Clinical challenges of type B insulin resistance: a case study.

In this article, a case study is presented of a 44-year-old woman with a rare disorder of type B insulin resistance. This autoimmune syndrome is caused by circulating antibodies directed at the insulin receptor. These antibodies impair insulin interaction with the cells, resulting in insulin resistance that can be so severe as to require thousands of units of exogenous insulin per day. The unusual presentation and management of this patient presented a challenge to nursing and other healthcare disciplines. This report includes a description of the diagnosis, treatment, discharge planning, and follow-up care.

Chronic cancer pain management with the Du Pen epidural catheter.

Chronic epidural administration of narcotics and/or local anesthetics is sometimes required in those few patients where utilization of systemic narcotics and appropriate adjuvant medications is unsuccessful in controlling intractable cancer pain. The Du Pen epidural catheter (Davol, Inc.) a silicone-based tunneled catheter modeled after the Hickman central venous catheter, has provided a safe, reliable means of long-term administration of drugs to the epidural space in over 400 patients to date. A systematic approach to the pharmacology of epidural pain control includes drug choice, bolus dosing versus infusion, volume guidelines, and titration protocols. Utilization of local anesthetics in combination with narcotics allows for enhanced pain relief in those patients refractory to narcotics as is frequently the case with neurogenic involvement. Follow-up care of patients receiving epidural narcotic with or without local anesthetic can be accomplished by a trained home cae team. Successful epidural pain management requires thorough patient and caregiver education, frequent pain assessment, and monitoring of side effects, with close collaboration between patient/family, pharmacist, home care nurse, and physician.