Hi, this is Cathy with Level Up RN. In this video, I'll be working through a dosage calculation problem that involves insulin titration and the use of an insulin drip protocol. You can find all the information that I'll be covering in this video in our Level Up RN dosage calculation workbook. If you are in nursing school, then you know how important it is to master dosage calculations, and our workbook will help you do just that. In a nutshell, our workbook contains all different types of dosage calculation problems that you are likely to encounter in nursing school. And we demonstrate how to solve each problem using multiple methods so you can pick the way that makes the most sense to you.
Patients in a critical care setting with hyperglycemia may require IV insulin administration, and it's important that we titrate the insulin drip. So titrate means to increase or decrease based on the patient's blood glucose level. In many hospital settings, you will need to check your patient's blood glucose level hourly while they're on an insulin drip, but definitely follow your specific facility's policy. In addition, you'll be using an insulin drip protocol, which can vary widely between facilities. So I have an example of a protocol here on the right. But I will say that even within the Level Up RN nurse team, we have used very different insulin protocols across the team. So my hospital's protocol is very different than some of my colleagues' hospital protocols, so definitely refer to whatever your facility wants you to use and just pay close attention to the specifics of that protocol.
All right. Let's work through an example problem here regarding an insulin drip. So we have an order for insulin 50 units in 50 ml to be delivered via IV pump and titrated according to the insulin protocol. And we need to round all of our answers to the nearest tenth. So part A asks us, your patient's blood glucose level prior to the initiation of insulin therapy is 302. What is the starting infusion rate in units per hour? Okay. So if we come on over here to our protocol, it says that we are aiming for a target blood glucose level between 140 and 199, and that we should initiate the insulin infusion rate according to the patient's blood glucose level. So our patient's blood glucose level is 302, which falls within this range right here, which means we're going to be starting their infusion rate at 3 units per hour. So that is the answer to part A. Now, part B says, one hour later, our patient's blood glucose is 305. How will the infusion rate be adjusted, and what is the new rate? So you can see our blood glucose actually went up. It went from 302 to 305. So let's look at step two with this protocol. This says, take the patient's blood glucose hourly and compare the current blood glucose to the previous blood glucose. Adjust the insulin drip according to the change in blood glucose with a maximum infusion rate of 4 units per hour.
So we're going to look up our current blood glucose level here in this column. So currently, it is 305, which falls within this range. Then we're going to pick which column to look at based on the change in blood glucose from the previous value. So our blood glucose increased by three. So you could see that if our blood glucose has not changed or has increased, this is the column we need to look at. So for our patient, we will need to increase their rate by 0.9 units per hour. So our new rate for part B is 3.9 units per hour. Okay. Let's go to part C. One hour later, our patient's blood glucose is now 280. How will the infusion rate be adjusted? So you can see our blood glucose level came down 25. So our current rate is 280, so let's find that here on this column. So 280 falls within this range right here. And like I mentioned, our blood glucose came down 25, so we need to figure out the appropriate column. This would be the column if our decrease was less than 20, which is not the case. This is our column since we had a decrease between 20 and 39 mg per DL. So we're going to take our previous rate of 3.9 units per hour and add 0.3 units per hour, so our new rate would be 4.2 units per hour.
However, you will notice here, it told us that we have a maximum infusion rate of 4 units per hour. So that's the max infusion rate, so we're not going to be giving this at 4.2 units per hour. We're going to stick to 4 units per hour. So that is going to be our new rate here for part C. And then finally, let's go to part D here. One hour later, our patient's blood glucose is 190. How will the infusion rate be adjusted? And what is the new rate? So our blood glucose level came down 90 in this case. So let's look up 190 here. 190 falls within this range, and now we need to figure out the appropriate column. We had a big drop. So if we go over here to the last column, this is the column we want to use if we had a decrease of 60 or more, and we definitely did. We had a decrease of 90 mg per DL. So we're going to need to reduce our infusion rate by 0.6 units per hour. So our new infusion rate, which previously was 4 units per hour, is now going to be 3.4 units per hour. And that is the answer to part D.
1 comment
Very useful. Thanks