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Samatha, age 4, has a glucose level of 329mg/dl. She is eating the following for lunch: grilled chicken, juice(15g carb), mashed potatoes (30g carb), applesauce (15g carb). Her insulin order is as follows: 

  1. Provide insulin coverage for meals at 1 unit novolog/1 carbohydrate exchange (15g carb=1 carb exchange) and,
  2. Provide insulin correction for blood glucose level based on scale:

Up to 249mg/dl: no correction

250-299 mg/dl: 0.5 unit novolog 300-349 mg/dl: 1 unit novolog

350-399 mg/dl: 1.5 unit novolog

How much total insulin should Samantha receive?

A.

5 units novolog

B.

5.5 units novolog

C.

4 units novolog

D.

2.5 units novolog

Answer and Explanation

The Correct Answer is A

A. Carbohydrate coverage: Samantha's meal includes 60g of carbs, which is 4 carb exchanges (60g ÷ 15g). She needs 4 units of Novolog for the carbohydrates. Correction dose: Since her glucose level is 329mg/dl, it falls within the 300-349mg/dl range, so she needs 1 unit of Novolog for correction. Total insulin = 4 units (meal coverage) + 1 unit (correction) = 5 units Novolog.

B. 5.5 units novolog: This would be incorrect because it adds an extra 0.5 units without a clear justification based on either the carbohydrate coverage or the blood glucose correction scale.

C. 4 units novolog: This is incorrect because it only accounts for the insulin needed to cover the carbohydrates in the meal and does not include the necessary 1-unit correction for her elevated blood glucose level.

D. 2.5 units novolog: This is incorrect as it significantly underestimates the insulin needed for both meal coverage and blood glucose correction. It doesn't accurately reflect either the carbohydrate content of the meal or the correction needed based on the provided scale.


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Related Questions

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"C"},"D":{"answers":"B"},"E":{"answers":"A"},"F":{"answers":"A"}}

Explanation

Effective (Helped Meet Expected Outcome)

Infant is pink and responsive to stimulation: Indicates improved oxygenation and neurological status.

Respirations: 69 breaths/min, saturation: 98% on 2L via HHFNC: Oxygenation has improved with supplemental oxygen, though the rate is still elevated. Nonetheless, SpO₂ is now within normal range.

Infant has a wet diaper: Suggests adequate hydration and renal perfusion, which is a positive outcome of supportive care.

Ineffective (Did Not Help Meet Expected Outcome):

Significant nasal congestion remains: Indicates suctioning or airway clearance interventions were insufficient or need to be repeated.

Subclavicular intercostal and subcostal retractions: Continued increased work of breathing means respiratory distress is still present.

Unrelated (Not Related to Expected Outcome):

Temperature is 100.7 °F: Mildly elevated, but not central to assessing respiratory effort or hydration in this scenario. It does not directly reflect effectiveness of current interventions for respiratory distress or hydration.

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"A","dropdown-group-3":"A","dropdown-group-4":"E","dropdown-group-5":"E"}

Explanation

Based on the available test results, the nurse suspects the child may be experiencing diabetic ketoacidosis because of ketones and glucose in the urine. The nurse anticipates that the child will need IV fluid replacement and IV regular insulin as soon as possible.

Rationale:

Diabetic ketoacidosis (DKA): The presence of both glucose (over 500 mg/dL) and ketones in the urine is a key indicator of diabetic ketoacidosis (DKA). DKA is a serious complication of diabetes mellitus, particularly type 1, where the body starts breaking down fats due to a lack of insulin, resulting in the production of ketones. When ketones build up in the blood, it leads to metabolic acidosis and a variety of other complications.

Ketones: High levels of ketones in the urine indicate that the body is unable to use glucose for energy and is instead breaking down fat. This is common in DKA, where the lack of insulin leads to fat breakdown and ketone production.

Glucose: The presence of glucose in the urine (glucosuria) suggests hyperglycemia, which is another hallmark of diabetes mellitus and typically present in diabetic ketoacidosis.

Treatment:

IV fluid replacement: In DKA, dehydration is common due to excessive urination from high blood sugar. IV fluids are administered to rehydrate the body and restore normal fluid and electrolyte balance.

IV regular insulin: Regular insulin is essential to lower the blood glucose level and stop the body from producing ketones. Insulin is administered via IV to quickly bring the glucose levels under control and prevent further production of ketones.

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