Term
| The largest influence exerted on healthcare organizations comes from the aging of the population. By the year 2025, more than |
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Definition
| 18% of the population is expected to be older than 65 years of age. |
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Term
| The numbers of “the old-old,” those older than |
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Definition
| 80, are increasing dramatically. |
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Term
| Insulin aspart [NovoLog], insulin lispro. |
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Definition
Insulin aspart [NovoLog] is an analog of human insulin with a rapid onset (10 to 20 minutes) and short duration (3 to 5 hours). The drug is structurally identical to human insulin except that one amino acid—proline in position 28 of the B chain—has been changed to aspartic acid. Production is by recombinant DNA technology. Insulin aspart is very similar to insulin lispro.
Insulin aspart (100 U/ml) is available in 10-ml vials and 3-ml PenFill cartridges. Administration is SC. Because of its rapid onset, the drug should be injected immediately before meals (eating should begin within 5 to 10 minutes of administration) or immediately after. Like insulin lispro, insulin aspart should be used in combination with an intermediate-acting or long-acting insulin to provide basal glycemic control between meals and during the night. Insulin aspart can be mixed with NPH insulin (provided mixing is done just before administration). There are no data on mixing the drug with lente or ultralente insulin. Like lispro insulin, insulin aspart is available only by prescription. |
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Term
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Definition
lispro (Humalog)
aspart (Novolog) |
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Term
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Definition
| regular (Humulin R, Novolin R, Regular Iletin) |
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Term
| Intermediate-acting insulin |
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Definition
| NPH (Humulin N, Novolin N) lente (Humulin L, Novolin L) |
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Term
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Definition
| ultralente (Humulin U) glargine (Lantus) |
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Term
| Combination therapy (premixed) |
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Definition
NPH/regular 70/30[*] (Humulin 70/30, Novolin 70/30)
NPH/regular 50/50 (Humulin 50/50)
NPH/lispro 75/25 (Humalog Mix 75/25) |
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Term
| Single dose |
Intermediate insulin (I) |
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Definition
| One injection should cover noon and PM meal. Hypoglycemia during sleep is not a problem. |
No fasting, breakfast, or nighttime coverage of hyperglycemia is available. |
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Term
| Split-mixed dose (70/30 premix) |
Intermediate and regular or Humalog insulin (I + R or I + H) |
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Definition
| Two injections provide coverage for 24 hr. |
Two injections are required. Patient must adhere to a set meal pattern. |
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Term
| Split-mixed dose |
Intermediate and regular or Humalog insulin (I + R or I + H) |
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Definition
| Three injections provide coverage for 24 hr, particularly during early AM hours. Potential is reduced for 2–3 AM hypoglycemia. |
Three injections are required. |
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Term
| Multiple dose |
Intermediate and regular or Humalog insulin (I + R or I + H) |
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Definition
| More flexibility is allowed at mealtimes and for amount of food intake. |
Four injections are required. Premeal blood glucose checks, establishing and following individualized algorithm are necessary. Patients with type 1 will require basal insulin (I or LA) during the day. |
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Term
| Multiple dose[†] (split dose long-acting insulin [ultralente]) |
Regular or Humalog and long-acting insulin (R + LA or H + LA) |
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Definition
| Insulin delivery pattern more closely simulates normal endogenous insulin pattern. Some flexibility is allowed in food intake pattern. Regimen gives a basal insulin coverage and regular or Humalog insulin covers meal blood glucose excursions. |
Required three or four injections and blood glucose check premeal and on retiring. Establishing and following individualized algorithm are necessary. |
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Term
| H, lispro (Humalog) or rapid-acting insulin (R)=_____; |
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Definition
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Term
| I, intermediate insulin=_____; |
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Definition
- NPH (Humulin N, Novolin N)
- lente (Humulin L, Novolin L)
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Term
| LA, long-acting insulin=_____ |
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Definition
- ultralente (Humulin U)
- glargine (Lantus)
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Term
|
R, regular insulin=_____.
