Lab 3 - BG Monitoring Flashcards
why is self-monitoring of BG important?
- allows the pt to make self-management decisions regarding diet, exercise, and meds
what is the chief advantage of SMBG
supplies immediate info about BG that can be used to make adjustments to;
- food intake
- activity patterns
- med dosages
also:
- alerts the pt to acute episodes of hypo/hyperglycemia
- provides the patient w a tool for achieving specific glycemic goals
- produces accurate records of glucose trends
what determines the frequency of BG monitoring?
- the glycemic goals
- type of diabetes
- ability & willingness to perform the test independently
- the treatment regimen
how often is it recommended for type 1 DM patients to test ther BG
- 3 times/day
- includes both preprandial and postprandial
- if they have an insulin pump = more often
how often should patients w type 2 DM monitor their BG
- at least once daily
what should be done if you suspect hypoglycemia?
- test the BG
what do you do if the pt with diabetes is ill
- test BG every 2-4 hrs to determine the stressor effects on BG
what are the 2 methods for self-testing of BG
both require obtaining a large drop of blood by skin puncture & applying the blood to a testing strip
- compares the strip to a color chart
- uses reflectance meters
what are examples of strips that use the first method of BG testing
- chemostrip bG
- glucostix
- trendstrip
what is a con to the first method of BG testing
- can be inaccurate
what are some examples of reflectance meters for BG testing
- glucometer II
- accu-check II
- glucoscan
- onetouch
what are 3 pros to the use of reflectance meters
- accurate
- fast: gets the results within 5-50 sec
- some meters can be programmed to monitor glucose levels for a continuous 72 hrs
what are 2 types of testing used for reflectance meters? do all meters require this?
- wet-wash
- dry-wipe
some do not require this
what is the wet wash method of testing
- the user flushes the blood coated testing strip with water before inserting it into the glucose meter
what is the dry-wipe method of testing
- the user wipes off the blood-coated testing strip with a dry cotton ball before the reading
what are 3 commonly used sites for puncture for BG monitoring? what are 3 alternative sites?
common:
- finger
- toe
- heel
alternative: - forearm
- palm
- thigh
describe the steps for BG monitoring pre-puncture; include risks, what to assess, etc. (6)
- assess the pt’s understanding of the procedure & purpose
- determine if specific conditions need to be met before or after (ex. after meals, with fasting, etc.)
- determine risks for performing skin ouncture (ex. low plt, anticoagulant therapy, bleeding disorders)
- assess puncture site
- review orders, times, & frequency
- explain procedure & purpose
what do you want to avoid when choosing a site for glucose puncture
- bruises
- open lesions
describe the steps for BG puncture
- hand hygeine
- get pt to wash hands
- position pt comfortably
- remove test strip
- turn on monitor & insert strip
- remove unused glucose test strip from meter & place on clean surface
- apply gloves
- choose puncture site & clean with alcohol wipe
- unconver lancet,hold perpendicular to site & pierce skin
- wipe away first drop of blood with cotton ball
- squeeze puncture site to get a good size of blood
- hold strip up to top of blood drop & place in meter for results
why dont we take the first drop of blood after puncture?
- it will contain more seroud fluid than blood
diabetic patients typically have peripheral vascular disease which makes it difficult to produce a large drop of blood. how can we improve blood flow?
- hold the pt’s finger in a dependent position before puncturing
describe the steps for monitoring post-puncture (6)
- turn meter off
- dispose of garbage
- discuss test results w patient
- reinspect puncture site for bleeding or tissue injury
- compare glucose monitor reading w normal BG levels
- ask patient to discuss procedures & explain test and results
what is a lancet
- the small, sharp object used to prick the skin in BG monitoring
what are 2 common puncture sites in infants
- heel & great toe
what is a common puncture site for older pediatric patients
- the earlobe
what is considered normal range for FBG
4-7 mmol/L
what is hypoglycemia
- low BG = <4 mmol/L
what 2 systems do signs of hypoglycemia occur in?
- SNS stimulation = below 3.5
- CNS depression= below 2.5
list some SNS signs of hypoglycemia
- tachycardia
- palpation
- anxiety
- shaking, trembling
- sweating
- hunger
- nausea
list some CNS signs of hypoglycemia
- confusion
- difficulty concentrating
- weakness
- drowsiness
- convulsions
- coma
- cold, clammy skin
what are some of the nurses immediate reactions to a low BG? when should you retest
give some sort of sugar
- juice
- glucose tabs
- glucagon IV or dextrose (if severe)
retest in 10-15 min
what is hyperglycemia
- high BG >11 mmol/L
what are some signs of hyperglycemia
- glucosuria
- polyuria & nocturia
- polydipsia
- polyphagia
- blurred vision
- abdominal cramps
- NV
- fatigue
what is hypoglycemic protocol
- the steps you follow when someone has a low BG
- the steps vary on the severity of the hypoglycemia
what is a hematoma
- pool of clotted or partially clotted blood in an organ, tissue or body space
- usually caused by a broken blood vessel
what are the categores of insulin
- rapid acting
- short acting
- intermediate acting
- long acting
what is the prototype of rapid acting
- lispro
- aspart
what is the onset, duration, and peak of rapid acting
onset: 10-15
peak: 30-90
duration = very short but intense
what is the prototype of short acting
- humulin R
what is the onset, peak, and duration of short acting
- onset: 30
- peak: 2-3 hr
- duration = shorter ( but not as short as rapid)
what is the prototype of intermediate acting
- isophane suspension
- NPH
what is the onset, peak, and duration of intermediate acting insulin
onset = 1-3 hr
- peak = 4-8 hr
- duration = up to 12 hr
what is the prototype of long acting insulin
- glargine
- detemir
what is the onset, peak, and duration of long acting
- onset = 1-3 hr
- peak = non
- duration = up to 24 hrs
what type of insulin cannot be mixed?
- long acting
when mixing two types of insulins into 1 syringe (rapid/short acting & NPH), which is drawn first
- put air into cloudy, then air into clear
2. draw out of clear, draw out of cloudy
describe the procedure for mixing 2 kinds of insulin in 1 syringe
- complete all the necessary MAR & med checks
- hand hygeine
- roll cloudy insulin in hands
- wipe tops both vials with alcohol wipe
- air into cloudy, then air into clear
- without removing the syringe after injecting the air, withdraw fluid from clear
- remove any bubbles & ensure correct dose
- place needle into the cloudy (or longer acting insulin) & withdraw required med amt for this one
- remove needle, cap, and dispose of garbage
- hand hygeine
how soon should you administer mixed insulin after preparing it? why?
- within 5 min
- bc rapid or short acting insulin binds with the NPH which will reduce the action of the long acting
only which type of insulin can be administered IV?
- regular (short acting)
what is an insulin sliding scale
- a tool that dictates a certain dose of insulin based of the pt’s BG level
what type of insulin is typically ordered for sliding scales
- rapid or short acting
define induration
- localized hardening of soft tissue of the body
- the area becomes hard but not as hard as bone
