In order to successfully treat your patient you will need to:

2. In order to successfully treat your patient you will need to: • Choose your patient • Review the patient chart • Review the nurse report • Choose the best method of treatment You will also have a glossary of terms

3. Choose your patient:

5. Glossary: Asymptomatic - a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms. Diabetic Ketoacidosis - is a type of metabolic acidosis associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. Glucose - a simple sugar (monosaccharide), is an important carbohydrate in biology. Cells use it as a source of energy and a metabolic intermediate. Lantus (insulin glargine) is used to treat type 1 or type 2 diabetes. Lispro – also known as Humalog, is a rapid onset insulin. It results from switching two amino acids on the human insulin chain - lysine and proline. NPO - Latin for “nil per os” (nothing by mouth) NPO, abbreviation for nothing by mouth. Subcutaneuosly - performed or introduced under the skin, as an injection by a syringe. Type 1 diabetes – (IDDM, or juvenile diabetes) is a form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas. Type 2 diabetes - a chronic (lifelong) disease marked by high levels of sugar (glucose) in the blood.

6. Patient Chart:

7. Nurse Report: Ms. Lopez is a 72-year-old Hispanic female with type II diabetes. She takes 25 units of 70/30 insulin subcutaneously twice a day. Ms. Lopez has a right 20 gauge peripheral I.V. that is saline locked. Ms. Lopez has been NPO for a surgical procedure, and her glucose this morning is 63. Ms. Lopez is asymptomatic and her morning dose of insulin was held. How should her low blood sugar be treated?

8. Choose your treatment: 4 ounces of orange juice • 1 tube of glucose gel • Obtain M.D. order • for ½ - 1 amp of D50 • No intervention

9. Incorrect 4 ounces of orange juice Rational: Patient is NPO for procedure and could not have the procedure if she consumes orange juice Please choose a different treatment.

10. Incorrect • 1 tube of glucose gel Rational: Patient is NPO for procedure and could not have the procedure if she consumes the gel Please choose a different treatment.

11. Incorrect • No intervention Rational: Patients blood sugar is critically low glucose <80 should be considered for treatment especially if client is NPO Please choose a different treatment.

12. Correct • Obtain M.D. order for ½ - 1 amp of D50 Rational: Per protocol glucose <70 nurse should call M.D. for an order to give ½ - 1 amp of D50 and recheck glucose 20 minutes later Congratulations! You successfully treated your patient. Please click below to choose the next patient or to treat this patient again.

14. Glossary: Asymptomatic - a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms. Diabetic Ketoacidosis - is a type of metabolic acidosis associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. Glucose - a simple sugar (monosaccharide), is an important carbohydrate in biology. Cells use it as a source of energy and a metabolic intermediate. Lantus (insulin glargine) is used to treat type 1 or type 2 diabetes. Lispro – also known as Humalog, is a rapid onset insulin. It results from switching two amino acids on the human insulin chain - lysine and proline. NPO - Latin for “nil per os” (nothing by mouth) NPO, abbreviation for nothing by mouth. Subcutaneuosly - performed or introduced under the skin, as an injection by a syringe. Type 1 diabetes – (IDDM, or juvenile diabetes) is a form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas. Type 2 diabetes - a chronic (lifelong) disease marked by high levels of sugar (glucose) in the blood.

15. Patient Chart:

16. Nurse Report: Timothy Jones is a 35-year-old white male with a history of type I diabetes, diagnosed when he was 10 years old. He also has a history of multiple hospital admissions for diabetic ketoacidosis (DKA). He is scheduled for O.R. for a right below the knee amputation (BKA). He has been NPO since midnight. He received 15 units of Lantus at hour of sleep (hs), which is ½ of his usual dose of 30 units. He has an order for 5 units Lispro with each meal, which has been suspended. He has the following sliding scale which is still in effect: <180 no Lispro; 181-240 2 units Lispro; 241-300 4 units Lispro; 300-350 6 units Lispro; 351-400 8 units Lispro. When the patient care tech (PCT) checked his blood glucose, his glucose was 234. The PCT notified the nurse immediately. How should you treat this patient?

17. Choose your treatment: Obtain an order to hold the Lispro • Give ½ the sliding scale ordered • No intervention needed except to document the blood glucose • Give sliding scale as • ordered

18. Correct Obtain an order to hold the Lispro Rational: Lispro is only to be given before meals because of the rapid onset Congratulations! You successfully treated your patient. Please click below to choose the next patient or to treat this patient again.

19. Incorrect • Give sliding scale as ordered Rational: Lispro must be given before meals Please choose a different treatment.

20. Incorrect • Give ½ the sliding scale ordered Rational: Lispro must be given before meals Please choose a different treatment.

21. Incorrect • No intervention needed except to document the blood glucose Rational: Glucose >200 should be reported to the physician because WBC (white blood count production is reduced when blood glucose reaches this level; increasing the patients risk for an infection Please choose a different treatment.