Week 3 Blog #2

Week 3 January 18-24
Tuesday, January 19, 2016 
5p-9p 4 Hours Interned

As I said in my last blog I would share my experience with my first insulin injection which was performed last week as indicated in Week #2 Blog #2. I explained how nervous I was and how nice the Sister was in saying she didn’t even feel a thing! I was completely nerve wrecked because I had never done it before, was trying to remember all the proper steps and techniques without flipping through my notebook (didn’t want to look like I was following the instructions as if I were putting together a table from Ikea lol!), and was trying to maintain my cool so that the Sister didn’t see how nervous I was! I wouldn’t want someone about to poke me with a needle looking nervous! But all in all I passed with flying colors! One thing I neglected to mention when I initially posted about me giving the Sister her insulin injection was that I gave her TWO! Not that I gave her two cause one was accidental, but because she required two administrations! Was saving that good stuff for this post! For the sake of making this easier for me and HIPPA, I’m going to refer to the Sister as Sister A when talking about her.

So what did I do…

·      I referred to Sister A’s MAR. Her MAR said at 8pm to administer 5 units of Humulin R insulin (fast- acting insulin) and a predetermined amount of NPH (long-acting insulin) based on her given blood sugar amount at that time. This predetermined amount is known as a sliding scale. According to http://dtc.ucsf.edu/ , “The term “sliding scale” refers to the progressive increase in the pre-meal or nighttime insulin dose, based on pre-defined blood glucose ranges. Sliding scale insulin regimens approximate daily insulin requirements.”. What this means is that once her blood glucose level is determined, we refer to a chart made by her doctor and give her the amount of NPH insulin that matches to her blood glucose level.
·       I gathered my supplies. My supplies consisted of the two types of insulin, two insulin 100-U needles, alcohol prep pads, glucometer, glucometer strips, lancet, gloves, and Band-Aids (just incase she began to bleed!). FYI the glucometer is a small medial device that is used to approximate the concentration of glucose in the blood. The glucometer strip goes into the glucometer and what comes into contact with a small drop of blood. We obtain the blood by pricking the Sister’s fingertip with the lancet.
·       Washed my hands and applied gloves.
·       Asked Sister A which finger she would like to have pricked by the lancet. Once she picked the finger I wiped it with an alcohol prep pad for 30 seconds in a circular motion. I then let it dry for another 30 seconds. Note: when letting the area dry, do not blow the area because that will unsterilized the area!
·       Once the area was dry, I got the lancet and pricked Sister A’s finger :( had to squeeze the sides of her finger to get a drop of blood to come out.
·       I then placed the glucometer strip in the glucometer, let it boot up, and touched the strip to the Sister’s drop of blood. Waited 5 seconds, read her blood glucose level, removed the strip and disposed it in the biohazard container, recorded her blood glucose level in the mar, and referred to her sliding scale. Her sliding scale indicated to administer 4 units based on her given blood glucose level.
·       I then began to prepare for the injection. I got her NPH insulin, removed the cap, and wiped the top of the insulin bottle with an alcohol prep pad for 30 seconds. While it was drying I grabbed one of the insulin needles, drew the plunger back to 4 units, waited until the insulin bottle’s top was dry (20 more seconds), put the needle into the insulin bottle, pushed the 4 units of air into the bottle (air against air), flipped the bottle on top of the needle, pulled the plunger back to 4 units to withdraw the insulin from the bottle, and then removed the insulin bottle from the needle. I checked to make sure there wasn’t any air bubbles (which there wasn’t), recapped the needle, marked it so I knew which insulin it was, and then returned the insulin to its proper storing place.
·       After I was done preparing for the NPH insulin injection, I did the same steps as above but for Sister A’s Humulin R insulin. The only difference here was she needed 5 units of this insulin vs the 4 units from the NPH.
·       Now I was done preparing for the injections and had to administer them! I went to Sister A and explained I would be giving her two insulin injections. The NPH of 4 units based on her blood glucose levels and the 5 units of Humulin R insulin. I asked her if she had a personal preference to which sites she would like to have them administered, noting that they could not both be administered at the same site. She said she would like to have one on the posterior part of her upper right arm and one in her abdomen. No personal preference to where which insulin went to.
·       I chose to administer the Humulin R insulin in her abdomen because it was a fast acting insulin and the abdomen is the fastest absorption site. Decided this because it would correct her elevated blood glucose level to normal.
·       To her lower right quadrant, 2 inches away from her navel, I wiped the area with an alcohol prep pad in a circular motion from inward to outward and let it dry for 30 seconds. While the area was drying I grabbed the labeled Humulin R insulin syringe and uncapped it.
·       Once the area was dry I pinched up the skin area to be injected with my left hand and with my right hand quickly pushed in the needle into her skin at a 45-degree angle and pushed the plunger to administer the insulin! Released the pinched skin from my left hand and waited 5 seconds to make sure all the insulin was disposed from the syringe. These five seconds seemed like they took forever! There was that awkward moment of me just sitting there counting to 5 holding a needle in someone!
·       When the five seconds were up I withdrew the needle at the same angle in which it went in and there was no blood to apply a Band-Aid to, pushed the safety over the exposed needle, and disposed it into the sharps container…. and I WAS DONE!
·       Asked Sister A if she had any pain of discomfort during the procedure and she said she didn’t feel a thing! Hope the next one would be just as good! (Not to put any pressure on me or anything right?!)
·       I then got ready to administer the NPH to the posterior area of her upper arm. Followed the same steps as above but to the posterior area of her upper arm rather than her abdomen. Another success!

This was definitely a nerve wrecking experience for me but I couldn’t have done it without how assuring the nurses were and what a good sport Sister A was! I don’t know if she was just saying she didn’t feel a thing because she knew how nervous I was, but all in all I felt good about the overall experience. I did not make her bleed after the injections and feel very confident in my administration technique. It was awesome! Since my first experience last week, I have done this 2 other times and am becoming more and more confident and fluid in my administration technique.