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NURS 2532 > Lab 3 - BG Monitoring > Flashcards

Lab 3 - BG Monitoring Flashcards

1
Q

why is self-monitoring of BG important?

A
  • allows the pt to make self-management decisions regarding diet, exercise, and meds
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2
Q

what is the chief advantage of SMBG

A

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

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3
Q

what determines the frequency of BG monitoring?

A
  • the glycemic goals
  • type of diabetes
  • ability & willingness to perform the test independently
  • the treatment regimen
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4
Q

how often is it recommended for type 1 DM patients to test ther BG

A
  • 3 times/day
  • includes both preprandial and postprandial
  • if they have an insulin pump = more often
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5
Q

how often should patients w type 2 DM monitor their BG

A
  • at least once daily
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6
Q

what should be done if you suspect hypoglycemia?

A
  • test the BG
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7
Q

what do you do if the pt with diabetes is ill

A
  • test BG every 2-4 hrs to determine the stressor effects on BG
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8
Q

what are the 2 methods for self-testing of BG

A

both require obtaining a large drop of blood by skin puncture & applying the blood to a testing strip

  1. compares the strip to a color chart
  2. uses reflectance meters
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9
Q

what are examples of strips that use the first method of BG testing

A
  • chemostrip bG
  • glucostix
  • trendstrip
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10
Q

what is a con to the first method of BG testing

A
  • can be inaccurate
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11
Q

what are some examples of reflectance meters for BG testing

A
  • glucometer II
  • accu-check II
  • glucoscan
  • onetouch
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12
Q

what are 3 pros to the use of reflectance meters

A
  • accurate
  • fast: gets the results within 5-50 sec
  • some meters can be programmed to monitor glucose levels for a continuous 72 hrs
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13
Q

what are 2 types of testing used for reflectance meters? do all meters require this?

A
  1. wet-wash
  2. dry-wipe

some do not require this

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14
Q

what is the wet wash method of testing

A
  • the user flushes the blood coated testing strip with water before inserting it into the glucose meter
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15
Q

what is the dry-wipe method of testing

A
  • the user wipes off the blood-coated testing strip with a dry cotton ball before the reading
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16
Q

what are 3 commonly used sites for puncture for BG monitoring? what are 3 alternative sites?

A

common:

  • finger
  • toe
  • heel
    alternative:
  • forearm
  • palm
  • thigh
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17
Q

describe the steps for BG monitoring pre-puncture; include risks, what to assess, etc. (6)

A
  • 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
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18
Q

what do you want to avoid when choosing a site for glucose puncture

A
  • bruises

- open lesions

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19
Q

describe the steps for BG puncture

A
  • 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
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20
Q

why dont we take the first drop of blood after puncture?

A
  • it will contain more seroud fluid than blood
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21
Q

diabetic patients typically have peripheral vascular disease which makes it difficult to produce a large drop of blood. how can we improve blood flow?

A
  • hold the pt’s finger in a dependent position before puncturing
22
Q

describe the steps for monitoring post-puncture (6)

A
  • 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
23
Q

what is a lancet

A
  • the small, sharp object used to prick the skin in BG monitoring
24
Q

what are 2 common puncture sites in infants

A
  • heel & great toe
25
Q

what is a common puncture site for older pediatric patients

A
  • the earlobe
26
Q

what is considered normal range for FBG

A

4-7 mmol/L

27
Q

what is hypoglycemia

A
  • low BG = <4 mmol/L
28
Q

what 2 systems do signs of hypoglycemia occur in?

A
  • SNS stimulation = below 3.5

- CNS depression= below 2.5

29
Q

list some SNS signs of hypoglycemia

A
  • tachycardia
  • palpation
  • anxiety
  • shaking, trembling
  • sweating
  • hunger
  • nausea
30
Q

list some CNS signs of hypoglycemia

A
  • confusion
  • difficulty concentrating
  • weakness
  • drowsiness
  • convulsions
  • coma
  • cold, clammy skin
31
Q

what are some of the nurses immediate reactions to a low BG? when should you retest

A

give some sort of sugar

  • juice
  • glucose tabs
  • glucagon IV or dextrose (if severe)

retest in 10-15 min

32
Q

what is hyperglycemia

A
  • high BG >11 mmol/L
33
Q

what are some signs of hyperglycemia

A
  • glucosuria
  • polyuria & nocturia
  • polydipsia
  • polyphagia
  • blurred vision
  • abdominal cramps
  • NV
  • fatigue
34
Q

what is hypoglycemic protocol

A
  • the steps you follow when someone has a low BG

- the steps vary on the severity of the hypoglycemia

35
Q

what is a hematoma

A
  • pool of clotted or partially clotted blood in an organ, tissue or body space
  • usually caused by a broken blood vessel
36
Q

what are the categores of insulin

A
  • rapid acting
  • short acting
  • intermediate acting
  • long acting
37
Q

what is the prototype of rapid acting

A
  • lispro

- aspart

38
Q

what is the onset, duration, and peak of rapid acting

A

onset: 10-15
peak: 30-90
duration = very short but intense

39
Q

what is the prototype of short acting

A
  • humulin R
40
Q

what is the onset, peak, and duration of short acting

A
  • onset: 30
  • peak: 2-3 hr
  • duration = shorter ( but not as short as rapid)
41
Q

what is the prototype of intermediate acting

A
  • isophane suspension

- NPH

42
Q

what is the onset, peak, and duration of intermediate acting insulin

A

onset = 1-3 hr

  • peak = 4-8 hr
  • duration = up to 12 hr
43
Q

what is the prototype of long acting insulin

A
  • glargine

- detemir

44
Q

what is the onset, peak, and duration of long acting

A
  • onset = 1-3 hr
  • peak = non
  • duration = up to 24 hrs
45
Q

what type of insulin cannot be mixed?

A
  • long acting
46
Q

when mixing two types of insulins into 1 syringe (rapid/short acting & NPH), which is drawn first

A
  1. put air into cloudy, then air into clear

2. draw out of clear, draw out of cloudy

47
Q

describe the procedure for mixing 2 kinds of insulin in 1 syringe

A
  • 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
48
Q

how soon should you administer mixed insulin after preparing it? why?

A
  • within 5 min

- bc rapid or short acting insulin binds with the NPH which will reduce the action of the long acting

49
Q

only which type of insulin can be administered IV?

A
  • regular (short acting)
50
Q

what is an insulin sliding scale

A
  • a tool that dictates a certain dose of insulin based of the pt’s BG level
51
Q

what type of insulin is typically ordered for sliding scales

A
  • rapid or short acting
52
Q

define induration

A
  • localized hardening of soft tissue of the body

- the area becomes hard but not as hard as bone

NURS 2532 (5 decks)

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