For which of the following patients would the RN anticipate an order for sodium bicarbonate IVP?

Choice A rationale:

Insulin lispro is a rapid-acting insulin that begins to work within 15 minutes of injection. If administered 15 minutes after eating, it may not be able to effectively control the rise in blood glucose levels that occurs after a meal. This could lead to hyperglycemia, which can have negative short-term and long-term health consequences.

Administering insulin lispro 15 minutes after eating would delay its action and potentially lead to suboptimal blood glucose control. It's crucial to match the timing of insulin administration with the meal to ensure optimal glucose management.

Choice C rationale:

Administering insulin lispro 10 minutes after eating would also delay its action. While not as delayed as 15 minutes, it still wouldn't align with the peak of meal-related glucose absorption, potentially leading to suboptimal glucose control.

Choice D rationale:

Insulin lispro has a shorter duration of action compared to regular insulin. Administering it 30 minutes before eating could lead to hypoglycemia, a condition characterized by low blood glucose levels. Hypoglycemia can cause a variety of symptoms, including shakiness, sweating, dizziness, confusion, and even loss of consciousness.

It's essential to closely align the timing of rapid-acting insulins like insulin lispro with mealtimes to minimize the risk of hypoglycemia.

Choice A rationale:

Mixing insulins in a vial is generally not recommended unless specifically instructed by the healthcare provider. It can alter the effectiveness of the insulins and increase the risk of dosage errors.

Premixed insulins, which are already combined in a specific ratio, are available if a combination of insulins is needed.

However, in this case, the patient is instructed to administer regular and NPH insulin separately, indicating that they should not be mixed in a vial.

Choice B rationale:

Insulin can be injected into various subcutaneous sites, including the abdomen, thighs, upper arms, and buttocks.

There is no specific requirement to inject mixed insulin into the buttocks only.

The choice of injection site can be based on individual preferences, absorption rates, and the presence of lipohypertrophy (thickening of the subcutaneous tissue due to repeated injections).

Choice C rationale:

Drawing up NPH insulin first could lead to contamination of the regular insulin vial with NPH insulin.

NPH insulin is a suspension, and drawing it up first could introduce some of its particles into the regular insulin vial, potentially altering its absorption and action profile.

Choice D rationale:

It's crucial to draw up the regular insulin first to prevent contamination of the regular insulin vial with NPH insulin. The following steps outline the correct procedure:

Wash hands thoroughly with soap and water.

Inspect the insulin vials for clarity, expiration date, and any damage.

Roll the NPH insulin vial gently between the palms to resuspend the insulin particles (if applicable). Wipe the rubber stoppers of both vials with an alcohol swab.

Using a sterile syringe, withdraw air into the syringe equal to the amount of regular insulin to be drawn.

Inject the air into the regular insulin vial, keeping the needle tip above the fluid level to avoid creating bubbles. Invert the regular insulin vial and withdraw the prescribed dose of regular insulin.

Without injecting air into the NPH insulin vial, withdraw the prescribed dose of NPH insulin. Administer the insulin as directed, using proper injection technique.