Lecture 02 Point of Care Testing: BG Testing and Monitoring

Question 1

What does BG testing monitor?

Answer 1

1. •finger stick (FS) blood glucose (BG) levels for those at risk for hypoglycemia or hyperglycemia.
2. •effectiveness of insulin and oral hypoglycemic medications.
3. •glucose for those on parenteral feedings (TPN), steroid treatment, and with pancreatitis

Question 2

What does Point of Care Testing Refer to?

Answer 2

lab testing procedures done in area where pt is located, instead of tradiational clinical lab

Question 3

What is Point of Care testing suited for?

Answer 3

Suited for patient centered care.

Question 4

What type of blood is used for BG testing?

Answer 4

Any type, i.e capillary, venous, arterial

Question 5

What are the units of BG testings?

Answer 5

reported in mg/dl

miligrams per deciliter

Question 6

Why do we care about BG testing/monitoring?

Answer 6

Glucose is an important sugar to keep cells supplied with energy

Question 7

BG normal range?

Answer 7

60mg/dl~100mg/dl

Question 8

What are BG critical values? What should you do if they are?

Answer 8

Critcal values: x< 40 mg/dl or x>500 mg/dl

Repeat the pt test. If still critical value, notify the provider and inquire about obtaining a serum glucose sample. If result compatible with patient symptoms and clinical intervention indicated, do not wait for serum result confirmation. Implement provider orders or procedure based on prior orders.

Question 9

Why must 2 Levels of Glucometer Quality Control testing must be done?

Answer 9

1. •Within 24 hours prior to patient testing
2. •Usually done on nights in in-patient units
3. •If not done you will be locked out & unable to do patient testing
4. •If a patient test has been repeated and results are still outside expected range.
5. •When troubleshooting
6. •If meter has been dropped
7. •If there are other indications that the meter is not working properly.

Question 10

For pt bg test, refer to PPT

Answer 10

Refer to PPT

Question 11

What are some adrenergic signs and symptoms of hypoglycemia? This typically occurs first and quickly due to deecline in plasma glucose

Answer 11

Adrenergic response include adrenaline and glucagon increase as a defense mechanism…essentially fight or flight

1. Anxiety
2. Nervousness
3. Palpitations
4. Sweating
5. Tachycardia
6. Tremors

Question 12

What are Neuroglycopenic Signs and Symptoms of Hypoglycemia?

This typically occurs after or concurrently with adrenergic signs

Answer 12

Change in behaviors such as change in mental status from confusion and agitation to loss of consciousness…r/t the shortage of glucose in the brain…essentially alters brain function

1. Headache
2. Irritability
3. Seizures

Question 13

What can be done to manageme hypoglycemia? (3)

Answer 13

1. Administer 25 to 50 grams dextrose (aka D50)
   Administer intravenously
2. Graham crackers or saltine crackers and juice
3. Glucagon

Question 14

What are some signs of Hyperglycemia? (The 3 Ps are the most important to remember)

Answer 14

1. Polydipsia
2. Polyurea
3. Polyphagia
4. Anorexia, Nausea, Vomiting
5. Fatigue
6. Rapid shallow respirations (Kussmaul’s respirations)
7. Loss of consciousness
8. Dehydration
9. Hypotension
10. Tachycardia

Question 15

Why does Kussmaul’s respirations occur in hyperglycemic people?

Answer 15

Kussmaul’s respirations are the bodies way of compensating for the metabolic acidosis – body is attempting to blow off excess CO2. Breath smells fruity

Question 16

All signs and symptoms of hyperglycemia can lead to Diabetic Ketoacidosis. What happens? And what are some considerations when you’re correcting hyperglycemia?

Answer 16

All of the manifestions listed can ultimately lead to DKA…whereby increased glucose levels lead to the body using fat for energy causing a production of ketones

In correcting hyperglcemia…it may be done aggressively but slowly or could lead to rebound hypoglycemia

Question 17

How would you manage hyperglycemia? (4)

Answer 17

1. Fluid resuscitation: Normal saline (0.9%) bolus
2. Regular insulin – depending on glucose value
3. Initially a continuous IV infusion; as glucose stabilizes/decreases, stop IV insulin and start sliding scale Regular insulin usually administered before meals
4. In addition other insulins such as an intermediate or long acting one may be ordered and administered – Lantus frequently used as an evening injection.