Hypothetical cases for analysis and presentation

NAME OF STUDENTS:
Sol, Andreana Maria G.
Soriano, Ashley Alyson Hnah V.
Suguitan, Godwin Allen L.
Tigno, Angelica Geanne A.
Tresmaria, Juliana Louise T.
Trinidad, Karylle Francesca V.
Valdez, Jon Kobe I.
Viana, Jhanssen Daniel
Victoria, Sherilyn R.
Villanueva, Sophia D.

SECTION: 19
 Case #5: GENITOURINARY SYSTEM

Case 5 situation

This is a case of a 35 year old male, single, working as an executive in a world-renowned

company. He has a girlfriend of 6 years. Admitted due to complain of blood in the urine, no pain.

Vital signs are as follows: BP 160/100; PR-65; RR-20; Temp-37.8

Laboratory and diagnostic work-ups done were as follows: Blood Urea Nitrogen (BUN), K+,
Na+, EgFR, GFR, Urinalysis, creatinine clearance, serum creatinine, Complete Blood Count,
Urea, Glomerular Filtration Rate (GFR), Renal ultrasound, ECG and X-ray., FBD

Medications prescribed were as follows: Cefuroxime, Calcium, Enalapril, Erythropoietin,

Humulin-N

1. Explain the structure and function of the renal system. How is urine produced?
● The renal system comprises kidneys responsible for urine production, with urethra,
ureters, and bladder serving as pathways for urine passage, storage, and voiding. These
two kidneys regulate blood electrolyte composition, eliminating waste products and
excess substances, excreting them in urine. Then, this urine travels from kidneys to the
bladder through thin muscular tubes called ureters, wherein, the bladder holds urine until
it is expelled through the urethra. Clearly, the terms "excretory" and "urinary" underscore
the renal system's elimination function (David Le Vay & Mitchell, 2018).
2. Considering the given demographic profile, who is at risk for having Acute Renal
Failure?
● Given the client's demographic profile, several factors such as age, pre-existing health
disorders, renal illnesses, infections, and drugs all contribute to the risk of Acute Renal
Failure. For starters, as an individual ages, he or she may be predisposed to Acute Renal
Failure due to the aging process and the cumulative influence of various health issues.
Second, the client’s blood pressure is 160/100 mmHg which means that he has a high
blood pressure, and this pre-existing disease is at a higher risk. Third, hematuria, or blood
in the urine, can be caused by kidney disease, which renders a person more susceptible to
sudden episodes of renal failure. Fourth, a body temperature of 37.8 degrees Celsius
might be caused by a serious infection, such as urinary tract infections, which damage the
kidney and pose risks. Lastly, antibiotics medications prescribed were Cefuroxime,
 Calcium, Enalapril, Erythropoietin, and Humulin-N could affect the kidneys and pose a
risk.
3. Looking at the vital signs of the patient, what situations may cause changes (decrease or
increase) in these vital signs? Why did you say so? (ex. infection, overdose, under dose,
pain, bleeding)
● The vital signs assessed of the client have an increased blood pressure of 160/100
which is indicated stage 2 hypertension that is a deviation from normal, the
temperature rises at 37.7°C which is also deviated from normal. The interpretation
for this is a cause of the changes that have to do with a certain hemodynamic with
the vital signs during each dialysis session. On top of that, having the maintenance
of a post-dialysis session will likely cause complications, in a nursing diagnosis
these includes hypotension and may also manifest nausea, fever, vomiting,
headaches, shortness of breath, edema, urine output decrease, anxiety, confusion,
and weight gain.
4. Define the laboratory and diagnostic tests ordered by the physician. Why are they being
requested to this patient?
- It is a requested sample test for analyzation and performing clinical trials
in the laboratory to see if there are abnormalities or malfunction of the
kidneys and to diagnose the condition, the following lists below are the
laboratory and diagnostic tests that are being ordered by the physician:
● Urinalysis - To get a sample of urine to test in searching for any abnormalities that
suggest kidney failure
● Blood Urea Nitrogen (BUN) - This is requested to see the accumulated
glomerular filtration rate
● Glomerular Filtration Rate (GFR) - It determines if the patient has a kidney
disease
● Creatinine Clearance - It provides information whether the kidney is still
functioning or not
● Serum Creatinine - It is used for evaluating kidney function
● Complete Blood Count (CBC) - It assesses the white blood cells, red blood cells,
and the platelets, It also checks if there is any abnormalities in the blood cells.
● Renal ultrasound - It needs to assess the kidney’s shape, size, location, and its
structures to identify the abnormalities
● ECG - It helps to detect and determine if there is a possibility of Chronic Kidney
Disease (CKD). It is also applied to predict the risk evaluation of CKD patients.
● X-Ray - To check through tomography if there are any abnormalities in the kidney
5. Given the laboratory and diagnostic tests, what are the important points that you should
include in your health teaching prior to and/or after the tests?
 ● Health teaching prior to and after the mentioned laboratory and diagnostic tests is
crucial to ensure patient understanding and cooperation. Before undergoing
urinalysis, patients should be instructed on proper urine sample collection
techniques to obtain accurate results. For Blood Urea Nitrogen (BUN),
Glomerular Filtration Rate (GFR), Creatinine Clearance, and Serum Creatinine
tests, it’s important to explain that these tests assess kidney function, emphasizing
the significance of following any pre-test fasting or hydration guidelines.

