The nurse has administered NPH insulin at 1700.
At what time would the nurse anticipate the peak action of this insulin?

Rationale for A:

Regular insulin is the only insulin formulation that can be safely administered intravenously. It is a rapid-acting insulin that starts working within 15 minutes and peaks in 1-2 hours, making it ideal for urgent glucose control in situations like diabetic ketoacidosis.

NPH insulin is an intermediate-acting insulin that is not suitable for IV administration. It is designed to be absorbed slowly over several hours, and injecting it intravenously could lead to unpredictable and potentially dangerous fluctuations in blood glucose levels.

Subcutaneous (SQ) injection is the standard route of administration for both regular and NPH insulin outside of acute care settings. This route allows for a more gradual and consistent absorption of insulin, which is essential for maintaining stable blood glucose control.

The patient's transfer to the med/surg unit indicates that their condition has stabilized and no longer requires the aggressive glucose control that is achieved with an IV insulin infusion. Therefore, it is appropriate to transition them to SQ insulin injections.

Rationale for B:

While mixing insulins can potentially alter their absorption rates and action profiles, the primary concern with mixing NPH and regular insulin is not an increased risk of hypoglycemia. It is the incompatibility of the formulations for IV administration.

Rationale for C:

NPH and regular insulin can be mixed together for subcutaneous injection, but they are not compatible for intravenous administration.

Rationale for D:

While NPH insulin can be administered as part of an IV insulin drip in the ICU, this is typically done in specific situations where a continuous infusion of both rapid-acting and intermediate-acting insulin is required. It is not the standard practice for NPH insulin administration.

Rationale for Choice A:

Decreasing the morning insulin dose by half without consulting the provider could lead to hyperglycemia, which can be dangerous for patients with diabetes, especially those undergoing surgery.

It is important to individualize insulin doses based on the patient's blood glucose levels, insulin sensitivity, and other factors. The provider may need to assess the patient's blood glucose levels and adjust the insulin dose accordingly.

Rationale for Choice B:

It is not safe to assume that the provider would want the client to receive the usual insulin dose prior to surgery without confirming this with the provider.

Patients with diabetes who are NPO (nothing by mouth) are at risk for hypoglycemia, as they are not receiving their usual intake of carbohydrates.

It is important to adjust insulin doses to prevent hypoglycemia in these patients.

Rationale for Choice D:

Holding the morning dose of insulin until after a fasting glucose is done could lead to hyperglycemia, as the patient would not be receiving any insulin to cover their blood glucose levels.

It is important to administer insulin to patients with diabetes, even if they are NPO, to prevent hyperglycemia.

Rationale for Choice C:

This is the best action for the nurse to take because it ensures that the provider is aware of the situation and can provide appropriate orders for the patient's insulin management.

The provider may need to adjust the insulin dose, order a fasting glucose level, or provide other instructions for the patient's care.

It is important to communicate with the provider to ensure that the patient receives safe and appropriate care.