A patient with type 1 diabetes mellitus has been prescribed a glucagon emergency kit for home use.


When should the nurse instruct the patient and family that glucagon needs to be administered?

Choice A rationale

Glucagon should not be administered before meals to prevent hyperglycemia. Glucagon is a hormone that raises blood glucose levels and is used to treat severe hypoglycemia. It is not intended to prevent hyperglycemia.

Choice B rationale

Glucagon should be administered when signs of severe hypoglycemia occur. Hypoglycemia, or low blood sugar, can cause symptoms such as confusion, dizziness, hunger, and shakiness. If left untreated, severe hypoglycemia can lead to unconsciousness or seizures.

Choice C rationale

Glucagon should not be administered when unable to eat during sick days. While it’s important to maintain blood glucose levels during illness, glucagon is specifically used for severe hypoglycemia.

Choice D rationale

Glucagon should not be administered at the onset of signs of diabetic ketoacidosis. Diabetic ketoacidosis is a serious condition that requires immediate medical attention. Glucagon is not a treatment for this condition.

The correct answer is D. Immediately after completion of the IV dose and 30 minutes before the next administration of the medication.

Explanation:

• Peak levels measure the highest concentration of the drug in the bloodstream and should be drawn immediately after the IV infusion is completed.

• Trough levels measure the lowest concentration of the drug and should be drawn 30 minutes before the next scheduled dose. This helps ensure the drug remains within therapeutic levels and prevents toxicity.

Why the other options are incorrect:

• A. One hour after completion of the IV dose and one hour before the next administration – Waiting one hour for the peak level is too long and may lead to an inaccurate measurement.

• B. Two hours after completion of the IV dose and two hours before the next administration – Waiting two hours for both peak and trough levels is too late for effective monitoring.

• C. Thirty minutes into the administration of the IV dose and 30 minutes before the next administration – The sample drawn mid-infusion does not represent peak levels, making this method ineffective.

Key takeaway:

Proper timing of vancomycin peak and trough monitoring ensures therapeutic drug levels while minimizing nephrotoxicity and ototoxicity.