Class 6 - Nursing Interventions & Chronic Illness/ Capillary Blood Glucose Monitoring

Question 1

define blood glucose

Answer 1

the sugar that is transported through the bloodstream to supply energy to the cells

Question 2

define hyperglycemia

Answer 2

to much glucose in the bloodstream:

more than 7 heading towards hyperglycemia

Question 3

define HgB A1c

Answer 3

this test measures what percentage of hemoglobin is coated with sugar (glycated) over the past 3-4 months

Question 4

define hypoglycemia

Answer 4

not enough glucose in the bloodstream;
less than 4 heading towards hypoglycemia
(2.5 is severe hypoglycemia)

Question 5

define ketoacidosis

Answer 5

a complication of diabetes that occurs when the body produces high levels of blood acids called ketones. This develops when the body is unable to produce enough insulin. This lowers the bodies pH level.

Question 6

define ketones

Answer 6

a product of the breakdown of fatty acids

Question 7

what is glycogen and where is it stored

Answer 7

it is the unused glucose and is stored in the liver

Question 8

what is the role of glucagon in the body

Answer 8

to prevent glucose levels from getting to low in the bloodstream

Question 9

what is the role of insulin in the body

Answer 9

Insulin helps cells to take in glucose to be used for energy.

Question 10

what is hypodermocylsis

Answer 10

It is the subcutaneous administration of fluids to the body. It is usually done when a person is to sick to eat or drink anything
- often in the form of saline or a glucose
solution
- can be used where a slow fluid rate is
required
- limited to 1mL per minute but more sites can
be used if more fluid is required

Question 11

what are the advantages of hypodermocylsis

Answer 11

• it is cheaper than an IV
• can be administered by non-medical personnel with
  minimal supervision

Question 12

when would you use hypodermocylsis

Answer 12

• multiple symtoms to control
• end of life hydration
• less disruption to family and patient
• easily managed in home or LTC environment
• increased comfort for patient
• good if patient is unable to tolerate enteral
  routes

Question 13

what is the nurses responsibilities

Answer 13

• being able to advise the patient of the
  advantages of the infusion
• monitoring s/c site
• monitoring for effects r/t medication
• being able to provide patient, family and
  other HCP teaching r/t s/c infusion

Question 14

as the nurse what are you going to monitor in a s/c butterfly infusion

Answer 14

Insertion site:
- signs and symptoms of infection
- leaking/redness/exudates/localized pain
tenderness, hardness, burning, inflammation,
swelling/coolness/unresolved blanching or
necrosis, scarring
- occlusion of catheter with med admin
- correct labelling
- following facility policies with regard to
changing of site ex: q 7 days (14 days in
palliative care) or until compromised
- IF hypodermoclysis is infusing: all of the
above plus pooling of fluid/changes in drip
rate/fluid overload symptoms

Question 15

what is the standard needle gauge for s/c butterfly catheters

Answer 15

24 gauge

Question 16

what are the preferred sites for s/c butterfly catheters

Answer 16

abdomen
upper arm
upper scapula
anterior upper thighs
anterior upper chest
***avoid breast tissue and axilla areas***

Question 17

what is the prime for a s/c butterfly catheter

Answer 17

prime as per manufacturers instructions

Question 18

how many medications can you put into a s/c butterfly catheter and can all medications be given s/c

Answer 18

only one medication per catheter can be used and no not all meds can be given by s/c catheter (ex: beta blockers or antibiotics)

Question 19

what is the maximum amount of medication that can be put in the catheter per time

Answer 19

2.5mL maximum if doing an infusion; otherwise a maximum of 2mL per site if injected. If more is required insert another catheter

Question 20

Inserting a s/c butterfly catheter. How is it done

Answer 20

1. wash hands
2. draw up the amot of medication plus 0.4 mL
   to prime the tubing
3. select a site:
   
   • subclavicular area (not breast or axilla
     tissue)
   • abdomen
   • anterior thigh
4. cleanse skin with alcohol swab in a
   circular motion and allow to dry for 1 min
5. hold needle in dominant hand, remove
   guard; ensure you can see the bevel is
   facing up
6. gently raise skin with thumb and index finger
   of your non dominant hand
7. gently and firmly insert needle at a 30-45
   degree angle
8. release skin and allow butterfly wings to lay
   flat
9. cover butterfly needle site with a transparent
   dressing. Put the date, med name, med
   concentration and your initials on the
   dressing
10. secure the tubing near the dressing to the
    skin with tape, ensuring that the tubing is
    not kinked.

Question 21

what is the normal range for a glucose reading

Answer 21

4 to 7

• anything under 2.5 is severe hypoglycemic
• anything over 7.5 is hyperglycemic

Question 22

what can be given to someone that is hypoglycemic to increase their sugars quickly

Answer 22

• honey
• 3 teaspoons of sugar
• juice
• glucose/sugar tablets

Question 23

how do you know when a butterfly s/c site is not good anymore

Answer 23

• you see leakage or discharge

- the is induration (hard ridges around the site)

Question 24

what are the preferred sites for insulin injections

Answer 24

abdomen first
then upper arm
then thigh

Question 25

what is the difference btw insulins

Answer 25

the clear insulin does not have the added protein in it to give it the long lasting effect of the cloudy insulin NPH.

insulin R is the short acting (give 1/2 hr before meals)
insulin HPH is the long lasting