Transcript Blood Glucose Monitoring NUR 302 Developed by: Susan L Shelton RN, MSN, CNM

Blood Glucose Monitoring
NUR 302
Developed by:
Susan L Shelton RN, MSN, CNM
Revised by:
Jill Ray RN, MSN
Blood Glucose Monitoring
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Measures blood glucose levels for monitoring control
of diabetes mellitus.
Test results direct
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Diet
Amount and type of medication
Exercise prescription
Helps prevent diabetic emergencies by prompt
detection & treatment of hypo- & hyperglycemia
Generalizations
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Performed usually ac and hs…what does that mean?
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Each facility has a slightly different procedure. You will have to be
validated at ea facility for this procedure.
Know the Normal values for blood glucose.
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Why should the BGL be assessed before a meal?
Report values outside of the range of normal ASAP…very important as
immediate intervention is usually indicated.
You will usually repeat the test if you get a value outside of the range of
normal.
Know the values at which the monitor you are using is no longer
accurate: GMC less than 40 and greater than 300).
If the BGL if less than 90 you MUST intervene immediately. Don’t
wait on your clinical instructor to come to you…find her or another
RN.
See p. 1476 and 1477 for very good instructions re: this procedure.
Whoa, Nelly….
What is Diabetes????
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Inability of the pancreas to either produce
enough insulin or the body’s inability to utilize
the insulin it has.
Insulin is the substance that converts glucose
to a form that is usable by the body.
Thus, low insulin equal high glucose
circulating in the blood but not
utilized by the cells.
Hypoglycemia
vs.
Hyperglycemia
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Hypoglycemia
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Low blood sugar
hyperinsulinemia
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Hyperglycemia
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Elevated blood sugar
Inadequate insulin
Hypoglycemia
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Sweating
Tachycardia
Palpitations
Nervousness
Tremors
Weakness
Headache
Mental confusion
Fatigue
Hyperglycemia
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Thirst
Polyuria
Polyphagia
Weakness
Fatigue
Headache
Blurred vision
Nausea
Vomiting
Abdominal cramping
So What…?
Complications of Abnormal Blood Glucose
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Heart attack
Cerebrovascular accident
Kidney dysfunction
Blindness
Nerve damage
*Elkin et. al (2004, 3rd Ed.), Table
14-1, p.361
Goals for Glucose Control
Normal
Goal
Intervention
needed
Fasting
Glucose
<115
<120
<80 or >140
Postparandial
<140
<180
>180
Bedtime
Glucose
<120
100-140
<100 or >160
Glycosylated
Hemoglobin
<6%
<7%
>8%
Blood Glucose Monitoring
ASSESSMENT
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Client’s understanding
Health history
Specific conditions of specimen collection
Site selection
Client’s ability to self-test
Presence of signs & symptoms glucose
alteration
Calibration of equipment
Blood Glucose Monitoring
PLANNING
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“Expected outcomes
focus on minimizing
tissue damage with
finger stick, achieving
accurate results, and
maintaining glucose
levels within goal
range.”
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Equipment
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Glucometer
Gloves
Antiseptic swab
Cotton ball or gauze
Sterile lancet
Paper towel
Sharps box
Test strips
Blood Glucose Monitoring
IMPLEMENTATION
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Wash hands
Position site lower than heart
Gather supplies and turn on meter
Select site and cleanse
Position lancet firmly against site and pierce
skin
Collect sample
Read results
Blood Glucose Monitoring
IMPLEMENTATION
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Once results are available,
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Appropriate intervention for the value obtained,
then:
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dispose of used supplies
document results
turn meter off (enter comments as indicated)
Hypoglycemic Protocols
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All hospitals will have these
Need to be familiar with this for your facility
before you begin to do this procedure.
Note that you must be supervised by an RN,
and can only perform those skills that you
have been validated for in the skills lab.
Blood Glucose Monitoring
EVALUATION
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Observe site for bleeding or bruising
Compare client readings with normal values
Ask client to discuss procedures & test
results
Observe client performing self-testing
Blood Glucose Monitoring
But, what if…?
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Puncture site continues to bleed
Glucose meter malfunctions
Result is above or below normal value
Client expresses misunderstanding of
procedure or results
Blood Glucose Monitoring
DOCUMENTATION
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SAMPLE:
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0730 Blood glucose 110. No insulin required.
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1200 Blood glucose 240. Regular insulin (4 units)
given subcutaneously per sliding scale order.
**Some facilities have a flowsheet and others note
results on MAR.
Performance Criteria – Critical Behaviors
CONTROL TEST
1. Press ON/OFF to turn on meter. Select #2-Control Test.
2. Scan Operator ID. Scan Control Solution lot #. Scan strip lot #.
Make sure expiration dates are on control bottles. Use
Expiration labels in meter box. Controls are
good for 90 days
once opened
3. Open test strip foil packet, insert “lined” end of strip into meter
through the yellow port protector opening. Gently mix control
solution and apply solution by touching the drop of control to the
white target area at the tip of the test strip while meter is in a
horizontal position the entire time. KEEP YELLOW PORT
PROTECTOR ON AT ALL TIMES
4. Monitor will start reading and beep when completed.
5. Pass/Fail will appear on the screen . Failed controls must be
documented with a Comment Code ; #1Repeat Test. Controls
must Pass before proceeding to Patient Testing. See Troubleshooting
below.
TROUBLESHOOTING OUT OF RANGE CONTROLS:
1. Check for air bubbles in nozzle of control solution or on test strip.
2. Check room temp. or humidity.
3. Check storage of strips (39 – 86 F)
4. Ensure bottles of control solution not opened > 90 days and not
expired. Check solution level.
5. Repeat test – contact lab if results continue to FAIL.
Criteria
Met
Criteria
Not Met
PATIENT TESTING
1. Washes/cleanses hands. Wears gloves.
2. Select #1 – Patient Test. Scan Operator ID.
4. Scan the Account # on the patient’s armband. Scan strip lot #.
6. Select sample type (capillary/arterial or venous).
7. Open test strip foil packet and insert “lined” end of strip into meter through the opening on yellow port
protector. AGAIN, KEEP YELLOW PORT PROTECTOR ON AT ALL TIMES
8. Cleanse puncture site with alcohol, allow to dry, and wipe away first drop of blood with cotton ball.
9. Apply free flowing blood sample by holding the finger to the white target area at the tip of the test strip.
The blood is drawn into the target area.
10. Monitor will start reading and beep when results are ready.
( A “▼ or ▲” will appear in front of a value that is out of range; <60 or >400 for Adults; <40 or >200
for neonates/newborns, a Comment Code must be entered). All panic values are immediately repeated
using the same puncture site, if possible, for verification of initial result. If result is still critical, enter
appropriate Comment Code. See unit specific instructions for hypoglycemic/hyperglycemic protocols.
11. Discard contaminated material in a biohazard disposal container.
12. Knows normal adult glcucose reference range at GHS is 60-99 mg/dL
13. Knows basic troubleshooting of patient test results (possible ↓ results w/ severe dehydration,
DKA,HHNS,ect)
14. Knows why and how often the meter must be DOCKED in the docking stations
State process for blood glucose monitoring of patient in isolation