💓 Savvy Nurse打开应用

💊 药理学 · 第1课，共6课 · 7 min

Insulin峰值：患者何时会骤降

Insulin Peaks: When the Client Will Crash

🍬 Regular insulin在注射后两到四小时达到峰值。如果你在0730给药，考试中的低血糖问题就发生在1000，就在患者的午餐托盘送到之前。

🍬 Regular insulin peaks two to four hours after the shot. If you gave it at 0730, the hypoglycemia question on the exam happens at 1000, right before the client's lunch tray arrives.

💡 核心要点

速效型在30分钟至3小时达峰，regular在2至4小时达峰，NPH在4至12小时达峰，glargine无峰值。先抽清澈的，再抽混浊的。低血糖：给予15 grams碳水化合物，15分钟后复查。

Rapid peaks in 30 minutes to 3 hours, regular in 2 to 4, NPH in 4 to 12, glargine has no peak. Draw clear before cloudy. Hypoglycemia: 15 grams of carbohydrate, recheck in 15 minutes.

🧠 为什么重要

速效型（lispro、aspart、glulisine）：起效10至30分钟，峰值约30分钟至3小时，持续3至5小时；在餐前15分钟内给药，且餐食必须已备好。短效Regular：起效30至60分钟，峰值2至4小时，持续5至8小时；是IV输注的标准insulin。中效NPH：起效1至2小时，峰值4至12小时，持续12至18小时；外观混浊，滚动混匀。长效型（glargine、degludec）：无明显峰值，持续24小时或更久；切勿在注射器中与其他insulin混合。混合regular和NPH时，先抽清澈的再抽混浊的。低血糖（葡萄糖低于70）表现为颤抖、出汗、心动过速、意识模糊和饥饿；如果患者能吞咽，给予15 grams的快速碳水化合物（4 oz果汁或普通汽水、葡萄糖片），15分钟后复查，仍低则重复，然后给予含蛋白质的小吃；如果无意识，给予glucagon（IM、皮下或鼻内）或IV dextrose，切勿经口给予。在同一区域内轮换注射部位，不要回抽，并将未开封的药瓶冷藏；已开封的药瓶可在室温下保存约28天。

RAPID-ACTING (lispro, aspart, glulisine): onset 10 to 30 minutes, peak about 30 minutes to 3 hours, duration 3 to 5 hours; give within 15 minutes of a meal, and the meal must be there. SHORT-ACTING REGULAR: onset 30 to 60 minutes, peak 2 to 4 hours, duration 5 to 8 hours; the standard insulin for IV infusions. INTERMEDIATE NPH: onset 1 to 2 hours, peak 4 to 12 hours, duration 12 to 18 hours; cloudy, roll to mix. LONG-ACTING (glargine, degludec): no pronounced peak, lasting 24 hours or longer; never mix in a syringe with other insulins. When mixing regular and NPH, draw CLEAR before CLOUDY. HYPOGLYCEMIA (glucose under 70) shows as shakiness, sweating, tachycardia, confusion and hunger; if the client can swallow, give 15 grams of fast carbohydrate (4 oz juice or regular soda, glucose tablets), recheck in 15 minutes, repeat if still low, then a snack with protein; if unconscious, give glucagon (IM, subcutaneous or intranasal) or IV dextrose, never oral. Rotate sites within one region, do not aspirate, and refrigerate unopened vials; an opened vial can stay at room temperature for about 28 days.

🏥 真实场景

🥪 一名患者在0800接受NPH，随后因恶心拒绝午餐。护士意识到4至12小时的峰值窗口，并在1300检查葡萄糖：58 mg/dL，患者出汗且焦虑。果汁、复查、饼干配奶酪。考试正是这样出题：insulin的峰值、漏掉的餐食和一天中的时间。

🥪 A client receives NPH at 0800 and then refuses lunch because of nausea. The nurse recognizes the peak window of 4 to 12 hours and checks glucose at 1300: 58 mg/dL, sweaty and anxious. Juice, a recheck, crackers with cheese. The exam builds this exact question: the insulin's peak, the missed meal, and the time of day.

