The nurse is administering insulin to an obese adult client. Which is the correct method of administering ins… - BSF Staff Nurse - 2015

BSF Staff Nurse - 2015

Nursing Foundation

Medium

Appeared in: BSF Staff Nurse - 2015

Explanation

Insulin is administered into the subcutaneous tissue for gradual absorption, which is crucial for stable blood glucose control.
For an obese patient with a thick layer of adipose tissue, a 90-degree angle is required to ensure the needle reaches the subcutaneous layer and does not deposit the insulin intradermally.
A 1/2-inch needle is an appropriate length for a 90-degree subcutaneous injection in an adult.
A 27-gauge needle is a standard size for subcutaneous injections, providing a balance between patient comfort and efficient medication delivery.

Option A: Administering insulin via the intramuscular (IM) route leads to excessively rapid absorption, significantly increasing the risk of severe hypoglycemia.
Option B: The Z-track method is a specialized technique for intramuscular injections of irritating medications (like iron dextran) to seal the medication within the muscle and prevent tissue staining or irritation. It is not used for subcutaneous insulin.
Option D: The intradermal route is used for diagnostic purposes, such as tuberculin (TB) or allergy testing. The absorption from this layer is very slow and unreliable for glycemic control.

Clinical Relevance

Nursing practice connection: Use the key finding related to Correct technique for subcutaneous insulin administration in an obese patient to guide bedside assessment, documentation, and the next nursing action.
Correct insulin injection technique is a fundamental nursing skill critical for patient safety and effective diabetes management. Incorrect technique can lead to poor glycemic control, hypoglycemia, or hyperglycemia.
Nurses must assess the patient's body habitus (thin, average, obese) before every injection to select the appropriate needle length and angle.
What if the patient was very thin? The nurse would pinch the skin and inject at a 45-degree angle to avoid accidentally injecting into the muscle, which would cause rapid absorption and hypoglycemia.

How to Approach the Question

First, identify the core of the question: the correct method for administering insulin to an obese patient.
Recall the standard route for insulin: it is a subcutaneous (sub-Q) injection, not intramuscular (IM) or intradermal.
This immediately eliminates the options involving IM and intradermal routes.
Next, consider the patient-specific factor: obesity. An obese person has a thicker layer of subcutaneous fat.
Relate the patient's body type to the injection technique. To penetrate a thick fat layer and reach the subcutaneous tissue effectively, a 90-degree angle is necessary.
Evaluate the remaining option: 'Use a 1/2 inch 27-gauge needle at a 90° angle into subcutaneous tissue'. This aligns perfectly with the principles of subcutaneous injection for an obese individual.

Concept Tested & Keywords

Concept Tested: Correct technique for subcutaneous insulin administration in an obese patient.
Stem keywords: insulin, obese adult, administering, correct method
Lead-in keywords: Which is the correct method
Clinical cues: Patient is an obese adult, which directly influences the choice of injection angle and potentially needle length.

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E6 Nursing Fundamentals Potter Perry 12e Part 3 p. 173-175

E6 Nursing Fundamentals Taylor p. 862-864