Week 3 - BGM, hypo/hyperglycaemic & insulin protocol, insulin pen admin Flashcards
What are the goals of diabetes management?
- promote well-being
- reduce symptoms
- prevent acute complications of hyper/hypoglycaemia
- delay onset/ progression of long-term complications
What are the normal adult blood glucose readings of glycemic levels for fasting blood glucose (FBG)?
7.0mmol/L for diabetes
How does someone prepare for a fasting blood glucose (FBG)?
no caloric intake for at least 8hrs
What are the normal adult blood glucose readings of glycemic levels for hemoglobin A1C?
6.5% diagnosis of type 2DM
Why is hemoglobin A1C measured?
to determine the average blood glucose levels over the previous three months
What are the normal adult random plasma glucose levels without regards to meals?
<11.1mmol/L
what are the normal adult blood glucose readings on a nova machine?
3.3-7.0mmol/L
What are signs/ symptoms of hypoglycaemia?
- blood glucose <4
- cool/ clammy skin
- rapid HR
- HA, faintness, dizziness
- nervousness
- tremors/ shaking
- hunger
- emotional changes
- numbness of fingers, toes, mouth
- unsteady gait
- slurred speech
- changes in vision
- seizures
- coma
What causes hypoglycaemia ?
- insulin or sulphonylurea OD in response to recent change in dose
- missed/ inadequate meal
- unexpected exercise
- error in timing of dose
what are the 3 common signs of hyperglycaemia?
- polyuria
- polydipsia
- polyphagia
What are signs/ symptoms of hyperglycaemia ?
- elevated BG (>11)
- polyuria
- polydipsia
- polyphagia
- weakness/ fatigue
- blurred vision
- headache
- nausea/ vomiting
- abdominal cramps
- glycosuria
What are the causes of hyperglycaemia?
- adequate dose of insulin
- infection
- stress
- surgery
- medications (steroids)
- variations in nutritional intake
- individuals receiving enteral/ parenteral feeding
- critical illness
What are the goals of blood glucose monitoring?
- determine/ monitor BG levels of clients at risk for hyper/hypoglycemia
- promote BG regulation by client
- evaluate effectiveness of insulin/ oral hypoglycaemic medication
When should blood glucose monitoring be done?
(AC meal)
- within 30 mins before a meal
(PC meal)
- 2hrs after a meal
What are the nursing assessments in regards to blood glucose monitoring?
determine:
- frequency/ type of testing
- client’s understanding of procedure
- client’s response to previous testing
assess clients skin at puncture site
review clients record for medication that may be prolong bleeding
assess clients self-care abilities that may affect accuracy of results
What equipment is needed for blood glucose monitoring?
- BG meter
- reagent strips
- gauze/ Kleenex
- warming device prn
- Castile toilette
- clean gloves
- sterile lancet c injector
What deteriorates test strips?
- heat
- light
- moisture
describe quality (QC) solutions
- ensure proper function of BG monitor prior to use
- must do QC with low and high glucose solutions
What does NB mean in regards to glucose machines?
QC lockout if QC not performed q 24hrs
- meter will not download patient test until QC done
in regards to the QC solutions how long are they good for?
- 24 months from date of manufacture
- 90 days open
How much blood is needed for a BG level?
1.2uL size of a pinhead
What are the ranges for blood glucose results for adults using a nova?
normal 3.3-7.0
critical low <2.6mmol/L
critical high >25mmol/L
if a patient who has diabetes doesn’t have glucose in their urine what does that mean?
does not mean the person has normal blood glucose levels
if someone has hypoglycaemia and it does not get treated what could happen?
- lead to seizures, coma, death
- emergency situation
What are common types of insulin in regards to basal insulin?
- NPH
- glargine
- degludec
describe basal insulin
- long or intermediate acting insulin
- cover rise in BG between meals/ overnight
What are common types of insulin in regards to bolus insulin?
- aspart
- lispro
- regular
describe bolus insulin
- mealtime/rapid or short acting insulin
- cover rise in blood glucose due to meals
What are common types of insulin in regards to pre-mixed insulin?
- humalog
- humulin
describe pre-mixed insulin
both long-acting and short-acting
How often is insulin given ? What about the different types
- 1-4 times/ day
- long or intermediate 1-2times/day
- rapid/ short acting before meals
What are the nursing responsibilities for a client receiving insulin or oral hypoglycaemia agent (OHA)?
assessment
- adjustment/ understand and fears about therapy
- effectiveness
- adverse effects
patient education regarding administration
evaluation of clients ability to manage therapy safely
proper med admin
follow up assessment
in regards to the nursing responsibilities for a client receiving insulin or oral hypoglycaemia agent (OHA) what needs to be included in the follow-up assessment?
- inspect injections sites
- review insulation prep, storage, timing, injection technique
- history of hypoglycaemic episodes
- review recorded glucose tests
describe an insulin correction dose
- additional insulin added to the meal (bolus) does to correct elevated blood sugars
- based on how sensitive a patient is to insulin
- used alone (q4H) if patient is NPO
describe the insulin sensitivity factor (ISF)
- physician chooses ISF for client based on client’s sensitivity to insulin
- higher ISF more sensitive client is
by knowing the ISF you can calculate how much insulin will decrease blood sugar. Describe the ISF levels
- ISF 1 = 1 unit insulin decrease by 1mmol
- ISF 2 = 1 unit insulin decrease by 2mmol
- ISF 3 = 1 unit insulin decrease by 3mmol
- ISF 4 = 1 unit insulin decrease by 4mmol
where do subcutaneous (SC) injections go?
loose connective tissue under the dermis
describe medication absorption in regards to subcutaneous (SC) injections
absorbed more slowly compared to IM route
when might a subcutaneous (SC) medication administration not be recommended ?
route not recommended for severe, uncontrolled escalating pain due to slow absorption
What are the needle size ranges for insulin pens?
- 29-32 gauge
How is the length of an insulin pen needle determined?
- assessment of client’s adipose tissue
- 4mm-12mm
What angle should an insulin pen be administered?
90 degrees but 45 degrees is also ok
What amount of water-soluble medications should be given subcutaneously?
only small doses
0.5-1mL
Why do we pinch the skin when administering a SC injection?
necessary when using a longer needle to prevent an IM injection or for a slim person
for insulin SC injections which site has the fasts absorption?
abdomen
what are sites that are acceptable to use for SC insulin injections?
- outer aspect of the upper arms
- anterior/ lateral portions of thigh, ass, abdomen
in regards to SC insulin injections what should the sites be free of?
- lesions
- bony prominences
- large underlying muscles/ nerves
clients with diabetes that inject insulin should practice what?
- intrasite rotation
what is intasite rotation?
- rotating injection sites within the same body part to provide better consistency in absorption
How far apart should injection sites be in regards to SC insulin
2.5cm away from previous site
do you need to use a disinfectant wipe to disinfect prior to a subcutaneous injection, in regards to insulin?
- not recommended for clients at home
- clean site with alcohol swab in hospital setting
How do you use an alcohol swab for injection?
- wipe 15-30sec
- let dry for 30-60 sec
- touch swab to centre of site and rotate outward in circular motion
Why do you need to mix insulin suspensions prior to administering?
- if not mixed amount of dispensed insulin given to client can lack by 3-6%
- results in inaccurate dose of insulin
What are advantages of using an insulin pen vs. syringes?
- better glycemic control
- increased med adherence
- fewer hypoglycaemic events
- reduced risk of med error
- improved self management education
- cost saving
- improved safety for health care workers
- possible decreased insulin waste
- decreased nursing time