Patients undergoing a Complete Blood Count (CBC) should be informed about

the purpose of assessing blood cells and platelets and educated on the potential
implications of abnormalities in these counts. Renal ultrasound recipients should
understand the non-invasive nature of the procedure and the importance of
identifying kidney abnormalities based on the imaging results. For an ECG,
patients need to comprehend its role in detecting and assessing the risk of Chronic
Kidney Disease (CKD).

In the case of X-rays, patients should be informed about the use of tomography to
detect abnormalities in the kidney, and any necessary preparation or precautions.
Both pre- and post- tests, patients should be educated on the significance of these
tests in monitoring kidney health, potential implications of abnormal results, and
the importance of follow-up consultations for further management. Additionally,
any lifestyle or dietary changes recommended by the healthcare provider based on
the test results should be clearly communicated to ensure patient compliance and
proactive management of kidney health.

6. Considering the condition of the patient and his anatomy and physiology, what are the
reasons these symptoms arise?
●

The 35-year-old male patient who was admitted because he had blood in his urine needs to make
sure he takes his medication as prescribed. The patient needs to be aware of the intended use,
dosage, and possible adverse effects of these medications in order to ensure appropriate
medication management and prevent any health risks. Adhering to the recommended dosage
schedule can help guarantee that the patient gets the most out of the treatment plan and can stop
problems or the condition from getting worse. Healthcare professionals can help patients take
their medications safely and effectively, improving patient outcomes, by offering through
medication education. Medication education is a crucial component of medication management.
(Ross , 2022).
Cefuroxime is an antibiotic that is utilized to address bacterial infections, encompassing
respiratory tract, skin and skin structure, and urinary tract infections. It is crucial to instruct the
patient on the proper administration method and emphasize the significance of adhering to the
prescribed medication schedule, even if symptoms improve. Additionally, the patient should be
informed about potential side effects such as stomach upset, diarrhea, and allergic reactions.
(Cefuroxime: MedlinePlus Drug Information, n.d.).

To maintain strong bones and teeth, adequate calcium intake is essential. Calcium also plays a
critical role in muscle function, nerve transmission, and blood clotting. If calcium
supplementation is advised, the patient should be informed about the proper dosage and the
importance of adhering to their doctor's instructions. It is crucial not to exceed 1000–1200 mg of
calcium per day from supplements unless specifically directed by a physician. High levels of
calcium in the urine (above 300 mg/day) can result from various factors, such as chronic kidney
disease, high vitamin D levels, or excessive calcium consumption, which may lead to the
formation of kidney stones. In individuals with kidney disorders, calcium supplements can
elevate calcium levels excessively. Therefore, it is recommended to consult a healthcare provider
before taking calcium supplements, especially for those with kidney disorders. (CALCIUM:
Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews, n.d.)

