Medical Surgical Diabetes #6

Question

A nurse is providing instruction with client demonstration on self-administration of insulin. Which of the following Teach Back actions will the nurse observe by the client? Select all that apply.

Answers

  1. Client takes a vial and gently rotates it and states, “I will ensure that the insulin vial is never shaken.â€
    • Rationale:

      This answer is correct because the client should understand and demonstrate the importance of gently rotating the vial of insulin before administration (not shake). Shaking can cause bubbles and may interfere with the absorption of the medication. Rolling the vial in the hands is also a good way to mix insulin suspensions.

  2. Client describes where insulin will be stored, then states, “ I will never freeze insulin.â€
    • Rationale:

      This answer is correct because the client should understand and demonstrate the importance of never freezing insulin. Insulin should be kept away from heat and light. Insulin that is not currently being used and needing storage, should be kept in the refrigerator between 36-46 degrees F until needed. Insulin being currently used should be used at room temperature (between 56-80 degrees F) and should be kept at room temperature for no more than 30 days.

  3. Client looks at the hospital menu then states, “ I can give myself more insulin, then eat anything I want.â€
    • Rationale:

      This answer is not correct because the client should understand that insulin is not prescribed to allow the client to eat anything they want. Instead, it is prescribed to keep blood glucose levels controlled while eating a well-balanced diet.

  4. Client performs mock injection site selection and states, “I will rotate sites.â€
    • Rationale:

      This answer is correct because the client should understand and demonstrate the importance of how to inject insulin, including the importance of rotating sites. Rotating sites is important since it will be safer, easier, and less uncomfortable. If repeated site usage occurs, the client may develop areas that are hardened (lipohypertrophy) that will keep the insulin from absorbing properly.

  5. Client states, “On days I am sick and cannot eat or am vomiting, I will skip my insulin so my blood sugar will not get too low.â€
    • Rationale:

      This answer is not correct because infection usually increases the body’s need for insulin. The hormones that are released to fight infection make it more difficult for the body to use insulin. Client is to continue to take insulin as prescribed and call the doctor for specific instructions if there is a concern.

Overview

It is important for clients to understand the basics of self-administration of insulin. This includes to gently rotate the vial of insulin before administration (not shake), to never freeze insulin, and to rotate sites of administration.

Explanation

Learning Outcomes

If a client has been prescribed home insulin, it is the responsibility of the nurse to assure the client understands how to self-administer insulin. After the nurse teaches the client, if the client then demonstrates and verbalizes the teaching, this will help indicate if the client understands the teaching or not. Specific teaching for the client to understand includes to gently rotate the vial of insulin before administration (not shake), to never freeze insulin, and to rotate sites of administration. The client also needs to understand that insulin is not a tool to allow overeating. Instead, to eat a well-balanced diet and use insulin to balance blood glucose.

Test Taking Tip

Diabetic client education is extremely important and highly tested. Know how to instruct clients about various things, including their type of diabetes, symptoms of hypoglycemia and hyperglycemia, how to take medications, including insulin administration (if applicable), sick days, how to avoid complications, follow up visits for monitoring (primary care, eye visits) and self-checking (feet, other minor cuts), and when to seek medical attention.

Video Rationale