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Definition
| regular (Humulin R, Novolin R, Regular Iletin) |
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Term
| Synthetic rapid-acting insulins include ____ and ______. Onset of action is ____. |
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Definition
| lispro (Humalog) and aspart insulin (Novolog). They have an onset of action of approximately 5 to 15 minutes (as compared with 30 to 60 minutes for regular insulin). Rapid-acting insulin is considered to be the type that best mimics natural insulin secretion in response to a meal. It is injected at the time of the meal to within 15 minutes of the meal. When this type of insulin is used as mealtime coverage in people with type 1 diabetes, another longer-acting insulin must also be used as basal background insulin, because the duration of rapid-acting insulin is so short. |
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Term
| This insulin must not be diluted or mixed with any other insulin or solution. |
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Definition
| Insulin glargine (Lantus) is a long-acting insulin that is released steadily and continuously and does not have a peak of action (see Fig. 47-3). Glargine is used for once-daily subcutaneous administration at bedtime in patients with type 1 and type 2 diabetes mellitus who require basal (long-acting) insulin for the control of hyperglycemia. Because it lacks peak action time, the risk for hypoglycemia from glargine is greatly reduced. Glargine must not be diluted or mixed with any other insulin or solution.[7] |
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Term
| Insulin glargine (Lantus)use and action. |
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Definition
| Insulin glargine (Lantus) is a long-acting insulin that is released steadily and continuously and does not have a peak of action (see Fig. 47-3). Glargine is used for once-daily subcutaneous administration at bedtime in patients with type 1 and type 2 diabetes mellitus who require basal (long-acting) insulin for the control of hyperglycemia. Because it lacks peak action time, the risk for hypoglycemia from glargine is greatly reduced. Glargine must not be diluted or mixed with any other insulin or solution.[7] |
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Term
| Two different insulin types are commonly used in combination to mimic what ? |
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Definition
| Two different insulin types are commonly used in combination to mimic normal endogenous insulin secretion (see Table 47-4). Short- or rapid-acting insulin is often mixed with a longer-acting insulin to provide both mealtime and basal coverage without having to administer two separate injections. Patients may mix the two types of insulin themselves or may use a commercially premixed formula (see Table 47-3). These offer convenience to patients and are especially helpful to those who lack the visual, manual, or cognitive skills to mix insulin themselves. However, the convenience of these formulas sacrifices the potential for optimal blood glucose control, because there is less opportunity for flexible dosing based on need. |
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Term
| Insulin Storage Considerations |
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Definition
| As a protein, insulin requires special storage considerations. Heat and freezing alter the insulin molecule. Insulin vials that the patient is currently using may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86° F (30° C) or below freezing (less than 37° F [2° C]). Prolonged exposure to direct sunlight should be avoided. Extra insulin may be stored in the refrigerator. The same principles apply for a patient who is traveling. Insulin can be stored in a thermos or cooler to keep it cool (not frozen) if the patient is traveling in hot climates. |
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Term
| Prefilled syringes are stable for up to how many days? How should they be stored? |
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Definition
| Prefilled syringes are stable for up to 30 days when stored in the refrigerator. This may be beneficial to patients who are sight impaired or who lack the manual dexterity to fill their own syringes at home. In these cases family members, friends, and caregivers may prefill syringes on a periodic basis. Syringes prefilled with a cloudy solution should be stored in a vertical position with the needle pointed up to avoid clumping of suspended insulin binders in the needle.[8] When stored properly, prefilled syringes with mixed insulins should maintain potency for 30 days. Likewise, commercially prepared mixtures may be prefilled and stored for later use. Some insulin combinations are not appropriate for prefilling and storage because the mixture can alter the onset, action, and/or peak times of either of the types. Pharmacy references should be consulted as needed when mixing and prefilling different types of insulin. Prefilled syringes should be gently rolled between the palms before injection to warm the refrigerated insulin and to resuspend the particles. |
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Term
• U-500 insulin is 5 times as strong as U-100 insulin.
• Therefore the amount of U-500 insulin should be divided by 5.
• Dosage of U-500 insulin/5 = amount of insulin to draw into U-100 syringe.
