A practical nurse is preparing to administer a morning dose of 10 units of regular insulin and 20 units of NPH insulin subcutaneously to a client with type 2 diabetes mellitus. Arrange the following steps for preparing and mixing these insulins in the correct chronological order.
- 1Roll the NPH insulin vial gently between the palms of the hands.
- 2Inject 20 units of air into the NPH insulin vial and withdraw the needle.
- 3Inject 10 units of air into the regular insulin vial and keep the needle inserted.
- 4Invert the regular insulin vial and withdraw 10 units of regular insulin.
- 5Insert the needle into the NPH insulin vial and withdraw 20 units of NPH insulin.
Answer
The correct sequence is to roll the NPH vial, inject air into the NPH vial, inject air into the regular vial, withdraw the regular insulin, and finally withdraw the NPH insulin.
The standard 'clear before cloudy' procedure ensures that the shorter-acting, clear regular insulin is not contaminated by the longer-acting, cloudy NPH insulin. Rolling the NPH gently prevents bubble formation while ensuring the suspension is properly mixed. Injecting air into both vials prevents a vacuum from forming, which ensures accurate dosing.
Step-by-Step Solution
Key Concept
Safe preparation and mixing of short-acting (clear) and intermediate-acting (cloudy) insulins.