Pharmacology Routes of Admin #2

Question

Which would most support the nurse’s action of administering intravenous (IV) regular insulin to the critical care patient?

Answers

  1. The patient had consecutive bedside blood glucose readings of 250 mg/dL.
    • Rationale:

      This is not the correct answer because IV insulin is not an appropriate intervention for a consecutive 250 mg/dL blood glucose readings. The IV route for regular insulin is only used for emergent circumstances, such as during DKA, when extremely elevated blood glucose readings are sustained and other symptoms of metabolic acidosis are evident.

  2. The insulin should only be given subcutaneously, never intravenously.
    • Rationale:

      This is not the correct answer because subcutaneous insulin administration is not the appropriate route for this patient with sustained blood glucose readings of > 500 mg/dL in the critical care unit. The patient likely has DKA and is in a critical situation. Subcutaneous routes are most appropriate during non-emergent times, when blood glucose readings are relatively stable and lower than 500 mg/dL.

  3. The laboratory results indicate a sustained blood glucose of >500 mg/dL.
    • Rationale:

      This is the correct answer because IV administration of insulin is appropriate for a critical care patient with sustained blood glucose readings of >500 mg/dL. The IV route for regular insulin is generally used for emergent circumstances, such as during DKA, when extremely elevated blood glucose readings are sustained, with other symptoms of metabolic acidosis and end organ failure are evident. The subcutaneous route would not be most appropriate.

  4. The PO insulin was not available and the blood glucose is 550 mg/dL
    • Rationale:

      This is not the correct answer because PO insulin is non-existent. It would be destroyed by the stomach’s acid. Oral hypoglycemics would not be appropriate due to the extreme elevation of the blood glucose. IV insulin is the best, most effective source of insulin for this patient.

Overview

Diabetic ketoacidosis (DKA) is important to understand, including causes, symptoms, and treatments. IV insulin is rarely used, but is a uniquely significant treatment during DKA.

Explanation

Learning Outcomes

Intravenous insulin is indicated during emergencies or situations where there is sustained, dangerous blood glucose levels, such as in diabetic ketoacidosis (DKA). During the early stages of DKA, IV administration of regular insulin is indicated, since the patient risks dangerous damage to end organs and death from acidosis and lack of adequate blood glucose to necessary organs.

Test Taking Tip

There is a difference in understanding rare and insignificant things in nursing compared to unique. Unique is important to focus on since it is often tested, especially when it is associated with airway, breathing, and circulation.

Video Rationale