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NRSG 202 > Seminar #3: BGM + Insulin > Flashcards

Seminar #3: BGM + Insulin Flashcards

1
Q

Goals of Diabetes Management

A
  1. promote well-being
  2. reduce symptoms
  3. prevent acute complications of hyperglycemia and hypoglycemia
  4. delay onset of + progression of LT complications
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2
Q

What is fasting blood glucose?

A

= no caloric intake for at least 8h

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3
Q

FBG: normal, prediabetes, and diabetes?

A

normal: < or = 6 mmol/L
pre-diabetes: 6.1-6.9 mmol/L
diabetes: = / > 7.0 mmol/L

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4
Q

what is hemoglobin A1C?

A

glycated hemoglobin

measured to determine the average bld glucose levels over the previous 3 months

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5
Q

A1C %?

A

normal = < 5.5%
risk of diabetes = 5.5-5.9%
pre-diabetes = 6.0-6.4
T2D = 6.5% or higher

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6
Q

Random plasma glucose range?

A

less than 11.1 mmol/L

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7
Q

Nova machine range?

A

3.3-7.0 mmol/L

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8
Q

low BS rhyme

A

less than 4, I’m on the floor

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9
Q

healthy range BS

A

4-7, I’m in heaven

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10
Q

target range in hospital, not critically ill

A

5-8, still feeling great

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11
Q

BS target for critically ill

A

6-10, just til I’m well again

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12
Q

S/S Hypoglycemia

A

blood glucose < 4
cool clammy skin
rapid HR
HA, faintness, dizziness
nervousness, tremors, shaking
hunger
emotional changes (e.g., irritability)
numbness of fingers, toes, mouth
unsteady gait, slurred speech
changes in vision
seizures, coma

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13
Q

Hypoglycemia causes

A
  1. inadvertent insulin overdose or sulphonylurea overdose, or in response to recent change in dose
  2. missed or inadequate meal
  3. unexpected exercise
  4. error in timing of dose
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14
Q

S/S Hyperglycemia

A

elevated blood glucose (>11)
polyuria (incr urination)
polydipsia (incr thirst)
polyphagia (incr hunger) followed by lack of appetite
weakness, fatigue
blurred vision
headache
N/V
abdominal cramps
glycosuria

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15
Q

Hyperglycemia causes

A

inadequate doses of insulin
infection
stress
surgery
medications (e.g., steroids, benzodiazepines)
variations in nutritional intake
individuals receiving enteral/ parental feeding
critical illness

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16
Q

what meds can cause hyperglycemia?

A

steroids and benzodiazepines
- some pts on insulin also on dexamethasone

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17
Q

BGM Goals

A
    1. to determine / monitor BG levels of pt @ risk for hyper-/ hypoglycemia
      1. promote BG regulation by pt
      2. evaluate effectiveness of insulin / oral hypoglycemic medication administration
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18
Q

When should BGM be done?

A

within 30 minutes before meal (ac meal) or 2h after meal (pc meal)

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19
Q

When is BGM usually done in a hospital?

A

Usually done before meal + @ bedtime

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20
Q

What are some BGM nursing assessments?

A

1.determine frequency + type of testing
2.determine pt’s understanding of procedure
3. determine pt’s response to previous testing
4. assess skin @ puncture site (colour, warmth, cap refill)
5. review MAR that may prolong bleeding
6. assess self-care abilities, e.g., vision, finger dexterity

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21
Q

What to do if pt is on meds that will prolong bleeding after BGM?

A

apply pressure to puncture site for at least 5 minutes post-procedure

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22
Q

What equipment do you need for BGM?

A
  1. BG meter (glucometer)
  2. reagent strips
  3. gauze / kleenex
  4. warming device prn
  5. cloth/soap/h2o or castille toilette
  6. disposable clean gloves
  7. sterile lancet w/ injector
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23
Q

BGM Test Strips - how to use?

A
  1. check expiry date on vial (opened/unopened)
  2. close cap tightly
  3. use test strip immediately after removing from vial
  4. insert gold metal end into meter well
  5. apply blood to white edge test area
  6. don’t touch bld drop 2nd time if test strip doesn’t fill completely
  7. meter allows 3 attempts to sample if needed
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24
Q

Why do we close test strip caps tightly?

