Dosages Measured in Units Chapter 13 Dosages Measured in Units Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Units Epogen Fragmin Heparin Insulin Common drugs measured in units: What is a unit? A unit is the amount of a drug needed to produce a particular result. Heparin is an anticoagulant that is used to inhibit the clotting of blood. Insulin is a hormone secreted by the pancreas that is used to lower the blood glucose level. Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Epogen Helps combat effects of anemia caused by chemotherapy or chronic renal failure by increasing the production of red blood cells. Nurse should monitor blood pressure and lab results on a routine basis After administering Epogen, the nurse should monitor the patient’s blood pressure and laboratory results on a routine basis. Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Fragmin Used in the prevention of deep vein thrombosis after surgery and unstable angina/non−Q-wave myocardial infarction by preventing clotting of blood classified as an anticoagulant Only given subcutaneously; blood work should be monitored on a regular basis During treatment with Fragmin, the patient’s blood studies must be monitored on a routine basis. How is Fragmin administered? Fragmin may only be given by subcutaneous injection—never intramuscularly or intravenously. Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Heparin Used because prolongs bleeding times therefore prolong clotting Blood work results need to be monitored Need to monitor for bleeding, assess for bruising During treatment with Fragmin, the patient’s blood studies must be monitored on a routine basis. How is Fragmin administered? Fragmin may only be given by subcutaneous injection—never intramuscularly or intravenously. Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Insulin Is a hormone produced in the pancreas in the Islets of Langerhans that helps to lower blood glucose Refer to page 371 to see the various types of insulin available Nurses should be able to recognize the symptoms of both insulin shock and a diabetic coma so that immediate treatment can be initiated to stabilize the patient. What is the definition of U-100 insulin? U-100 insulin is 100 units of insulin dissolved in 1 mL of liquid. U-100 insulin is a universal standard preparation that all people requiring insulin can use. Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Insulin Doses that are too large might cause insulin shock. Doses that are too small might result in a diabetic coma. Available in prefilled insulin pens. ONLY INSULIN IS MEASURED IN INSULIN SYRINGES AND GIVEN IN INSULIN SYRINGES Nurses should be able to recognize the symptoms of both insulin shock and a diabetic coma so that immediate treatment can be initiated to stabilize the patient. What is the definition of U-100 insulin? U-100 insulin is 100 units of insulin dissolved in 1 mL of liquid. U-100 insulin is a universal standard preparation that all people requiring insulin can use. Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Dosages Measured in Units Involving Oral Medications Dimensional analysis method For example: The physician orders Mycostatin 400,000 units po four times a day. The drug is supplied 100,000 units/mL after reconstitution. How many milliliters will the nurse administer? Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Insulin Given With a Lo-Dose Insulin Syringe For example: The order states Lantus U-100 insulin 36 units subcutaneous in am. You have 10 mL of Lantus U-100 insulin and a U-100 Lo-Dose syringe. Draw a vertical line through the syringe to indicate the correct dose. Draw a vertical line through the syringe to indicate the correct dosage. In this case, the dose is 36 units of U-100 insulin. Therefore, find the 30-unit mark on the units scale of the Lo-Dose syringe. Counting the number of marks between the 30-unit mark and the 40-unit mark, it can be seen that each of the shorter marks indicates 1 unit. Therefore, the line should be drawn six shorter marks to the right (closer to the plunger) of the 30-unit mark. Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Insulin Supply dosage of insulin is 100 units per mL Abbreviated on label as U-100 Syringe must also be U-100 Think: U-100 = 100 units per mL Think: U-500 = 500 units per mL

Insulin (Continued) Accuracy is critical Nurses must understand and correctly interpret insulin order and label The correct syringe must be selected

Mixed Insulin Administration Guidelines: Inject air into each vial. Draw insulin from regular insulin bottle first. The practice of mixing insulins is decreasing with the rise in use of Lantus insulin. Remove any air bubbles found in syringe. Draw insulin from cloudy insulin bottle. Physicians sometimes prescribe two types of insulin to be administered at the same time. The two types of insulin are drawn into the same syringe to reduce the number of times that the patient needs to be injected. The air that is injected into each vial should be equal to the amount of insulin that will be withdrawn. Do NOT touch the insulin solution with the tip of the needle when injecting air into the vials. When the desired amount of insulin has been withdrawn from the regular insulin bottle, remove the syringe before checking it for any air bubbles. The same syringe should be used throughout this process. Therefore, the same syringe that was used to draw up the regular insulin also should be used to draw up the cloudy insulin. Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Combination Insulin Dosage 40 units NPH U-100 insulin 12 units regular U-100 insulin Total insulin dosage = 52 units

Preparing Combination Insulin Dosage Inject 30 units of air 2. Inject 10 units of air

Preparing Combination Insulin Dosage (Continued) 3. Withdraw 10 units regular 4. Withdraw 30 units NPH for a total of 40 units © Cengage Learning 2013

Procedure for Preparing Combination Insulin Dosage 4) Withdraw 30 units NPH for a total of 40 units 1) Inject 30 units air 2) Inject 10 units air 3) Withdraw 10 units regular

Insulin Sliding Scale Order Humulin R regular U-100 insulin subcut based on glucose reading at 1600

Insulin Sliding Scale (Continued) Insulin Dose Glucose Reading* No coverage Glucose less than 160 2 units 160–220 4 units 221–280 6 units 281–340 8 units 341–400 Glucose greater than 400: Hold insulin; call MD stat

Insulin: Avoiding Errors Check dosage with two nurses When combination dosages are prepared, two nurses must verify each step of the process