Enalapril is a medication used to treat high blood pressure and heart failure, either alone or in
combination with other drugs. It belongs to a group of drugs known as ACE inhibitors, which
work by reducing specific chemicals that constrict blood vessels, resulting in improved blood
flow and heart pumping efficiency. The patient should be educated about the proper dosage and
the importance of consistent medication adherence as prescribed by their doctor. Common
adverse effects of enalapril include headaches, coughing fits, and dizziness. It is advisable for the
patient to report any unusual or severe side effects to their healthcare provider. Caution should be
exercised when operating heavy machinery or driving, as lightheadedness and dizziness may
occur. Additionally, the patient should be advised to avoid alcohol and potassium-containing salt
substitutes, as they may interact with enalapril and elevate blood pressure. (Enalapril:
MedlinePlus Drug Information, n.d.)

A hormone called erythropoietin causes the bone marrow to produce more red blood cells.
Patients with chronic kidney disease or other disorders affecting the production of red blood cells
are prescribed it to treat anemia. Erythropoietin dosage should be explained to the patient, along
with the significance of following their doctor's instructions. There are various forms of
erythropoietin available, such as injections and intravenous infusions. The right way to
administer the medication and the significance of taking it at roughly the same times each day
should be explained to the patient. Because erythropoietin can increase the risk of blood clots,
the patient should be advised to avoid activities that could injure them or cause bleeding while
taking the medication. They should also be cautioned to avoid alcohol and smoking, as these can
interfere with the medication's effectiveness. (Hayat et al., 2008)

Humulin-N is a type of insulin used to manage high blood sugar levels in diabetic patients. The
patient should be educated on the proper dosage of Humulin-N and the importance of taking it
exactly as prescribed by their healthcare provider. Humulin-N is administered subcutaneously,
and the patient should be taught how to use the medication properly, either on their own or with
the assistance of a healthcare provider. Common side effects of Humulin-N include low blood
sugar, weight gain, itching, and mild skin rash. The patient should be advised to exercise caution
when operating heavy machinery or driving, as lightheadedness and dizziness may occur.
Additionally, they should be advised to abstain from alcohol and smoking, as these can impair
the medication's effectiveness. (Humulin N Insulin: Side Effects, Dosage & Uses, n.d.)

7. Do a drug study on ALL of the drugs prescribed by the doctor. Include only what is
relevant to your patient. Drug Study below
8. What will be your health teaching with regards to all the drugs prescribed? Drug Study
(Nursing Responsibilities)
9. Write your references/bibliography. - Reference List
 References list

CALCIUM: Overview, uses, side effects, precautions, interactions, dosing and reviews. (n.d.).
https://www.webmd.com/vitamins/ai/ingredientmono-781/calcium

Cefuroxime: MedlinePlus drug information. (n.d.).

https://medlineplus.gov/druginfo/meds/a601206.html

Enalapril: MedlinePlus drug information. (n.d.).

https://medlineplus.gov/druginfo/meds/a686022.html

Hayat, A., Haria, D., & Salifu, M. O. (2008, February 2). Erythropoietin stimulating agents in the
management of anemia of chronic kidney disease. Patient preference and adherence.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769266/

Humulin N Insulin: Side Effects, Dosage & Uses. (n.d.). Drugs.com.

https://www.drugs.com/humulin_n.html

Mayo Clinic. (2022, July 22). Acute Kidney Failure.

https://www.mayoclinic.org/diseases-conditions/kidney-failure/diagnosis-treatment/drc-2
0369053#:~:text=Analyzing%20a%20sample%20of%20your,Imaging%20tests.

Malkina, A. (2023, March). Acute Kidney Injury (AKI). Merck Manual.

https://www.merckmanuals.com/professional/genitourinary-disorders/acute-kidney-injury
/acute-kidney-injury-aki#:~:text=Evaluation%20should%20determine%20the%20presenc
e,and%20microscopic%20analysis%20of%20sediment.

