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NRSG 202 > Blood Glucose/ Insulin Administration > Flashcards

Blood Glucose/ Insulin Administration Flashcards

1
Q

Signs and Symptoms of Hypoglycemia:

A

Blood glucose <4
Cool, clammy skin
Rapid heart rate
HA, faintness, dizziness
Nervousness, tremors, shaking
Hunger
Emotional changes (eg. irritability)
Numbness of fingers, toes, mouth
Unsteady gait, slurred speech
Changes in vision
Seizures, Coma

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2
Q

Causes of Hypoglycemia:

A

Inadvertent insulin overdose or sulphonylurea overdose, or in response to a recent change in dose
Missed or inadequate meal
Unexpected exercise
Error in timing of dose

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3
Q

Signs and Symptoms of Hyperglycemia

A

Elevated blood glucose (>11)
Polyuria (increase in urination)
Polydipsia (increased thirst)
Polyphagia (increased hunger) followed by lack of appetite
Weakness, fatigue
Blurred vision
Headache
Nausea and vomiting
Abdominal cramps
Glycosuria

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4
Q

Causes of Hyperglycemia:

A

Inadequate doses of insulin
Infection
Stress
Surgery
Medications (eg. steroids, benzodiazepines)
Variations in nutritional intake
Individuals receiving enteral/parenteral feeding
Critical illness

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5
Q

Normal fasting blood glucose level

A

< or = 6 mmol/L is considered normal

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6
Q

Prediabetic fasting blood glucose level

A

6.1 -6.9 mmol/L for pre-diabetes

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7
Q

Diabetic fasting glucose level

A

= or > 7.0 mmol/L for diabetes

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8
Q

AC1 Diabetic result

A

> 6.5%

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9
Q

Prediabetic AC1 result

A

6.0% – 6.4% signals pre-diabetes (2013 CDA)

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10
Q

Normal AC1 level

A

less than 6.0% is considered normal

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11
Q

Random Plasma Glucose normal testing

A

less than 11.1 mmol/l (without regard to meals)

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12
Q

Normal nova machine

A

3.3 – 7.0 mmol/l

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13
Q

When should you test blood AC?

A

30 minutes before meal

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14
Q

When should you test blood PC?

A

1-2 hours after meal

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15
Q

What happens if blood touches the strip after you have started the reading?

A

Do not touch blood drop a second time if test strip does not fill completely (discard strip and repeat)

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16
Q

What are the know-hows with test strips?

A

Expiry date on vial (opened or unopened)
Close cap tightly (Strips deteriorate when exposed to *heat, *light, and *moisture)
Use test strip immediately after removing from vial

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17
Q

What is QC and how do you do it?

A

Quality control:
ensures adequate BLG readings
Must do QC with both the Low and High glucose solutions
Need to mix QC solutions vial prior to performing testing (to mix sugar solution)
NB: QC lockout if QC not performed every 24 hours meter will not allow patient testing until QC done (Nova)
QC prompting 2 hours prior to scheduled time for QC (Nova)

18
Q

Why do you use second blood drop?

A

First drop often filled with cells and proteins

19
Q

NOVA blood glucose results

A

Adult “Normal” range: 3.3 – 7.0

*Adult Critical Low: <2.6 mmol/l

*Adult Critical High: >25 mmol/l

20
Q

What could effect test results?

A

Physiological influences may affect results (shock, dehydration, anemia, circulatory disorders, edema; extreme hematocrit outside acceptable range 0.10 – 0.60 (less common with Nova); variation in sample type eg. venous/arterial/capillary)

Environment influences (strip absorption of moisture or exposure to light)

Operator influences (poor technique for capillary collection)
Excessive squeezing (contaminates sample with interstitial fluid; false low results)
Poor blood flow
Does not wipe first drop (raises interference risk from skin contaminants and interstitial fluid

21
Q

Treatment of hypoglycemia

A

Once hypoglycemia is confirmed with repeat testing, need to treat the low blood sugar immediately
Is an emergency situation. If untreated could lead to seizures, coma, and death
Must act quickly and efficiently but remain calm
Need to follow the Hypoglycemic Protocol per agency policy

22
Q

Basal (Long or intermediate-acting) Insulin:

A

NPH (Humulin N)
Glargine (Lantus)
Degludec (Tresiba)

23
Q

Bolus (Mealtime/rapid or short-acting) Insulin:

A

Aspart (Novo-rapid)
Lispro (Humalog)
Regular (Humulin R)

24
Q

Pre-Mixed (both long-acting and short-acting) Insulin:

A

Humalog Mix 25 (lispro 25% + lispro protamine 75%)
Humulin 70/30 (70 units N and 30 units R)

25
Q

Why are some insulins clear and some cloudy?

