben.

2. The children between the age group 2-18, face an elevated problem of parental fear of hypoglycemia. They face a parental stress problem along with their own behavioral problems. The children of this age group also show mealtime misbehavior symptoms such as refusing to eat, wasting time during their meal times and sometimes sitting idle for sometime before finally getting to bed. Ben’s parents are most likely to face these problems with Ben. Parents also find certain psychological symptoms among the children suffering from type 1 diabetes, such as depression, anxiety, and somatization. Children of Ben’s age pose greater challenges than younger children (Böber, Büyükgebiz, Verrotti & Chiarelli, 2005).

References

Atkin, S., & Aye, M. (2014). Patient safety and minimizing risk with insulin administration – role of insulin degludec. Drug, Healthcare And Patient Safety, 55.

Böber, Ε., Büyükgebiz, Α., Verrotti, Α., & Chiarelli, F. (2005). Hypoglycemia, Hypoglycemia Unawareness and Counterregulation in Children and Adolescents with Type 1 Diabetes Mellitus. Journal Of Pediatric Endocrinology And Metabolism, 18(9).

Choudhary, P., Geddes, J., Freeman, J., Emery, C., Heller, S., & Frier, B. (2010). Frequency of biochemical hypoglycaemia in adults with Type 1 diabetes with and without impaired awareness of hypoglycaemia: no identifiable differences using continuous glucose monitoring. Diabetic Medicine, 27(6), 666-672.

Haugen, D., & Musser, S. (2012). Health care. Farmington Hills, MI: Greenhaven Press.

Iwasaki, S., Kozawa, J., Kimura, T., Fukui, K., Iwahashi, H., Imagawa, A., & Shimomura, I. (2017). Insulin degludec is associated with less frequent and milder hypoglycemia in insulin-deficient patients with type 1 diabetes compared with insulin glargine or detemir. Diabetology International, 8(2), 228-236.

Kerr, D., Lu, S., Mill, D., & McKinlay, L. (2012). Medication Administration by Enrolled Nurses: Opinions of Nurses in an Australian Healthcare Organization. Nursing Forum, 47(4), 203-209.

Kostev, K., & Rathmann, W. (2016). Calculated Daily Insulin Dosages Overestimate Prescribed Insulin Doses in Type 2 Diabetes: A Primary Care Database Study. Journal Of Diabetes Science And Technology, 11(3), 597-601.

Kwok, R., Sztal-Mazer, S., Hopkins, R., Poole, S., Grannell, L., Coutsouvelis, J., & Topliss, D. (2017). Evaluation of NovoRapid infusion as a treatment option in the management of diabetic ketoacidosis. Internal Medicine Journal, 47(11), 1317-1320.

Leal, S., Herrier, R., & Soto, M. (2007). The role of rapid-acting insulin analogues and inhaled insulin in type 2 diabetes mellitus. Insulin, 2(2), 61-67.

SHIMIZU, T. (2012). CONTINUOUS SUBCUTANEOUS INSULIN INFUSION THERAPY. Juntendo Medical Journal, 58(6), 485-489.