Ross , M. (2022, April 6). What’s the importance of medication education for patients? Blog.
https://blog.cureatr.com/the-importance-of-medication-education-for-patients
 DRUG STUDY
Cefuroxime

Drug Indication Contraindication Mechanism of Side Effects/ Nursing

Action Adverse Effects Responsibilities

Generic Name: ● For Contraindicated in Inhibits cell-wall CV: phlebitis,

cefuroxime sodium injectable patients synthesis, thrombophlebitis ● Assess
form in hypersensitive to promoting osmotic GI: diarrhea, patient for
Brand Name:
adults with drug or other instability; usually pseudomembranous signs and
Zinacef
CrCI of 10 cephalosporins. bactericidal. colitis, nausea, symptoms
Therapeutic: to 20 ● Use anorexia, vomiting of infection
Antibiotics mL/minute, cautiously Half-life: 1-2 hours HEMATOLOGIC: prior to and
give 750 mg in patients hemolytic anemia, throughout
Pharmacologic IV every 12 hypersensiti thrombocytopenia, therapy.
classification: hours; if ve to transient ● Before
Second-generation neutropenia,
CrCI is less penicillin initiating
cephalosporins
than 10 mL/ because of eosinophilia therapy,
Dosage: minute, give the SKIN: obtain a
Infusion: 750 mg, 1.5 750 mg IV possibility maculopapular and history to
g every 24 of erythematous determine
hours. Give cross-sensiti rashes, urticaria, previous use
Route: patients on vity with pain, induration, of and
IV hemodialysi other sterile abscesses. reactions to
s an beta-lactam temperature penicillins
additional antibiotics. elevation, tissue or
dose after ● According sloughing at IM cephalospori
hemodialysi to the CDC, injection site ns. Persons
s. oral OTHER: with a
● Adults and cephalospori anaphylaxis, negative
children age ns aren't hypersensitivity history of
13 and recommend reactions, serum penicillin
older: 750 ed to treat sickness. sensitivity
mg to 1.5 g gonococcal may still
cefuroxime in-fections. have an
sodium IV ● According allergic
every 8 to clinical response.
hours for 5 practice ● Observe
to 10 days. guidelines, patient for
For cefotaxime signs and
life-threateni or symptoms
ng ceftriaxone of
infections should be anaphylaxis
and used to treat (rash,
infections childhood pruritus,
caused by bacterial laryngeal
less meningitis edema,
susceptible and wheezing).
organisms, pneumococc Discontinue
1.5 g IV al and the drug and
every 6 meningococ notify
hours; for cal physician or
bacterial meningitis other health
meningitis, caused by care
up to 3 g IV penicillin-re professional
every 8 sistant immediately
hours. strains and if these
Haemophilu symptoms
s influenzae occur. Keep
type b thromepinep
meningitis. hrine, an
● Use antihistamin
 cautiously e, and
in patients resuscitation
with a equipment
history of close by in
colitis and the event of
in those an
with renal anaphylactic
insufficiency reaction.
. ● Instruct
● Some patient to
products report signs
may contain of
phenylalani hypersensiti
ne or vity.
sodium. ● Drug may
Alert: Drug may increase
cause CDAD and INR and
pseu-domembrahou risk of
s colitis ranging bleeding.
from mild to Monitor
life-threatening, patient.
which can occur
even
2 months after
therapy:
● Some
cephalospori
ns have
been
asso-crated
with
 seizures in
patients
with renal
impairment
when the
dosage
wasn't
reduced.
● If
drug-associa
ted seizures
occur,
discontinue
drug and
treat with
anticonvulsa
nt therapy if
indicated.
● Dialyzable
drug: Yes.
 Calcium