• 20 units of U-500 insulin/5 = |
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Definition
| 4 units of insulin to draw into U-100 syringe. |
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Term
| cannot be mixed with other insulins. |
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Definition
| Insulin glargine (Lantus) cannot be mixed with other insulins. |
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Term
| Before withdrawing insulin from a vial, the nurse should |
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Definition
| Before withdrawing insulin from a vial, the nurse should rotate the vial at least 1 minute between both hands. This resuspends the modified insulin preparations and helps to warm the medication. The nurse should not shake insulin vials. Shaking causes bubbles to form, which take up space and alters the dose. |
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Term
| Cloudy to Clear or Clear to Cloudy ? Procedure for drawing two types of insulin into one syringe? |
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Definition
1 With an insulin syringe and needle, inject air, equal to the dose of insulin to be withdrawn, into the vial of intermediate- or long-acting (cloudy) insulin. Do not touch the tip of the needle to the solution.
2 Remove the syringe from the vial of cloudy insulin.
3 With the same syringe, inject air, equal to the dose of insulin to be withdrawn, into the vial of rapid- or short-acting insulin (clear vial). Then withdraw the correct dose into the syringe.
4 Remove the syringe from the clear insulin vial after carefully removing air bubbles in the syringe to ensure correct dose.
5 Return to the vial of intermediate- or long-acting (cloudy) insulin, and withdraw the correct dose.
6 Administer mixture of insulins within 5 minutes of preparing it. Rapid- or short-acting insulin can bind with intermediate- or long-acting insulin, thus reducing the action of the faster-acting insulin. |
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Term
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Definition
| Primary prevention is true prevention. It precedes disease or dysfunction, and you apply it to patients considered physically and emotionally healthy. It is not therapeutic, does not use therapeutic treatments, and does not involve symptom identification (Edelman and Mandle, 2002). The purpose of primary prevention is to decrease the vulnerability of the individual or population to an illness or dysfunction (Edelman and Mandle, 2002). Primary prevention includes passive and active strategies of health promotion. It is provided to an individual or to a general population or focuses on individuals at risk for developing specific diseases. Wellness activities (Edelman and Mandle, 2002) are synonymous with the activities identified for primary prevention by Leavell and Clark (1965) in Table 1-1. In our case study of Jack, primary prevention means simply wearing shoes at all times. Jack has diabetes and peripheral vascular disease. These conditions cause alterations in perception of pain in the extremities and alterations in circulation to the extremities. Both of these problems contribute to a risk for altered wound healing. Jack needs to make additional efforts to prevent injuries. |
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Term
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Definition
| Secondary prevention focuses on persons who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention, thereby reducing severity and enabling the patient to return to a normal level of health as early as possible (Edelman and Mandle, 2002). A large portion of secondary level nursing care is in homes, hospitals, or skilled nursing facilities. It includes screening techniques and treating early stages of disease to limit disability by delaying the consequences of advanced disease. If Jack had seen his primary care provider sooner, it is possible that earlier intervention would have prevented the progressive ulcer and the osteomyelitis. Then he could have avoided the surgical procedure and the lengthy course of IV antibiotics. |
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Term
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Definition
| Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration (Edelman and Mandle, 2002). Activities are for rehabilitation rather than diagnosis and treatment. Care at this level aims to help patients achieve as high a level of functioning as possible, despite the limitations caused by illness or impairment. This level of care is called preventive care because it involves preventing further disability or reduced functioning. Tertiary prevention for Jack includes continual monitoring and management of blood glucose levels and control of his diabetes. Tight control of blood glucose levels prevents further complications of his diabetes, such as diabetic ketoacidosis. |
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Term
| The team leader's responsibilities include: |
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Definition
| The team leader plans the care, delegates the work, and follows up with members to evaluate the quality of care. In the ideal circumstance the team leader updates the nursing care plans and facilitates patient care conferences. Time constraints during the shift may prevent scheduling daily patient care conferences. |
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Term
Management Theory:
Autocratic/Authoritative |
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Definition
Determines policy and makes all the decisions.
Ignores subordinates' ideas or suggestions.
Dictates the work with much control.
Gives little feedback or recognition for work.
Makes fast decisions.
Successful with employees with little education or training. |
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Term
Management Theory:
Democratic/Participative |
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Definition
Encourages staff participation in decision making.
Involves staff in planning and developing.
Believes in the best in people.
Communicates effectively and provides regular feedback.
Builds responsibility in people.
Works well with competent, highly motivated people. |
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Term
Management Theory:
Laissez-faire |
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Definition
Does not provide guidance or direction.
Unable or unwilling to make decisions.
Does not provide feedback.
Initiates little change.
Rules by memos.
May work well with professional people. |
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