Question

Calculate the dosage of insulin where necessary, and shade the dosage on the syringe provided. Labels have been provided for some problems. Order: Humulin R U-100 16 units subcut and Humulin N U-100 24 units subcut a.c. 7:30 \(\mathrm{AM}\).

Short answer

Inject 16 units of Humulin R and 24 units of Humulin N subcutaneously.

Step-by-step solution

Understand the Medication Order

The physician's order is for two types of insulin: Humulin R U-100 at 16 units and Humulin N U-100 at 24 units. Both are to be administered subcutaneously before meals (a.c.). The specific time mentioned is 7:30 AM.

Prepare the Insulin Syringes

Since both types of insulin are U-100, it is crucial to use a U-100 insulin syringe for accurate dosing. Each unit in the syringe corresponds accurately to the units ordered.

Measure the Dosage for Humulin R

Using a U-100 syringe, draw exactly 16 units of Humulin R insulin into the syringe. Ensure there are no air bubbles, and the dosage is precise by checking the syringe markings up to 16 units.

Measure the Dosage for Humulin N

Similarly, using another U-100 syringe, draw exactly 24 units of Humulin N insulin. Again, ensure the dosage is precise with no air bubbles, checking the syringe up to 24 units.

Administer and Record

Administer each insulin dose subcutaneously, as ordered. Record the administration time and dosage as part of the patient's medication administration record (MAR).

Key concepts

Medication Order Interpretation

Interpreting a medication order requires attention to detail and precision. The physician's order for Humulin R U-100 and Humulin N U-100 indicates the type and quantity of insulin needed. It's important to note that “U-100” refers to the insulin concentration, meaning there are 100 units of insulin per milliliter of solution. "Subcut" or subcutaneous is the route of administration, and “a.c.” means the medication should be administered before meals. Ensure the timing, such as 7:30 AM in this case, aligns with the patient's meal schedule for optimal blood glucose control. Read every detail of the order to ensure correct preparation and administration.

Insulin Syringe Preparation

Preparing an insulin syringe accurately is crucial to ensure the correct dosage is administered. Use a U-100 insulin syringe, as it aligns with the insulin concentration ordered. These syringes are specifically calibrated to measure insulin in a way that each line or marking on the syringe corresponds to one unit of U-100 insulin.

Steps for preparation:

• Select a syringe that matches the type of insulin you will draw. In this case, a U-100 syringe for both Humulin R and Humulin N.
• Check for clarity in the insulin, ensuring no particles or cloudiness for Humulin R, which should be clear. Humulin N should be mixed as it is cloudy.
• Sanitize your hands and clean the vial’s rubber top with an alcohol swab to prevent contamination.

These steps are essential to prepare the insulin for safe and effective administration.

Dosage Measurement

Accurate dosage measurement is crucial for effective insulin therapy. For Humulin R, draw exactly 16 units into the syringe. For Humulin N, measure 24 units. Each unit you draw needs to be precise.

Here are tips to ensure accuracy:

• Carefully pull back the plunger to fill the syringe with the required units.
• Check for air bubbles which can alter the measured amount. Tap the syringe gently to release air bubbles, then recheck the dose amount before proceeding.
• Use the syringe markings to guide proper dosing, ensuring the liquid lines up perfectly with the unit markings.

Each step ensures that the patient receives the exact prescribed dose, crucial for managing blood sugar levels effectively.

Subcutaneous Administration

Subcutaneous administration involves injecting medication into the tissue just under the skin. This route is chosen for insulin because it allows for slow, steady absorption into the bloodstream.

Here's how to administer subcutaneous injections:

• Select an appropriate injection site—common areas include the abdomen, outer thigh, or upper arm.
• Cleanse the site with an alcohol swab and allow it to dry.
• Pinch the skin to lift the subcutaneous tissue away from the muscle, then insert the syringe needle at a 45- to 90-degree angle, depending on the needle length and your judgment based on the patient's skin thickness.
• Administer the insulin slowly and withdraw the needle at the same angle as insertion.

After administration, it’s important to dispose of the syringe safely and document the dosage and time to maintain accurate medical records.