Drug Indication Contraindication Mechanism of Side Effects/ Nursing

Action Adverse Effects Responsibilities

Generic Name: ● hypocalcemi contraindicated in Replaces calcium Adverse effects: ● Use all
Calcium Acetate a patients with cancer and maintains calcium
adults: 7 - 14 mEq who have bone calcium level. CNS - tingling products
Brand Name:
elemental calcium metastases and in sensationd, sense of with
Phoslyra & Calphron
IV those with oppression or heat extreme
Therapeutic: may give 10% ventricular waves with IV use, caution in
Calcium Supplements calcium chloride fibrilation, syncope with rapid patients
solution hypercalcemia, IV use. taking
Pharmacologic hypophosphatemia, cardiac
classification: ● adjunctive or renal calculi CV - bradycardia, glycosides
Phosphate binders arrhythmias,
treatment of and in those
Dosage: magnesium cardiac arrest with with
500mg O.D intoxication rapid IV use, mild sarcoidosis,
adults: usually 7 drop in BP, renal or
Route: mEq IV. base vasodilation. cardiac
P.O subsequent doses disease, and
on patients response GI- constipation, electrolyte
irritation, chalky disturbance.
● during taste, hemorrhage, use calcium
exchange nausea, vomiting, chloride
transfusions thirst, abdominal cautiously
adults: 1.35 mEq IV pain in patients
with each 100mL with
citrated blood. GU - polyuria, renal corpulmonal
neonates: 0.45 mEq calculi e,
IV after each respiratory
100mL citrated Metabolic - acidosis,
blood. hypercalcemia and
respiratory
● Hyperphosp failure.
hatemia
adults: initially, 2 ● Double
capsules or tablets check that
or 10mL oral you're
solution PO T.I.D. giving the
with meals. tilrate correct form
dose every 2 to 3 of calcium;
weeks until an resuscitation
acceptable serum cart may
phosphorus level is contain both
reached; watch calcium
hypercalcemia. gluconate
most patients on and calcium
dialysis need 3 to 4 chloride.
capsules or tablets
or 15 to 20mL oral ● Monitor
solution with each calcium
meal levels
frequently.
hypercalcem
ia may
result after
large doses
in chronic
renal failure.
report
abnormalitie
s.
● Signs and
symptoms
of severe
hypercalcem
ia may
include
stupir,
confusion,
delirium,
and coma.

● Signs and
symptoms
of mild
hypercalcem
ia may
include
anorexia,
nausea, and
vomiting.
 Enalapril

Drug Indication Contraindication Mechanism of Side Effects/ Nursing

Action Adverse Effects Responsibilities

Generic Name: Adults: In patients Contraindicated in The sympathetic CNS: asthenia,

Enalapril maleate not taking diuretics, patients nervous system and headache, Nursing
initially, 5 mg PO hypersensitive to the dizziness, fatigue, Considerations
Brand Name:
once daily; then drug, in those with renin-angiotensin-al vertigo, syncope,
Epaned, Vasotec
adjusted based on a history of dosterone system weakness Before
Therapeutic: response. Usual angioedema related (RAAS) signaling CV: hypotension, Administration:
Antihypertensives dosage range is 10 to previous pathway collaborate chest pain, angina ● Inspect
to 40 mg daily treatment with an to control blood GI: anorexia, solution for
Pharmacologic as a single dose or ACE inhibitor, and pressure as well as diarrhea, nausea, particulate
classification: two divided doses. in patients with fluid and electrolyte abdominal pain, matter and
ACE inhibitors Or, 1.25 mg IV hereditary or equilibrium. vomiting discoloratio
Dosage:
infusion over S idiopathic GU: decreased n before
Enalaprilat minutes every 6 angioedema. renal function administrati
Injection: 1.25 mg/ hours. ● Safety and (especially in on.
mL effectiveness Pharmacodynamic: patients with ● Monitor
Oral Solution: Children ages 1 of IV use in bilateral renal artery CBC with
1 mg/mL Enalapril is an
month to 16 years: children stenosis or HF) differential
Tablets: 0.08 mg/kg (up to 5 haven’t been
antihypertensive
HEMATOLOGIC: counts
2.5 mg, 5 mg, 10 mg, agent that exhibits
mg) PO once daily; established bone marrow before and
20 mg natriuretic and
dosage should be ● Oral drug depression during
uricosuric
Route: adjusted as needed isn’t RESPIRATORY: therapy
properties.
PO up to recommend bronchitis: dry, ● Patients
Enalapril lowers
0.58 mg/kg ed neonates persistent tickling, with
blood pressure in
(maximum 40 mg). (younger nonproductive diabetes,
all grades of
Don't use if than age 1 cough; dyspnea. those with
essential and
CrCl is less than 30 month), SKIN: rash impaired
renovascular
mL/minute/1.73 preterm OTHER: renal
m^2 infants who hypertension, and angioedema, function or
haven’t peripheral vascular anaphylaxis HF, and
reached a resistance without those
corrected causing an increase receiving
postconcept in heart rate drugs that
ual age of can increase
44 weeks, potassium
and in level may
children develop
with GFR of hyperkalemi
less than a. Monitor
30mL/ potassium
minute/1.73 intake and
m^2 potassium
● Use level.
cautiously ● Black
in patients patients
with renal taking ACE
impairment inhibitors
or those have a
with aortic higher
stenosis or incidence of
hypertrophic angioedema
cardiomyop than
athy. non-Blacks
● Look alike
Dialyze sound alike:
drug: Yes. Don't
confuse
Overdose enalapril
S&S: with
Hypotension Anafranil or
Eldepryl.