📌 要点总结

  • Regular是标准IV insulin；速效型必须在食物可及的情况下给药Regular is the standard IV insulin; rapid-acting must be given with food in reach
  • 混合：先清澈的（regular）再混浊的（NPH）；glargine切勿混合Mixing: clear (regular) before cloudy (NPH); glargine never mixed
  • 低血糖15法则：15 g碳水化合物，15分钟后复查Hypoglycemia rule of 15: 15 g carbohydrate, recheck in 15 minutes

📖 本课术语

峰值（insulin） (Peak (insulin)): 给药后药物作用最强的时间；对insulin而言，是患者最可能发生低血糖的时段。

15法则 (Rule of 15): 对于低血糖，给予15克快速碳水化合物，并在15分钟后复查血糖。

TIRED（低血糖征象） (TIRED (hypoglycemia signs)): Tachycardia（心动过速）、Irritability（易怒）、Restlessness（坐立不安）、Excessive hunger（过度饥饿）、Diaphoresis（出汗）：低血糖的早期征象，在insulin峰值时间检查，并用15克碳水化合物治疗。

按起效和峰值分类的胰岛素 (Insulins by onset and peak): 速效胰岛素（lispro、aspart）在注射后30分钟到3小时达到峰值，常规胰岛素在2到4小时，NPH在4到12小时，glargine或degludec无峰值；低血糖最可能在峰值时发生，因此必须备好餐食。

Glucagon: 患者无法安全吞咽时用于严重低血糖的急救激素：1 mg IM或皮下注射（鼻内3 mg），然后将患者侧卧，因为呕吐常见，醒后喂食碳水化合物；它还可治疗β受体阻滞剂过量。

✅ 自我测试

一名患者在0700接受了regular insulin。患者在什么时间发生低血糖的风险最高？A client received regular insulin at 0700. At which time is the client at greatest risk for hypoglycemia?
  1. 0730
  2. 1500
  3. 1900
  4. 0900 to 1100

答案: D · 0900 to 1100

Regular insulin在给药后2至4小时达到峰值，因此0900至1100是风险最高的窗口。0730反映的是regular insulin约30分钟的起效时间，此时作用才刚开始，并非峰值。

Regular insulin peaks 2 to 4 hours after administration, so 0900 to 1100 is the highest-risk window. 0730 reflects regular insulin's onset of about 30 minutes, when the effect is only beginning, not its peak.

将regular和NPH insulin混合在同一注射器中时，哪一步是正确的？When mixing regular and NPH insulin in one syringe, which step is correct?
  1. 在NPH之前抽取regularDraw up the regular before the NPH
  2. 先抽取NPH，再抽取regularDraw up the NPH first, then the regular
  3. 在NPH药瓶中混合它们Mix them in the NPH vial
  4. 抽取前用力摇晃NPH药瓶Shake the NPH vial vigorously before drawing

答案: A · 在NPH之前抽取regular

先清澈后混浊可防止NPH污染regular insulin药瓶。NPH应滚动混匀，不要摇晃。

Clear before cloudy prevents contaminating the regular insulin vial with NPH. NPH is rolled, not shaken.

一名无意识的糖尿病患者血糖为38 mg/dL。哪项措施是正确的？An unconscious client with diabetes has a blood glucose of 38 mg/dL. Which action is correct?
  1. 暂停所有治疗直到患者醒来Hold all treatment until the client wakes
  2. 将葡萄糖凝胶涂在面颊内侧并等待Place glucose gel inside the cheek and wait
  3. 给予4 ounces橙汁Give 4 ounces of orange juice
  4. 给予IM glucagonAdminister IM glucagon

答案: D · 给予IM glucagon

无意识患者不可经口给予任何东西，因为有误吸风险。治疗是glucagon或IV dextrose。

Nothing goes by mouth in an unconscious client because of aspiration risk. Glucagon or IV dextrose is the treatment.

免费开始这节课 →

在应用中练习 NCLEX 风格的题目，赚取 XP、保持连续天数，英文学习，中文辅助。无需注册。

更多：药理学

🔗 相关课程