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

3. Choose your patient:

5. 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. Glossary:

6. Name Lopez, Mia A DOB 07/05/38 Address 21 Sweet Lane Scrubs, AR 76543 Phone 876-5309 Problems Type II Diabetes Medication s 25 units of 70/30 insulin 2 Xs daily Chart Notes Ms. Lopez will be having a surgical procedure on 11/08/10 and has been having low glucose. Patient Chart:

7. 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? Nurse Report:

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

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

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

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

12. Correct 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. Obtain M.D. order for ½ - 1 amp of D50 Please click below to choose the next patient or to treat this patient again.

14. 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. Glossary:

15. Patient Chart: Name Jones, Timothy B DOB 08/08/75 Address 53 Saccharine St. Ivy, AR 77777 Phone 555-8765 Problems Type I Diabetes Medication s 30 units of Lantus at (HS) 5 units of Lispro (AC) Chart Notes Mr. Jones will be having a BKA on 11/08/10. He Lispro has been suspended until after surgery and he has been having high glocuse.

16. 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? Nurse Report:

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

18. Obtain an order to hold the Lispro Correct 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 Rational: Lispro must be given before meals Please choose a different treatment. Give sliding scale as ordered

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

21. Incorrect Please choose a different treatment. 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