Question

What are your primary nursing considerations for a client with an insulin pump and for Ashley in specific?

Ashley is a 17-year-old Type 1 diabetic. She was diagnosed at the age of 14 and is managing her insulin needs "mostly" independently, but in the office because she is going to start using a lispro insulin pump for control, with a basal rate and boluses as needed based on FSBG and carbohydrate counting. She checks her FSBG upon awakening (fasting), before eating lunch and dinner, and at bedtime. She is currently applying to colleges which are mainly located out of state. Her parents are having a great deal of difficulty dealing with Ashley's choices of where to go to college because of the distance. She is academically motivated and has a high GPA. She has a partner, and is not yet sexually active although she admits that they have been "talking about it." Ashley is on the varsity swim team and practice is every weekday morning at 0630-0730. From there she goes to classes and lunch is at 1130. Ashley states she "sometimes gets up too late to have breakfast before swimming."

Answer 1

Nursing considerations for a client with insulin pump

Insulin pump is a small externally worn battery powerd device. It contain a samll syringe or container attached to along tubewith a needle or small teflon catheter is inserted into the subcutaneous tissues.( usually on the abdomen).

Nuring care/ interventions includes:

- Ask history about life pattern, dietary practices, excercise pattern, leisure activities,Schooling,  sexuality( if the patient is adolecent or adult)

- Asses level of kowledge about diabetes and management and using insulin pump for controlling sugar level.

- Asses parents uderstanding about management of diabetes, using insulin pump,life style modifications needed for thier child and readiness to accept new treatment for thier child. or patient.

- After assesment and collecting baseline data the child and their parents should be counselled .

1.Disease process, management of type 1 diabetes mellitus which includes dietary modifications- including wheat and wheat products, plenty of vegetables, moderate level of protein, restrict carbohydrate containing food, and fat. Prepare a menu plan .

2. With regard to using insulin pump

- explain about need for using insulin pump.It mimics normal pancreatic function, beacuse pancrease in your body is not secreting adequate amount of insulin

- Insulin pump wear at outside of the body, usually over abdomen by securing it using belt.

- The container has a syringe it is filled with insulin, usually with regular insulin

- The needle is attached at the one end of the tube and it is inserted in to the subcutaneous tissue where, insulin will be absorbed slowly in to the blood stream.

- The needle/ subcutaneous catheter should be replaced every 24hrs or as per the manufacturer guidelines.After insertion of needle, it should be secured with skin using adesive tap to prevent dislodgement.

- Then the insulin delivering rate is set on the pump. it is administered in the form of basal rate( 0.5- 2 units/hr) or bolus form.

- Insulin pump care:

-do hand washing and make sure hands are clean

- open the battery cap and close it.

- clean and disinfect pump with sanitizer and dry it properly.

- keep small cloth or pouch in between skin and pump to avoid irritation. Or you can keep the pump in a pouch of waist belt

- Connect tubings and needle. Turn on battery and set infusion rate as prescribed. Read directions provided on the label.

- Regularly chaeck injection site for bruising, infection,Dystrophy of subcutaneous tissue.

_ teach them about different site of insulin administration. Change site in abdomen in quadrent wise with period of interval.

- Also watch for hyperglycemia( blood sugar goes beyond 160mg/dl). Always try to maintain fasting sugar Between 60-110mg/dl. Report if glucose instability present.

2. Regarding life style modifications:

- do excercise regularly. Better to avoid too much streneous type of excercises , it may cause extreme hypoglycemia.

- Before doing excercise, check blood sugar level and have adeqaute amount of food , to prevent hypoglycemia

- Check blood sugar regulary , Fasting sugar , Before meal, dinner and bedtime.

- Have breakfast, lunch and dinner at regular time as well as snacks. Keep carbohydrate contained candy or biscuit with you, and have if feel guidiness, sweating, faintaing beacuse these are the signs of hypoglycemia. Dring adequate amount of fluid.

- Avoid magnetic based investigations.Avoid swimmingand water activities.

3. keep good personal hygiene

- Take bath dailyand wear clean cloths. If securing belt is dirt change it with new one.

4. Involve in school academic activites.

5. Psychological preparation of family and child about readiness to accept new treatment , and comply with lifestyle mofdifications.

6. Do not excert pressure over the pump and needle while having physical contact.

7. Tell the client to keep medic-Alert card when ever going outside.

Note : The procedure should be demonstrated by the nurse and make the child or parent do it own. Clarify thier doubt. Refer to community health nurse, and inform to school health nurse,because the child need lifelong followup.

Considering to Ashley

- Make sure whether she knows how to use insulin syringe, checking blood sugar level and carbohydrate counting.

- She should be taught about the action of Lispro isulin, it is rapid acting type and calculation

- teach - insulin calculation

Eg . based on fasting blood sugar

consider target blood sugar of fasting is 120mg/dl

actual blood sugar level of fasting is 200mg/dl

correction factor, generally 1 unit of insulin neededed to lower 50 mg of blood sugar in the blood

formula for identifying corrction dose

= Difference between actual-target blood sugar/ correction factor= 200-120/50

= 80/50=1.6 units . so you will need to take 1.6 units of insulin to correct excess 80mg blood sugar.

2. Based on carbohydrate counting

one unit of insulin will lower 10 gm carbohydrate,

Assume you have consumed 50 gm of carbohydrate ,

calculate= consumed carbohydrate/ 10

=50/10= 5 units of insulin needed to for 50 grams of carbohydrate brakfast

Adminsiter bolus of 1.6units to correct FBS  then regulate 5units for 4 hours. beacuse lispro action long for 4-5 hrs .  

- Provide pshcological support for parents. Inform School authorities about her health needs. Ask her to keep medic alert card with her.

- Water excercise affect the viability of battery and cause infection to the site.Better to select other excercises or activities.

_ Take food regularly. and check blood sugar smae time everyday. it will help to regulate blood sugar as weel as to set up infusion rate.

- Do not skip breakfast before excercise, because it may cause hypoglycemia,, lethargy.

- Do regular check-up or reviews with physician/ nurse.

- Inform her boy friend about her need as well as to privide support.