Wash your hands and observe standard precautions.
Assess the need for medication, in this case, checking the blood sugar.
Explain what you are doing and check the patient's ID.
Nurse: Hi there Alma, I need to take your blood sugar.
Nurse: Can you tell me your full name and date of birth?
Patient: Alma Jones, 2/6/38.
Nurse: Thank you, Alma.
Nurse: Alma, what finger would you like me to use?
Patient: I think my middle finger.
Nurse: Okay, you're going to feel a small prick here.
Nurse: Your blood sugar is 154. I'll need to get you some insulin.
Confirm the insulin dose with the physicians orders and the MAR.
Read the label three times: when it is taken from the medication cart,
before withdrawing medication and after withdrawing medication.
Mix the solution by rolling the vile gently between your hands.
When mixing insulin, always withdraw the regular insulin (which is clear) first
to minimize the possibly of the regular insulin becoming contaminated with the additional protein in the NPH (which is cloudly).
Remember: clear before cloudy.
Clean the tops of the viles with an anteseptic swab in a circular motion.
In this example, we will mix 10 units of regular insulin and 30 units of NPH.
With the vile placed on a firm surface, insert the needle into the center of the rubber cap, maintaining sterility.
Inject 30 units of air into the NPH vile and withdraw the needle. There should be no insulin in the needle and the needle should not touch the insulin.
Inject 10 units of air into the regular insulin vile and promptly withdraw 10 units of regular insulin.
Reinsert the needle into the NPH vile and withdraw 30 units of NPH. Be careful to withdraw only the ordered amount.
If excess medication has been withdrawn, discard the syringe and begin again with both insulins.
Withdraw the needle and replace the cap using the scoop method to maintain sterility.
Recheck the patient's ID and create privacy.
Wash your hands.
Nurse: I'm going to need to have access to your arm, so I'd like you to raise your arm up.
Compare the MAR to the medication to be given.
Wipe the injection site with alcohol swab and let dry.
Nurse: Okay Alma, please take a nice, deep breath.
Pinch the skin and insert the needle at an 80 to 90 degree angle and inject.
Discard the needle and syringe into a sharps container.
As always, document that you gave the medication on the MAR, including the injection site.
Nurse: I'm going to let you get some rest. Call me if you need anything at all.