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Zorluk: OrtaPharmacological Therapies

A practical nurse is preparing to administer a combination of regular insulin and neutral protamine Hagedorn (NPH) insulin to a client with diabetes mellitus. Arrange the following steps for preparing the mixed insulin injection in the correct chronological order.

  1. 1Roll the NPH insulin vial gently between the palms of the hands.
  2. 2Inject the appropriate volume of air into the NPH insulin vial.
  3. 3Inject the appropriate volume of air into the regular insulin vial.
  4. 4Withdraw the prescribed dose of regular insulin.
  5. 5Withdraw the prescribed dose of NPH insulin.

Cevap

The correct chronological sequence is to roll the NPH vial, inject air into the NPH vial, inject air into the regular insulin vial, withdraw the regular insulin, and finally withdraw the NPH insulin.
The 'clear before cloudy' procedure is a standard pharmacological safety protocol. It ensures that the short-acting (clear) regular insulin is not contaminated by the intermediate-acting (cloudy) NPH insulin. Contamination would unpredictably change the pharmacokinetics of the regular insulin remaining in the vial.

Adım Adım Çözüm

1
Roll the NPH insulin vial.
The intermediate-acting insulin suspension is thoroughly mixed.
NPH is a suspension that settles when standing; rolling mixes it without creating bubbles that could lead to inaccurate dosing.
2
Inject air into the NPH insulin vial and remove the needle.
The NPH vial is pressurized.
Injecting air equal to the prescribed dose prevents a vacuum from forming when the medication is withdrawn later.
3
Inject air into the regular insulin vial and keep the needle inserted.
The regular insulin vial is pressurized and ready for withdrawal.
Pressurizing the vial allows the medication to flow easily into the syringe.
4
Invert the regular insulin vial and withdraw the prescribed dose.
The clear insulin is loaded into the syringe.
Drawing the clear insulin first ensures that no cloudy NPH insulin can accidentally enter and contaminate the regular insulin vial.
5
Insert the needle into the NPH vial and withdraw the prescribed dose.
The exact total volume of mixed insulin is achieved.
The cloudy insulin is added last to complete the mixture, ensuring the 'clear before cloudy' safety principle is maintained.

Anahtar Kavram

Safe Preparation and Mixing of Insulins (Clear Before Cloudy)
Tahmini Süre:1m 30s
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Pharmacological Therapies

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