A former Pennsylvania nurse who had been accused of killing two patients with doses of insulin faces more murder charges and has confessed to trying to kill 19 additional people at several locations, the authorities said Thursday.

In May, Heather Pressdee, 41, admitted to the authorities that she had intended to kill three patients in her care with insulin doses, resulting in her arrest on two counts of murder and one count of attempted murder.

Now the Pennsylvania Attorney General’s Office says Ms. Pressdee has admitted to trying to kill 19 other patients with insulin at five different rehabilitation centers across the state as far back as 2020 and as recently as this year. In all, the authorities say 17 patients died under Ms. Pressdee’s care.

The new charges announced on Thursday include two additional counts of murder, 17 counts of attempted murder and 19 counts of neglecting a care-dependent person.

Ms. Pressdee was arraigned on Thursday, but it was unclear what plea she had entered. A message left with her lawyer, Phillip P. DiLucente, was not immediately returned.

“The allegations against Ms. Pressdee are disturbing,” Michelle Henry, the state attorney general, said in a news release. “It is hard to comprehend how a nurse, trusted to care for her patients, could choose to deliberately and systematically harm them.”

According to the attorney general’s office, first-degree murder charges were filed against Ms. Pressdee only in cases where “physical evidence” was available. The 17 attempted-murder charges were filed in cases where “the victims either survived the excessive dosage of insulin, or the cause of death could not be determined.”

She is accused of mistreating a total of 22 patients, ranging in age from 43 to 104.

One of the victims was Marianne Bower, 68, who died in September 2021 under Ms. Pressdee’s care at Belair Healthcare and Rehabilitation Center in Lower Burrell.

For two years, family members believed that Ms. Bower had died of respiratory failure. Then, in September, investigators informed them that Ms. Pressdee had admitted to killing Ms. Bower, who was not diabetic, with insulin, according to Rob Peirce, a lawyer representing Ms. Bower’s estate in a separate wrongful-death lawsuit against the rehabilitation center.

“This is one of the worst cases we have seen with someone in the health care system going from facility to facility and, unfortunately, admitting to killing multiple people,” Mr. Peirce said in a phone interview.

Ms. Bower’s family wants to know how Ms. Pressdee managed to work at 11 rehabilitation facilities over five years since 2018, Mr. Peirce said.

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