A

Mostinsulinsareclear, colorless liquids, but some intermediate-acting ones arecloudy. The cloudiness comes from added substances used as buffers (usually zinc or isophane) that make them work over a longer time

26
Q

Cloudy vs clear

A

Cloudyinsulin is usually longer actinginsulin.Clearinsulin is often shorter acting but can be longer acting

27
Q

Do you use clear or cloudy insulin first?

A

You can use both a clear and a cloudy insulin in the same syringe but need to draw, and verify, theclearinsulinbefore drawing up thecloudy insulin

28
Q

Insulin regimes

A

Usually insulin is given 1 - 4 times per day
Long-acting or Intermediate-acting insulin once or twice a day (eg. before breakfast and bedtime)
Rapid or short-acting before meals
Or a combination of both

29
Q

Basal Insulin:

A

Required to cover rise in blood glucose between meals and overnight
Calculation depends on weight (dose estimated at 1/2 of TDD)
Includes long-acting and intermediate-acting insulins
eg. NPH (20 units SC ac breakfast and ac supper),
glargine (Lantus), degludec (Tresiba)

30
Q

Bolus Insulin:

A

Required to cover rise in blood glucose due to meals
May use the pre-admission meal (bolus) dose
Usually ½ of TDD divided equally amongst the three meals
eg. Aspart 6 units SC before meals

31
Q

Pre-Mixed Insulin:

A

Sometimes a pre-mixed insulin is used
Mix 25 Humalog
(Contains both long-acting and short-acting insulin)
Eg. Lispro 25% and Lispro Protamine 75%

32
Q

Insulin Correction Dose:

A

Physician chooses no insulin correction or mealtime/hs correction
Additional insulin added to the meal (bolus) dose to correct elevated blood sugars, based on how sensitive a patient is to insulin
Used alone (q4h) if patient is NPO (see PPO for NPO)

33
Q

Insulin sensitivity factor

A

Physician chooses ISF for the client based on the client’s sensitivity to insulin (so the higher the ISF, the more sensitive the client is to insulin eg. requires less insulin):

34
Q

ISF

A

The blood glucose drop in mmol/l per unit of insulin given
By knowing the ISF you can calculate how much insulin will decrease blood sugar
ISF 1 = 1 unit of insulin will decrease BS by 1 mmol
(eg. need more to do less)
ISF 2 = 1 unit of insulin will decrease BS by 2 mmol
ISF 3 = 1 unit of insulin will decrease BS by 3 mmol
ISF 4 = 1 unit of insulin will decrease BS by 4 mmol
(eg. need less to do more)

35
Q

ISF calculation

A

ISF Calculation = 100 divided by TDD
eg. If the total daily dose is 50:

100 = ISF of 2
50

36
Q

Insulin needle size + length

A
  • needle length is usually determined by assessment of a client’s adipose tissue but generally an insulin pen needle is 4 mm – 12 mm (5/32 -1/2 inch)
  • the angle of insertion is usually 90 degrees (though 45 degrees is also acceptable for a SC injection)
37
Q

Volume of SC medication

A

only small doses (0.5 - 1 mL) of water-soluble medications should be given subcutaneously (but up to 2 mL is safe)

38
Q

SC Site Selection for Insulin:

A

the outer aspect of the upper arms, anterior and lateral portions of the thigh, buttocks and abdomen

39
Q

Rotating sites

A

clients with diabetes that inject insulin should practice intrasite rotation (rotating injection sites within the same body part to provide better consistency in the absorption of insulin and subsequent injections should be given at least 2.5 cm away from the previous site)

40
Q

Do you need to use a disinfectant wipe to disinfect prior to a subcutaneous injection?

A

disinfection of the injection site is not usually required
In the home, clients often do not use an alcohol swab for subcutaneous injections
In a facility, alcohol swabs may be used prior to injections to prevent infection (FIT Canada)

41
Q

Advantages of Using an Insulin Pen vs Syringes:

A

Better glycemic control (result of shorter needle length availability)
Increased medication adherence rates
Fewer hypoglycemic events
Reduced risk of medication errors
Improved self-management education (insulin pen devices are rated higher in terms of patient preference)
Cost-savings (converting to insulin pen devices results in overall cost savings to the institution)
Improved safety for health care workers (reduced risk of needle stick injuries and associated costs)
Possible decreased insulin waste and decreased nursing time

NRSG 202 (4 decks)

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