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Difficulty: HardPharmacological and Parenteral Therapies

An adult client admitted with severe diabetic ketoacidosis (DKA) is prescribed a continuous intravenous (IV) infusion of regular insulin. When initiating and managing this high-alert parenteral therapy, which actions should the nurse include in the plan of care? (Select all that apply.)

  1. Prime the intravenous tubing with 50 mL50\text{ mL} of the insulin solution and discard the fluid before connecting the line to the client.Answer
  2. Anticipate adding an intravenous fluid containing 5% dextrose once the client's blood glucose level decreases to 250 mg/dL250\text{ mg/dL}.Answer
  3. Monitor the client frequently for the development of new-onset muscle weakness and cardiac dysrhythmias.Answer
  4. D
    Discontinue the continuous insulin infusion immediately once the client's blood glucose level reaches 150 mg/dL150\text{ mg/dL} to prevent hypoglycemia.
  5. E
    Add prescribed long-acting insulin glargine directly into the continuous regular insulin intravenous bag to establish basal glycemic control.
  6. F
    Regulate the continuous insulin infusion using a manual gravity drip with a microdrip chamber to ensure steady administration.

Answer

The correct actions are priming the tubing with 50 mL of the insulin solution, adding a dextrose-containing IV fluid when blood glucose reaches 250 mg/dL, and monitoring for signs of hypokalemia.
Safe administration of continuous intravenous insulin requires addressing the drug's tendency to bind to PVC tubing by wasting a priming volume. Clinically, the nurse must anticipate the profound intracellular shift of potassium caused by insulin, necessitating vigilant monitoring for hypokalemia (dysrhythmias, muscle weakness). Furthermore, DKA protocols mandate the addition of 5% dextrose to IV fluids when blood glucose reaches 250 mg/dL to prevent hypoglycemia while allowing the insulin drip to continue until the acidotic state is fully resolved.

Step-by-Step Solution

1
Analyze the pharmacological properties of intravenous regular insulin in the context of IV administration.
Regular insulin adsorbs to PVC plastic. To ensure the client receives the correct dose, the IV tubing must be primed with insulin solution (typically 20-50 mL) to saturate binding sites before the tubing is connected to the client.
Failure to prime with the insulin solution results in the client receiving a lower-than-prescribed dose initially.
2
Determine the physiological effects of continuous IV insulin on serum electrolytes.
Insulin promotes the intracellular shift of potassium, lowering serum potassium levels. The nurse must monitor for hypokalemia, which presents with muscle weakness and cardiac dysrhythmias.
Hypokalemia is a life-threatening complication of DKA treatment.
3
Evaluate the protocol for blood glucose management during DKA resolution.
When blood glucose drops to approximately 250 mg/dL, the primary goal shifts from rapidly lowering glucose to clearing ketones and closing the anion gap. Dextrose must be added to the IV fluids.
Adding dextrose allows the continuous insulin infusion to remain running without causing severe hypoglycemia.
4
Identify contraindicated actions related to insulin infusions.
Insulin infusions should never be stopped abruptly without subcutaneous coverage, glargine cannot be given IV or mixed, and gravity drips are unsafe for high-alert medications.
These actions compromise patient safety through rebound acidosis, incompatibility reactions, and inaccurate dosing.

Key Concept

Pharmacological management of Diabetic Ketoacidosis (DKA) and IV insulin safety
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Topics

Pharmacological and Parenteral Therapies

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