During
Administration:
● Closely
monitor BP
response to
the drug.
● Inject the
drug slowly
over at least
5 minutes,
or dilute in
50 mL of a
compatible
solution and
infuse over
15 minutes.
● Incompatibil
ities:
Amphoterici
n B,
cefepime,
phenytoin.
After
Administration
● Instruct
patient to
report
breathing
 difficulty or
swelling of
face, eyes,
lips, or
tongue
Swelling of
the face and
throat
(including
swelling of
the larynx)
may occur,
especially
after first
dose.
● Advise
patient to
report signs
of infection
such as
fever and
sore throat.
● Inform
patient that
light-headed
ness can
occur,
especially
during first
few days of
therapy. Tell
 patient to
rise slowly
to minimize
this effect
and to notify
prescriber if
symp-
toms
develop. If
fainting
occurs,
advise pa-
tient to stop
drug and
call
prescriber
immediately
.

● Tell patient
to use
caution in
hot weather
and during
exercise.
Inadequate
fluid intake,
vomiting
diarrhea,
and
excessive
 perspiration
can lead to
light-headed
ness and
fainting
● Advise
patient to
avoid salt
substitutes;
these
products
may contain
potassium,
whichcan
cause high
potassium
levels in
patients
taking this
drug.
 Erythropoietin

Drug Indication Contraindication Mechanism of Side Effects/ Nursing

Action Adverse Effects Responsibilities

Generic Name: ● Dosage is ● Patients Functions as a CNS: asthenia, Assessment:

epoetin alfa individualiz with chronic growth factor and dizziness, ● Check for
(erythropoietin) ed. For renal as a differentiating depression, fatigue, any
patients on disease have factor, enhancing headache, contraindica
Brand
Name:Retacrit hemodialysi an increased RBC production. insomnia, tion
s, start risk of paresthesia, ● Monitor BP
Therapeutic: treatment death, pyrexia, chills, before
Colony-stimulating only if Hb serious seizures. therapy
factors level is less adverse CV CV: edema, HTN, ● Assess for
than 10g/dL. events, and increased clotting any adverse
Pharmacologic of arteriovenous
For patients stroke when effect and
classification:Recom
binant human not on erythropoies grafts, vascular side effects
erythropoietins hemodialysi is-stimulatin occlusion, DVT. ● Monitor Hb
s start g agents are EENT: pharyngitis. levels twice
Dosage: 50-100 treatment used to GI: diarrhea, weekly until
units/kg 3 times only if Hb increase Hb nausea, vomiting, it stabilizes
weekly level is less level to stomatitis. in the target
than 10g/dL, more than Metabolic: range and
Route: IV
the rate of 11g/dL. hyperglycemia, maintenance
decline of Individualiz hypokalemia, dose is
Hb level e therapy hyperphosphatemia, established,
indicates and use hyperuricemia, then
that patient lowest weight loss. continue to
will require dosage Musculoskeletal: monitor at
an RBC needed to arthralgia, myalgia, least
transfusion, reduce the bone pain, muscle monthly.
and need for spasm. Resume
reducing the RBC Respiratory: twice
risk of transfusion cough, shortness of weekly
alloimmuniz breath, URI. testing after
ation and Skin: injection-site any dosage
other RBC reactions, rash, adjustment
transfusion urticaria, pruritus. ● Before
related risks Other: medical starting
is a device malfunction therapy,
treatment evaluate
goal. patients iron
Starting status
dose is 50 to Diagnosis:
100 units/kg ● Ineffective
subcut or IV renal tissue
three times perfusion
weekly. IV related to
route is impaired
preferred for renal
patients function
receiving ● Low levels
hemodialysi of RBC
s. Intervention:
Maintenanc ● Do not
e dosage is shake the
highly vial
individualiz ● Protect the
ed. Give the medication
lowest from light
effective ● Store
dose to solution in
 gradually refrigerator,
increase Hb don't freeze
to a level at ● Give by
which blood direct
isn't injection
necessary. without
● For all dilution
patients, ● Give
don't necessary
increase support if
dosage more the patient
frequently manifest any
than every 4 side or
weeks. adverse
Reduce effect
dosage by ● Give
25% or necessary
more as health
needed to teaching to
reduce rapid the patient
responses if Evaluation:
Hb level ● Monitor the
rises more patient's
than 1g/dL response to
in any 2 the drug
week ● Monitor any
period. side or
Increase adverse
dosage by effects
25% if Hb ● Monitor the
level is less vital signs
than 10g/dL of the
and hasn’t patient
increased by ● Evaluate the
1g/dL after effectiveness
4 weeks or of the given
if Hb level health
falls down teaching to
below the patient
10g/dL. For
adults on
dialysis if
Hb level
approaches
or exceeds
11g/dL,
reduce
dosage or
interrupt
therapy. For
adults not
on dialysis,
if Hb level
exceeds
10g/dL,
reduce
dosage or
interrupt
therapy.
 Humulin-N