BGM test strips

A

strips deteriorate/ sensitive to heat, light, and moisture

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25
What do we do with test strip if it doesn't fill completely?
Don't use a second time, discard strip and repeat with new one
26
What is the range for StatStrip Glucose Test Strips?
0.6 - 33.3 mmol/L - won't read anything outside of that range
27
When do glucose test strips expire?
in 6 months -- always need to put expiry date on vial
28
What are QC solutions? | why do we need them?
to ensure proper function of BGM before use - must do QC w/ low + high solutions - need to mix QC solutions vial prior to performing testing (mix sugar solution) - will get locked out if QC not done q24h, will be prompted 2h before schedules time
29
What is the range of QC stability?
24 months from date of manufacturing 90-day open-vial stability (3 months)
30
How much blood is needed for BGM?
very small amount of fresh, whole blood 1.2 uL, size of pinhead
31
What should you do with first drop of blood?
Wipe away first drop, apply second drop of blood to strip
32
blood glucose results (Nova) - ranges
normal: 3.3-7.0 adult critical low: < 2.6 mmol/L adult critical high: > 25 mmol/L
33
# BGM Factors to Consider: What should you do if there is an unexpected result?
repeat the test, might have to ask lab to do blood test to confirm result
34
35
# BGM Factors to Consider: What are some physiological influences that can affect results?
1. shock 2. dehydration 3. anemia 4. circulatory disorders 5. edema 6. extreme hematocrit outside acceptable range (0.10-0.60) 7. variation in sample type, e.g., venous/arterial/capillary
36
# BGM Factors to Consider: What are some environmental influences?
strip absorption of moisture or exposure to light
37
# BGM Factors to Consider: What are some operator influences?
poor technique for capillary collection 1. excessive squeezing – contaminates sample w/ interstitial fluid --> don't milk finger 2. poor blood flow 3. doesn't wipe away 1st drop – raises interference risk from skin contaminants and interstitial fluid
38
Hypoglycemia Treatment
1. once confirmed w/ repeat test, treat low BG immediately 2. emergency situation – can lead to seizures, coma, death 3. follow hypoglycemic protocol
39
What are the drug therapies available for diabetes?
insulin & oral hypoglycemic agents (OHA)
40
# Common types of Insulin in IH (PPO) Basal Insulin
Long or intermediate-acting insulin
41
# Common types of Insulin in IH (PPO) Bolus insulin
mealtime or rapid/short-acting insulin
42
What are the different basal insulins?
1. NPH (humulin N) 2. glargine (lantus) 3. degludec (Tresiba)
43
what are the different bolus insulins?
1. aspart (novo-rapid) 2. lispro (humalog) 3. regular (humulin R)
44
what is pre-mixed insulin?
long-acting & short-acting; only for T2D 1. humalog mix 25 (lispro 25% + lispro protamine 75%) 2. humulin 70/30 (70 units & 30 units R)
45
# Cloudy vs Clear Insulins: Clear insulin
1. short-acting, few long-acting 2. aspart insulin + regular insulin 3. glargine
46
# Cloudy vs Clear Insulins: Cloudy insulins
some intermediate-acting insulin cloudyness comes from added substances used as buffers (usually zince or isophane) that make them work over longer period - mix vials before administration - usually longer-acting insulin - NPH
47
# cloudy vs clear insulin Which insulin is drawn first?
Draw and verify clear insulin before drawing up cloudy insulin
48
Insulin Regimens - how often?
usually given 1-4x/day - longer acting / intermediate acting insulin 1 or 2x/day (b4 breakfast + bedtime) - rapid or short-acting before meals - or combo of both
49
Basal insulin - why needed?
req to cover rise in blood glucose b/t meals & overnight - calculation depends on weight (dose estimated @ 1/2 TDD) - includes long-acting + intermediate-acting insulins - e.g., NPH, glargine, degludec
50
Bolus insulin - why needed?
to cover rise in blood glucose due to meals - may use pre-admission meal (bolus) dose - usually 1/2 TDD divided equally amongst 3 meals
51
How to calculate total daily dose (TDD) of T1D/ slim T2D (BMI
TDD = weight x 0.3 to 0.6 units/kg
52
how to calculate TDD of T2D obese (BMI > 25)
TDD = weight x 0.3 (if insulin naive) to 1 unit/kg
53
What is Insulin Correction Dose?
additional insulin added to meal (bolus) dose to correct elevated BS, based on how sensitive pt is to insulin - physician chooses no insulin correction or mealtime/hs correction
54
when is insulin correction dose used alone?
used alone, q4h, if pt NPO
55
How is insulin sensitivity factor (ISF) chosen?
chosen based on pt's sensitivity to insulin - higher ISF = more sensitive pt is to insulin = req less insulin
56
what is ISF?
blood glucose drop in mmol/L per unit of insulin given - can calcuate how much insulin will decr BS
57
ISF 1
= 1 unit of insulin will decrease BS by 1 mmol - need more to do less
58
ISF 2
= 1 unit of insulin will decr BS by 2 mmol
59
ISF 3
= 1 unit of insulin will decr BS by 3 mmol
60
ISF 4
= 1 unit insulin will decr BS by 4 mmol (need less to do more)
61
How to calculate ISF
ISF calcuation = 100 / TDD | e.g., TDD = 50 --> 100/50 = 2 ISF
62
SC med admin - what is it?
administer meds in loose CT under dermis
63
SC Med Admin - absorption
absorbed more slowly than medication given by IM route
64
SC med admin - info
- need doctor's order prior to adminstration of medication via subcu - route not recommended for severe, uncontrolled, escalating pain d/t slow absorption
65
Insulin Pen needle size range
needle ranges from 29-32 gauge - the inner measurement or opening of needle
66
insulin pen needle length
usually determined by assessment of pt's adipose tissue but generally 4 mm-12mm (5/32 inch to 1/2 inch)
67
How to insert insulin pen?
- 90 degrees, 45 degrees also acceptable for sc injection - pinch or spread skin
68
Dose volume of SC medication?
only small doses, 0.5- 1mL of h2o solution meds - up to 2 mL safe
69
why do we pinch skin when using insulin pen?
- to prevent IM injection or for a slim person - always want to pinch arm bc want to pull fat away
70
Where to select site for insulin
outer aspect of upper arms, anterior and lateral portions of thigh, buttocks, and abdomen
71
How to select SC site for insulin
should be free of skin lesions, bony prominences, and large underlying muscles / nerves
72
What is intrasite rotation & why?
rotating injection sites w/in same body part to provide better consistency in absorption of insulin - subsequent injections should be given at least 2.5cm away from previous site
73
Which place has the quickest absorption for insulin?
abdomen
74
why do you need to mix insulin suspensions prior to administering?
inappropriate resuspension or lack thereof can affect amount of dispensed insulin by 3-6% - results in inaccurate dose of insulin throughout use of that pen

NRSG 202 (9 decks)

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