A client on Regular insulin develops lipohypertrophy at injection sites. What would the nurse instruct the patient to do?

Step 1: Convert the patient’s weight to kilograms
Weight in kg = 231 ÷ 2.2 ≈ 105 kg

Step 2: Calculate the insulin dose in units per hour
Dose (units/hr) = 0.1 units/kg/hr × 105 kg = 10.5 units/hr

Step 3: Determine the concentration from the insulin label (typically, insulin is supplied as 100 units/100 mL for IV infusion unless otherwise specified; if we assume 1 unit/mL)
mL/hr = Units/hr ÷ Concentration (units/mL)

Assuming 1 unit/mL:
mL/hr = 10.5 ÷ 1 ≈ 11 mL/hr

Final Answer: 11 mL/hr

Rationale:

A. Difficulty falling asleep (sleep-onset insomnia) and frequent nighttime awakenings (sleep-maintenance insomnia) are common non-motor symptoms of Parkinson’s disease. Sleep disturbances may result from dopaminergic dysfunction, nocturia, restless legs, pain, or medication side effects, and can significantly affect quality of life, cognition, and daytime functioning. Assessing and addressing sleep hygiene, medication timing, and environmental factors is essential for managing this symptom.

B. Anxiety may coexist with sleep disturbances but is not the primary cause of difficulty falling asleep and frequent awakenings in this scenario. Anxiety typically presents as excessive worry, restlessness, or tension, rather than isolated nocturnal sleep disruption.

C. Excessive daytime sleepiness (EDS) is a related non-motor symptom, often secondary to poor nighttime sleep or as a side effect of dopaminergic medications. However, the client’s current complaint focuses on nocturnal insomnia, not daytime somnolence.

D. Hallucinations, such as visual or auditory perceptions without external stimuli, are non-motor symptoms of PD, often associated with advanced disease or medication side effects. They do not explain difficulty initiating or maintaining sleep.