Drug Indication Contraindication Mechanism of Side Effects/ Nursing

Action Adverse Effects Responsibilities

Generic Name: Type 1 diabetes Contraindicated Lowers blood CV: peripheral ● Monitor
Insulin isophane mellitus; type 2 during episodes of glucose level by edema blood
suspension diabetes mellitus hypoglycemia or stimulating EENT: visual glucose
that can't be ketoacidosis. peripheral glucose disturbance levels and
Brand Name:
Humulin N & properly controlled • Contraindicated in uptake and SKIN: adjust
Novolin N (insulin by diet, exercise, patients with a inhibiting hepatic injection-site insulin
NPH) and weight control history of glucose production; reaction, dosages as
hypersensitivity to also inhibits lipodystrophy, rash needed.
Therapeutic: Adults and children drug or its lipolysis and OTHERS: allergic ● Monitor
Antidiabetics age 12 and older: components Severe, proteolysis, and reaction, patients
Usual dosage is 0.4 life-threatening, enhances protein immunogenicity taking other
Pharmacologic
classification:
to 0.5 unit/kg/day; generalized allergy. synthesis. medica-tians
Insulins may consider including with insulin
conservative initial anaphylaxis, can more
Dosage: doses of 0.2 to 0.4 occur with insulin closely
Injection: 100 units/ units/kg/day to products. because
mL in 3-mL and avoid potential for • Use cautiously in other drugs
10-mL vials, 3-mL hy-poglycemia. patients susceptible may mask
pens (Humulin N);
Higher initial doses to hypokalemia, signs and
100 units/ mL in
10-mL vials, 3-mL may be required in such as patients symptoms
pens (Novolin N) patients who are who are fasting, are of
 obese, sedentary, or taking hy-poglycen
presenting with potassium-lowering ia or may
Route: Subcutaneous ketoacidosis. drugs, or are cause an
Adjust-a-dose: concurrently taking increase or
Individualize drugs that may decrease in
dosage based on affect potassium blood
metabolic needs, level. Untreated glucose
blood glucose hypokalemia can level.
monitor-ing, and cause respiratory ● Increase
glycemic control paralysis, frequency of
goal. Adjust dosage ventricular glucose
to achieve premeal arrhythmias, and monitoring
plasma glucose death. in pains who
level of 90 to 130 • Hypoglycemia is are acutely
mg/dL and peak the most common ill or under
postprandial plasma adverse reaction. emo-fional
and bedtime Severe stress, or if
glucose level of less hypoglycemia can changes in
than 180 mg/dL. cause seizures, and diet,
Insulin may be exercise, or
requirements may life-threatening or medication
be altered during fatal. regimen
acute illness, Hypoglycemia can occur, as
emotional distress, occur suddenly and these may
or stress. Adjust as symptoms may affect rate of
needed in older differ. Risk insulin
adults, patients who increases with absorption.
have renal or intensity of Also closely
hepatic dysfunction, glycemic control monitor
or have changes in and changes in patients
physical activity or glycemic treatment, after
meal patterns, and meal patters, changes to
in patients physical activity, insulin
concurrently taking and concomitant dosage.
drugs that lower medications and in ● Monitor
blood glucose level. patients with renal patients
Refer to or hepatic carefully for
manufacturer' impairment. signs and
instructions for • Use cautiously in symptoms
dosage adjustments older adults, who of
when converting may be at increased hypoglycem
from other insulin. risk for adverse ia. Treat
regimens and effects, signs and according to
formulations. symptoms of individual
hypoglycemia may facility
be more difficult to policy and
recognize in these procedure if
patients necessary.
● Mild
episodes of
hypoglycem
ia may be
treated with
oral glucose.
More severe
episodes of
hypoglycem
ia, such as
coma,
seizure, or
neurologic
impairment,
 may be
treated with
IM or
subcut
glucagon or
con-centrale
d IV
glucose.
● Monitor
potassium
levels in
patients at
risk for
hypokalemi
a, especially
those taking
potassium-d
epleting
drugs.
● Assess
patient for
signs and
symptoms
of
hypoglycem
ia (seizures,
sweating,
shaking,
Trembling,
confusion)
and
 hyperglyce
mia
(drowsiness,
fruity breath
odor,
frequent
uri-nation,
thirst.
Notify
prescriber if
any of
These signs
or
symptoms
occur.
● Periodically
measure
HbAte
levels.
● Monitor
patients for
generalized
allergic
reactions,
including
anaphylaxis.
● Look
alte-sound
allie: Don't
confuse
Humulin
 with
Humalog;
don't
confuse
Norolin with
Novolog.

