MED SURG ENDOCRINE PRT 2.docx

Identify and describe the various types of insulin by completing the table below. Insulin Classification/ Generic Name Brand Name Onset (hour) Peak (hour) Duration (hour) Rapid-Acting: aspart lispro glulisine Short-Acting: regular insulin Intermediate-Acting: NPH Long-Acting: glargine determir 2. Match each classification of oral hypoglycemic agents its corresponding mechanism of action. Term Definition Sulfonylureas Meglitinides Biguanides Alpha-glucoside inhibitors Thiazolidinedione antidiabetic agents Definitions Reduce glucose production by the liver; enhance the insulin sensitivity; improve glucose transport into the cells Improve insulin sensitivity, transport, and utilization at target tissues; do not increase insulin production Increase insulin production from the pancreas; decrease glycogenolysis and gluconeogenesis; enhance cellular sensitivity to insulin When taken just before meals, increase pancreatic insulin production during and after the meal, mimicking the normal blood glucose response to eating Slow down the absorption of carbohydrate in the small intestine; lower postprandial blood glucose 3. Identify and describe two additional pharmacologic agents useful in treating diabetes mellitus. Questions Exercise 2 Online This exercise will take approximately 40 minutes to complete. Sign in to work at Pacific View Regional Hospital for Period of Care 1. (Note: If you are already in the virtual hospital from a previous exercise, click on Leave the Floor and the on Restart the Program to get to the sign-in window.) From the Patient List, select Harry George (Room 401). Click on Go to Nurses' Station. Click on Chart and then on 401. Click on Emergency Department. 1. What medication was ordered to control Harry George's diabetes? 2. How would you give the IV insulin? (Hint: Consult the Drug Guide in the Nurse's Station.) 3. At what point after administering Harry George's regular insulin will he be at the greatest risk for hypoglycemia?  Within 30 minutes of administration  1 to 2 hours after administration  2 to 3 hours after administration  4 to 6 hours after administration Click on Physician’s Orders. 4. Look at the orders for Monday at 1345. What was the sliding scale insulin order? Click on Return to Nurses' Station. Click on Kardex and then on tab 401 for Harry George's record. 5. According to the Kardex, how often should the capillary blood glucose be tested? Click on Return to Nurses' Station. Click on MAR and then on tab 401. 6. According to the MAR, when should the insulin sliding scale be administered? What was the time of this order? 7. What would you do regarding the inconsistencies identified above? 8. What problems might you anticipate for Harry George if he does not receive insulin coverage at bedtime? Click on Return to Nurse’s Station and then on 401 at the bottom of the screen. Click on Clinical Alerts. 9. Harry George's fasting morning glucose is 206 mg/dL. This manifestation may be explained by:  the dusk to dawn effect.  the Somogyi effect.  the dawn phenomena.  the insulin rebound effect. Prepare and administer the sliding scale insulin for this glucose level by following these steps: Click on Medication Room on the bottom of the screen. Click on MAR or on Review MAR at any time to verify how much insulin to administer based on sliding scale. (Hint: Remember to look at the patient's name on the MAR to make sure you have the correct records and to click on the correct room number within the MAR.) Click on Return to Medication Room after viewing the correct MAR. Click on Unit Dosage and then on drawer 401 for Harry George's medications. Select Insulin Regular, click on Put Medication on Tray, and then click on Close Drawer. Click on View Medication Room. Click on Preparation and choose the correct medication to administer. Click on Prepare. Click on Next, choose the correct patient to administer this medication to, and click on Finish. You can click on Review Your Medications and then on Return to Medication Room when ready. Once you are back in the Medication Room, you can go directly to Harry George's room by clicking on 401 at the bottom of the screen. Click on Patient Care. Click on Medication Administration and follow the steps in the Administration Wizard to complete the insulin administration. 10. How much insulin should be administered? 11. What is the preferred site of administration for fastest absorption? 12. Fill in the chart below regarding the insulin you just administered. Expected Length of Time Actual Time After 0730 Dose Onset Peak Duration 13. When performing the assessments on Harry George, which of the following manifestations, if present, may be indicative of hypoglycemia? Select all that apply.   Diaphoresis   Irritability   Bradycardia   Hunger   Hypertension   Visual disturbances   Weakness 14. While you are preparing to administer Harry George's insulin, he asks you why he is taking this since he did not use insulin at home. How would you answer him? 15. For what side effects related to the current insulin regimen should you monitor Harry George? Questions Exercise 3 Online This exercise will take approximately 40 minutes to complete. Sign in to work at Pacific View Regional Hospital for Period of Care 4. (Note: If you are already in the virtual hospital from a previous exercise, click on Leave the Floor and then on Restart the Program to get to the sign-in window.) Click on Chart and then on 401. (Remember: You are not able to visit patients or administer medications during Period of Care 4. You are able to review patients' records only.) Click on Nurse's Notes. 1. Glyburide has been prescribed for Harry George. To which of the following classifications does this medication belong?  Alpha-glucosidases  Meglitinides  Sulfonylureas  Biguanides 2. Read the notes for Wednesday at 1730. What does Harry George request regarding glyburide? 3. How would you respond to the patient's demands? 4. How often did Harry George take the glyburide at home? 5. Why do you think this was increased in the hospital? What concerns might you have regarding this increase? (Hint: Patient is also receiving insulin.) 6. For what side effects of glyburide should you assess Harry George? Select all that apply.   Headache   Hypotension   Dizziness   Drowsiness   Peeling skin rash   Itching   Constipation   Feelings of stomach fullness 7. What specific patient teaching points should you give this patient regarding glyburide? 8. What additional patient teaching related to diabetes would be appropriate for Harry George? Click on Go to Nurses' Station. Click on Chart and then on 401. Click on Laboratory Reports. 9. Below, chart Harry George's blood glucose level and insulin administration since admission to the medical-surgical unit. (Hint: You may have to review the expired MARs in the chart to verify whether insulin was given for before the bedtime glucose measurement on Tuesday.) Date/Time Blood Glucose Level Amount of Regular Insulin Administered 10. Based on Harry George's pattern of blood glucose levels, would you evaluate his current therapy as effective? If not, how might the physician further treat the patient's diabetes? 11. If you were reviewing the chart on Wednesday evening and found the information recorded in the table in question 9, what concern would you be ethically and legally bound to report?