NURS 1566 Clinical Form 3: Clinical Medications Worksheets

(You will need to make additional copies of these forms)

Generic Name Trade Name Classification Dose Route Time/frequency

insulin glargine Lantus hormones 90 units SQ Q HS
Peak Onset Duration Normal dosage range
5 hr Within 1 hr 24 hrs Initiation in patients with type 2 diabetes already being treated
with oral antidiabetic agents--10 units once daily; then adjusted
on the basis of patient's needs (range 2-100 units/day).
Changeover from other intermediate- or long-acting insulin.
Decrease total daily NPH dose by 20% during the first week,
then adjust on the basis of patient's needs.
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or solutions
Diabetes mellitus Do not mix insulin glargine with any other insulin or solution, or
use syringes containing any other medicinal product or residue.
Solution should be clear and colorless with no particulate matter.
Administer subcutaneously once daily at any time during the
day, but at the same time each day. Do not administer IV.
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
Lowers blood glucose by increasing transport Allergy or hypersensitivity to insulin glargine. Use cautiously
into cells and promoting the conversion of in: Stress, infection (may temporarily increase insulin
glucose to glycogen. Promotes conversion of requirements), renal/hepatic impairment (may ↓ insulin
amino acids to proteins in muscle and requirements).
stimulates triglyceride formation. Inhibits Common side effects
release of free fatty acids. Iletin II is derived Lipodystrophy, HYPOGLYCEMIA.
from pork; all other are biosynthetic.
Interactions with other patient drugs, OTC
or herbal medicines (ask patient specifically)
Beta-adrenergic blocking agents may block
some of the signs and symptoms of
hypoglycemia and delay recovery from
hypoglycemia (Coreg). Alcohol and ACE
inhibitors (Prinivil) may ↓ insulin
requirements.
Nursing Process- Assessment
(Pre-administration assessment)
Assess 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-
Lab value alterations caused by medicine
Monitor 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
medication
Instruct 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 selection and rotation of injection sites, and
compliance with therapeutic regimen. 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 on 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.
Assessment Evaluation
Why would you hold or not give this Check after giving
med? Control of blood glucose
Overdose is manifested by symptoms of levels without the
hypoglycemia. Mild hypoglycemia may be appearance of hypoglycemic
treated by ingestion of oral glucose. Severe or hyperglycemic episodes.
hypoglycemia is a life-threatening
emergency; treatment consists of IV
glucose, glucagon, or epinephrine.
Recovery from hypoglycemia may be
delayed due to the prolonged effect of
subcut insulin glargine. Medication errors
involving insulins have resulted in serious
patient harm and death. Clarify all
like breath odor; rapid, deep
breathing, frequent urination; loss of
appetite; tiredness; unusual thirst)
periodically during therapy. Monitor
body weight periodically. Changes in
weight may necessitate changes in
insulin dose.
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.