Giving Insulin

SANDRA1 · Nov 24, 2003

Thank you so much for your reply this really is a test question and the teacher does not care how I get the answer,but it has to be right. I will be keeping you posted as to the answer to this question. As well ill let you know when I graduate. I intend to go to the nursing lab to gain more knowledge from the nursing lab instructors... Keep me in your prayers...

kids · Nov 24, 2003

Good luck on your test question, I don't feel like sorting out what I think is the "right" answer right now, am tired and my back hurts.

Anyway...could you please undo your caps lock? In the world of bulletin boards and chat rooms typing in caps means you are yelling.

Thanks

SANDRA1 · Nov 24, 2003

thanks . iam to .going to bed and will sleep on this.

PMHNP10 · Nov 24, 2003

yeah, you can give that much NPH or lantus...and there is no specific mention of what kind as the question is presented to us; but perhaps that detail was accidently left out; it certainly would be the type of question a nursing instructor would ask.

kids · Nov 24, 2003

Originally posted by psychrn03
It must be. If it's sliding scale, that'd mean the pt would have a accucheck of 1100. The answer is...call 911, initiate CPR.

I disagree, I have given 50 units regular on a sliding scale basis many times. I know a lot of hospitals have a preprinted sliding scale sheet but they don't work for everyone. When it comes to diabetics and insulin there are so many variables that affect the dosage. I once had a patient in LTC who took 50 units of NPH and 20 units of regular BID. She was all of 4'10" and 75 #.

PMHNP10 · Nov 24, 2003

Perhaps the sliding scale has changed since they taugh it to me in school, but I remember them teaching (accucheck-100)/20 = no. of units. In reality, there are an unlimited number of sliding scales, but again, I don't recall us needing to know any sliding scale other than the aforementioned one. Using that one, you get a blood glucose of 1100, which is way beyond critical. I made the mistake of assuming we weren't given all of the information for the question.

athomas91 · Nov 24, 2003

50u - what type of insulin are you giving - if it is regular you might kill em'...........

the only other syringe that have measurements marked like an insulin syringe is a tb syringe - that is the only way to accurately measure your insulin which is of the utmost importance......

50u?!?!?!?!?!?

cannoli · Nov 24, 2003

Insulin and Tb syringes are not interchangeable. I know of an instance where an LPN gave insulin in a TB syringe instead of an insulin syringe and the patient got about a ten-fold overdose.

A lot of patients do take 50 units of long acting insulin.

SANDRA1 · Nov 24, 2003

thank you for your reply. the question read give 50 units of nph in my insulin syringe, but it breaks . use a regular syringe.

# 1) how many cc is this of course its o.5 cc which is 1/2 cc.

# how many minums i know this as well.

# 3 what size needle do you use is what i dont understand.

***** i do know that #28, #29 gauge is for insulin and that #25 -# 27 is for sub-q, as well that # 21 -#24 is for I.M. but th is teacher is from the old school it has to be exactly the right answer for her. I hate this pressure its my last two weeks. to repeat this semester would kill me. #$#$%& ESPECIALLY WHEN I HAVE FUNCTIONED IN A SPECIALTY HOSPITAL AS AN L.P.N. I have done just about anything an R.N. does in a hospital setting. Its very boring handing not vitamin pills and laxatives as a student with one or two patients at a time when I am used to 7 or 8 pts. DONT GET ME WRONG IM VERY HUMBLE. Ive even worked with patients on ventalators......I know I have to jump through the hoops just like everyone else has done. >> God keep me in your prayers I couldnt do another semester..... iF YOU CAN FURTHER HELP WITH SUGGESTIONS LET ME KNOW iLL KEEP YOU POSTED.

loisane · Nov 24, 2003

While a TB syringe and an insulin syringe are not exactly the same, in my clinical experience they will substitute one for another in a pinch.

The posters instructor specified a setting in which this scenario occured-a home health visit. Part of home health nursing is the ability to "improvise", and realize you do not have all the resources available that you might have in the hospital. IMHO (and we are all just giving our best guess), this is the point of the exercise. If an insulin syringe is not available, how do you best make a substitute? (I assume allnurses has a home health section, did you give that group a crack at this question?)

It is nice when systems are developed that reduce the risk of error. Hence the development of a specific syringe for the administration of insulin. When operating without the benefit of these additional safety systems, it merits a larger degree of attention to detail from the nurse.

So if forced to use a TB syringe, checking, double checking, and checking again would all be appropriate. This is something CRNAs are very comfortable with. We routinely give drugs that require incredible precision in dosing, and do this dozens of times a day. Thought I would find a way to connect this thread to nurse anesthesia ;-)

loisane crna

SANDRA1 · Nov 24, 2003

Thanks for your reply its interesting to see all the different responds to such a question. I certainly have done a lot of research for the answer. I have gathered several opinions .I have read many reference books as well. In response is there only one right answer to the question ? What is everyone's opinion that is out there reading this think ? ***** references textbooks, pharmacist,nurses,dr. all gave answers that were similar ,but not the same.

athomas91 · Nov 25, 2003

thank you loisane........in a pinch - a tb syringe would be my first alternate choice.