ZZ21882 - SCANNED TO PHARMACY STAT MEDICATION CONTINUOUS IV...

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Unformatted text preview: SCANNED TO PHARMACY STAT MEDICATION CONTINUOUS IV INSULIN INFUSION A. 1. 2. 3. 4. B. 1. General Guidelines: Goal blood glucose (BG) 100-180 mg/dl, or per physician order ___________ mg/dL. Patient source of exogenous glucose: IV solution TPN Enteral None Stop all existing insulin orders and all anti-diabetic agents. Insulin infusion to be discontinued when the patient is eating AND has received 1st dose of subcutaneous insulin &/or oral hypoglycemic agent. Initiating the infusion: 100 units of Regular insulin mixed in 100 mL of 0.9% normal saline given by infusion pump (to be mixed by pharmacy). Start at Level 1 except for the following patients per physician order: Level 2: Patients receiving glucocorticoids (steroids), or diabetic patients receiving more than 80 units per day of insulin as an outpatient. Level 3: Patients with mild to moderate Hyperglycemia per physician order. Level 4: No patients to start here. Contact physician if BG not controlled on Level 4. Blood Glucose 111-150 151-200 201-300 Initial Bolus Dose IVP Prior to Starting Infusion No Bolus Lispro 2 units Lispro 5 units Level 1 BG Less than 100 100-119 120-149 150-179 180-209 210-239 240-269 270-299 300-329 330-359 Greater than 360 Level 2 Units/hr Off 0.5 1 1.5 2 2 3 3 4 4 6 BG Less than 100 100-119 120-149 150-179 180-209 210-239 240-269 270-299 300-329 330-359 Greater than 360 Blood Glucose 301-400 greater than 400 Initial Bolus Dose IVP Prior to Starting Infusion Lispro 10 units Notify MD for orders Level 3 Units/hr Off 1 1.5 2 3 4 5 6 7 8 12 BG Less than 100 100-119 120-149 150-179 180-209 210-239 240-269 270-299 300-329 330-359 Greater than 360 Level 4 Units/hr Off 2 3 4 5 6 8 10 12 14 16 BG Less than 100 100-119 120-149 150-179 180-209 210-239 240-269 270-299 300-329 330-359 Greater than 360 Units/hr Off 3 5 7 9 12 16 20 24 28 30 Patient Monitoring: 1. Check capillary blood glucose (BG) hourly until within goal range for 4 consecutive hours and then decrease to every two hours x 24 hours. 2. If BG remains within goal range AND there is no change in nutritional intake, check BG every 4 hours. 3. If TPN or tube feeds are stopped, if patient is made NPO, or if there is a change in steroid dose, notify physician for orders. If Insulin drip is changed, reinstate hourly BG checks (following guidelines in #1 above) and adjust insulin (per scale) as necessary to keep BG within goal range. Moving from level to level: a) Moving Up: If BG remains above the goal range and has not decreased by at least 60 mg/dL in one hour, advance to the next higher level, check BG in one hour, and follow instructions per scale above. b) Moving Down: For BG less than 100 mg/dL, turn infusion off. Then ° Recheck BG every 30 minutes ° For BG 100 mg/dL or greater restart insulin infusion: • For BG between 100-119 mg/dL restart infusion at one level lower than previous level (If drip was previously at Level 2, restart at Level 1) • If drip was previously at Level 1, restart insulin infusion at Level 1. • For BG 120 mg/dL or greater, restart infusion at previous level. Treatment of Hypoglycemia: Less than 70 = Hypoglycemia 1. For BG less than 70 mg/dL STOP insulin infusion AND give D50W IV. A. Patient awake: Give 25 mL or ½ amp of D50W IV. B. Patient not awake: Give 50 mL or 1 amp of D50W IV. 2. Recheck BG every 15 minutes until greater than 80 mg/dL. Repeat D50W dose X 1 if needed. 3. When BG is Greater than 100 mg/dL, restart infusion at next lower level (see Patient Monitoring above. Moving Down). 4. If patient was at Level 1, check with physician before restarting insulin infusion. Reportable Conditions: Notify the physician if hypoglycemia does not resolve after 2 treatments. Date ______________ Time____________ Physician __________________________________ ZZ21882-SMCS (11/24/09) Patient Identification SAFH SDH SMCS SRMC Continuous IV Insulin Infusion ORDERS ...
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This note was uploaded on 12/26/2009 for the course PHYS 341 taught by Professor Mavromatis during the Spring '09 term at American University of Beirut.

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