Question

Drugs Affecting the Endocrine & Reproductive Systems

Scenario: During your shift at the local emergency department, patient H.G., a 47 year of age female, is brought in by her friend. According to the friend, she and H.G. had been participating in a fund-raising walk for breast cancer awareness when H.G. began to complain of feeling “shaky and nervous”. The neighbor explains how, since these complaints did not seem to be “too serious”, H.G. decided to avoid calling an ambulance and instead have her friend bring to the hospital to be “checked out”. The friend reports that while on the way to the hospital, H.G. “passed out” and wouldn’t wake up. Upon brief inspection, you note H.G. to be unresponsive and to be wearing a blouse that is saturated in perspiration. Upon concluding that H.G. likely has experienced a severe hypoglycemic episode, you check her blood glucose which is revealed to be 18.

1. In terms of pharmacological interventions, what would be your priority action at this time?

2. Upon being stabilized, H.G. is diagnosed with type II diabetes mellitus and is to begin a new prescription for metformin (Glucophage). While you are providing H.G. with education on her new medication, she reports, “I thought people with a diabetes had to take insulin shots.” As the nurse, how are you going to respond to this statement?      

3. In speaking with H.G. in regard to her experience, she expresses concern related to the fact that her symptoms had came on “all of a sudden”. In considering the information you had gotten in report from H.G.’s friend:

1. What information could you offer to H.G. as a likely explanation for why her blood sugar had dropped so suddenly?

2. What pharmacological-related education could you provide to her in order to mitigate the likelihood of a similar incident occurring in the future?

4. H.G. is ultimately discharged but subsequently calls the facility several days later requesting clarification on some of the education provided. While reading through the literature that was provided to her with her new medication, H.G. noticed that it instructed her to carefully limit her amount of alcohol consumption. In addition to alcohol’s effects on blood glucose levels, what other alcohol-related teaching, specific to her new medication, should you provide to H.G.?

5. The following week, H.G. attends a concert. During the intermission, H.G. steps into what she believes to be a portable toilet but is in fact a time machine! Now, 20 years in the future, H.G.’s diabetes mellitus has progressed, and she is informed that it will now require insulin therapy in order to be adequately managed. In recognizing this, the nurse understands that H.G. will require significant amounts of education. Elaborate on each of the following teaching points that the nurse will need to cover with H.G.:

1. Prevention of lipohypertrophy

2. Technique to be observed when resuspending (mixing) a vial of insulin

3. Proper storage of insulin

4. Importance of using a syringe designed specifically for insulin administration

Answer 1

Lipohypertrophy is an abnormal accumulation of fat underneath the surface of the skin.

A.preventing lipohypertrophy include:Rotate your injection site each time you inject. Keep track of your injection locations you can use a chart. Use a fresh needle each time. When injecting near a previous site, leave about an inch of space in between the two.inspect your injection sites for signs of lipohypertrophy. Early you’ll be able to feel the firmness under your skin. You may also notice that the area is less sensitive and you feel less pain when you inject. Increases risk for hypo or hyperglycemia.

B.Technique to be observed when resuspending (mixing) a vial of insulin: Roll the bottle of insulin between your hands two to three times to mix the insulin. Do not shake the bottle, as air bubbles can form and affect the amount of insulin withdrawn. Wipe off the rubber part on the top of the insulin bottle with an alcohol pad or cotton ball dampened with alcohol. Set the insulin bottle nearby on a flat surface. Remove the cap from the needle. Draw air into the syringe equal to the amount of cloudy (intermediate or long-acting) insulin needed. Always measure from the top of the plunger. Insert the needle into the rubber stopper of the cloudy insulin bottle. Push the plunger down to inject air into the bottle. Do not withdraw the insulin into the syringe at this time. Take the needle out of the bottle. Draw the required number of units of air into the syringe by pulling the plunger back. Draw air into the syringe equal to the amount of clear (short-acting) insulin needed. Always measure from the top of the plunger. Insert the needle into the rubber stopper of the clear insulin bottle. Push the plunger down to inject air into the bottle. Turn the bottle and syringe upside-down. Be sure the insulin covers the needle. Pull back on the plunger to the required number of units of clear insulin needed. Check the syringe for air bubbles. Air bubbles in the syringe will not harm you if they are injected, but they can reduce the amount of insulin in the syringe. To remove air bubbles, tap the syringe so the air bubbles rise to the top and push up on the plunger to remove the air bubbles. Recheck the dose and add more insulin to the syringe if necessary. Remove the needle from the clear insulin bottle and insert it into the rubber stopper of the cloudy insulin bottle. Turn the bottle and syringe upside-down. Be sure the insulin covers the needle. Pull back on the plunger to the required number of total units of insulin needed.

C. Proper storage of insulin: Keep your insulin away from heat and light. Any insulin that you don't store in the refrigerator should be kept as cool as possible. Never let your insulin freeze. If your insulin freezes, don't use it, even after it's thawed. Keep unused bottles, cartridges, and pens of insulin in the refrigerator. If stored properly, these will be good until the expiration date listed on the insulin. Keep insulin cartridges and pens that you're currently using at room temperature.

D.Importance of using a syringe designed specifically for insulin administration: Conventional insulin administration involves subcutaneous injection with syringes marked in insulin units. There may be differences in the way units are indicated, depending on the size of the syringe and the manufacturer. Insulin syringes are manufactured with 0.3, 0.5, 1, and 2ml capacities.jet injectors that inject insulin as a fine stream into the skin. A potential advantage may be a more rapid absorption of short-acting insulin.