Patient Teaching

● Instruct
patient in
self-manage
ment,
including
glucose
monitoring,
injection
prepart-tion
and
technique,
proper
storage of
insulin, and
recognition
and
management
of
hypoglycem
ia and
hyperglyce
mia.
● Explain to
patient that
insulin
requirement
s may vary
due to
illness,
stress or
emotional
disturbance,
inadequate
food intake,
and skipped
meals.
● Advise
patient that
hypoglycem
ic episodes
can impair
the ability to
concentrate
and re-act;
advise
patient to
use caution
while
driving and
operating
machinery.
● Advise
patient that
 allergic and
hypersensiti
vity
reactions
can occur,
including
injection-sit
e reactions
(local pain,
redness, or
swelling),
and to report
signs and
symptoms
to health
care
provider.
Teach
patient signs
and
symptoms
of
anaphylaxis
and to seek
emergency
medical
attention
promptly if
anaphylaxis
occurs.
● Instruct
 patient to
rotate
injection
sites to
avoid
developing
lipodystroph
y.
● Alert: Warn
patient not
to share
multi-dose
pen with
other
people, even
if the
nee-die is
changed,
because of
risk of
bloodborne
pathogen
transmission
, including
HIV and
hepatitis.
● Explain
importance
of checking
insulin label
before each
 injection as
accidental
mixups
among
insulin types
have been
reported.
● Explain that
intermediate
-acting
insulins can
be mixed
with regular
insulin.
● Instruct
patient to
visually
inspect
insulin
before use
to ensure
that there's
no
particulate
matter in
vial and that
the
medication
appears
uniformly
cloudy.
● Teach
patient that
alcohol and
some other
medications
may
increase or
decrease
glucose
levels.
Advise
patient to
inform
health care
provider of
all
medications
and
supplements
being taken.
● Instruct
patient not
to stop
insulin
abruptly or
change
amount
injected
without
consulling
prescriber.
● Advise
patient that
any insulin
changes
should be
made
cautiously
and only
under
medical
supervision.
Changes in
insulin
strength,
manufacture
r, type
(regular,
NPH, or
insulin
analogues),
species
(animal,
hu-man), or
method of
manufacture
(rDNA
versus
animal-sour
ce insulin)
may result
in the need
 for a dosage
change.
Dosage of
concomitant
oral
antidiabetic
may need
ad-justment.
● Warn patient
to inform
prescriber if
she is
pregnant or
plans to
become
pregnant.
● Advise
patient of
childbearing
potential of
importance
of
maintaining
tight
glucose
control if
she is
pregnant or
plans to
become
pregnant.
● Advise
patient of
the change
in insulin
requirement
s that may
occur during
pregnancy
and after
childbirth.
● Instruct
patient not
to use
insulin after
the printed
expiration
date and to
follow
manufacture
r's
instructions
for
refrigerated
and room
temperature
storage.