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nrsg 202 > Week 3 - BGM, hypo/hyperglycaemic & insulin protocol, insulin pen admin > Flashcards

Week 3 - BGM, hypo/hyperglycaemic & insulin protocol, insulin pen admin Flashcards

1
Q

What are the goals of diabetes management?

A
  • promote well-being
  • reduce symptoms
  • prevent acute complications of hyper/hypoglycaemia
  • delay onset/ progression of long-term complications
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2
Q

What are the normal adult blood glucose readings of glycemic levels for fasting blood glucose (FBG)?

A

7.0mmol/L for diabetes

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3
Q

How does someone prepare for a fasting blood glucose (FBG)?

A

no caloric intake for at least 8hrs

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4
Q

What are the normal adult blood glucose readings of glycemic levels for hemoglobin A1C?

A

6.5% diagnosis of type 2DM

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5
Q

Why is hemoglobin A1C measured?

A

to determine the average blood glucose levels over the previous three months

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6
Q

What are the normal adult random plasma glucose levels without regards to meals?

A

<11.1mmol/L

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7
Q

what are the normal adult blood glucose readings on a nova machine?

A

3.3-7.0mmol/L

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8
Q

What are signs/ symptoms of hypoglycaemia?

A
  • 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
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9
Q

What causes hypoglycaemia ?

A
  • insulin or sulphonylurea OD in response to recent change in dose
  • missed/ inadequate meal
  • unexpected exercise
  • error in timing of dose
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10
Q

what are the 3 common signs of hyperglycaemia?

A
  • polyuria
  • polydipsia
  • polyphagia
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11
Q

What are signs/ symptoms of hyperglycaemia ?

A
  • elevated BG (>11)
  • polyuria
  • polydipsia
  • polyphagia
  • weakness/ fatigue
  • blurred vision
  • headache
  • nausea/ vomiting
  • abdominal cramps
  • glycosuria
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12
Q

What are the causes of hyperglycaemia?

A
  • adequate dose of insulin
  • infection
  • stress
  • surgery
  • medications (steroids)
  • variations in nutritional intake
  • individuals receiving enteral/ parenteral feeding
  • critical illness
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13
Q

What are the goals of blood glucose monitoring?

A
  • determine/ monitor BG levels of clients at risk for hyper/hypoglycemia
  • promote BG regulation by client
  • evaluate effectiveness of insulin/ oral hypoglycaemic medication
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14
Q

When should blood glucose monitoring be done?

A

(AC meal)
- within 30 mins before a meal

(PC meal)
- 2hrs after a meal

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15
Q

What are the nursing assessments in regards to blood glucose monitoring?

A

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

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16
Q

What equipment is needed for blood glucose monitoring?

A
  • BG meter
  • reagent strips
  • gauze/ Kleenex
  • warming device prn
  • Castile toilette
  • clean gloves
  • sterile lancet c injector
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17
Q

What deteriorates test strips?

A
  • heat
  • light
  • moisture
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18
Q

describe quality (QC) solutions

A
  • ensure proper function of BG monitor prior to use

- must do QC with low and high glucose solutions

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19
Q

What does NB mean in regards to glucose machines?

A

QC lockout if QC not performed q 24hrs

- meter will not download patient test until QC done

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20
Q

in regards to the QC solutions how long are they good for?

A
  • 24 months from date of manufacture

- 90 days open

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21
Q

How much blood is needed for a BG level?

A

1.2uL size of a pinhead

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22
Q

What are the ranges for blood glucose results for adults using a nova?

A

normal 3.3-7.0
critical low <2.6mmol/L
critical high >25mmol/L

23
Q

if a patient who has diabetes doesn’t have glucose in their urine what does that mean?

A

does not mean the person has normal blood glucose levels

24
Q

if someone has hypoglycaemia and it does not get treated what could happen?

A
  • lead to seizures, coma, death

- emergency situation

25
Q

What are common types of insulin in regards to basal insulin?

A
  • NPH
  • glargine
  • degludec
26
Q

describe basal insulin

A
  • long or intermediate acting insulin

- cover rise in BG between meals/ overnight

27
Q

What are common types of insulin in regards to bolus insulin?

A
  • aspart
  • lispro
  • regular
28
Q

describe bolus insulin

A
  • mealtime/rapid or short acting insulin

- cover rise in blood glucose due to meals

29
Q

What are common types of insulin in regards to pre-mixed insulin?

A
  • humalog

- humulin

30
Q

describe pre-mixed insulin

A

both long-acting and short-acting

31
Q

How often is insulin given ? What about the different types

A
  • 1-4 times/ day
  • long or intermediate 1-2times/day
  • rapid/ short acting before meals
32
Q

What are the nursing responsibilities for a client receiving insulin or oral hypoglycaemia agent (OHA)?

A

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

33
Q

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?

A
  • inspect injections sites
  • review insulation prep, storage, timing, injection technique
  • history of hypoglycaemic episodes
  • review recorded glucose tests
34
Q

describe an insulin correction dose

A
  • 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
35
Q

describe the insulin sensitivity factor (ISF)

A
  • physician chooses ISF for client based on client’s sensitivity to insulin
  • higher ISF more sensitive client is
36
Q

by knowing the ISF you can calculate how much insulin will decrease blood sugar. Describe the ISF levels

A
  • 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
37
Q

where do subcutaneous (SC) injections go?

A

loose connective tissue under the dermis

38
Q

describe medication absorption in regards to subcutaneous (SC) injections

A

absorbed more slowly compared to IM route

39
Q

when might a subcutaneous (SC) medication administration not be recommended ?

A

route not recommended for severe, uncontrolled escalating pain due to slow absorption

40
Q

What are the needle size ranges for insulin pens?

A
  • 29-32 gauge
41
Q

How is the length of an insulin pen needle determined?

A
  • assessment of client’s adipose tissue

- 4mm-12mm

42
Q

What angle should an insulin pen be administered?

A

90 degrees but 45 degrees is also ok

43
Q

What amount of water-soluble medications should be given subcutaneously?

A

only small doses

0.5-1mL

44
Q

Why do we pinch the skin when administering a SC injection?

A

necessary when using a longer needle to prevent an IM injection or for a slim person

45
Q

for insulin SC injections which site has the fasts absorption?

A

abdomen

46
Q

what are sites that are acceptable to use for SC insulin injections?

A
  • outer aspect of the upper arms

- anterior/ lateral portions of thigh, ass, abdomen

47
Q

in regards to SC insulin injections what should the sites be free of?

A
  • lesions
  • bony prominences
  • large underlying muscles/ nerves
48
Q

clients with diabetes that inject insulin should practice what?

A
  • intrasite rotation
49
Q

what is intasite rotation?

A
  • rotating injection sites within the same body part to provide better consistency in absorption
50
Q

How far apart should injection sites be in regards to SC insulin

A

2.5cm away from previous site

51
Q

do you need to use a disinfectant wipe to disinfect prior to a subcutaneous injection, in regards to insulin?

A
  • not recommended for clients at home

- clean site with alcohol swab in hospital setting

52
Q

How do you use an alcohol swab for injection?

A
  • wipe 15-30sec
  • let dry for 30-60 sec
  • touch swab to centre of site and rotate outward in circular motion
53
Q

Why do you need to mix insulin suspensions prior to administering?

A
  • if not mixed amount of dispensed insulin given to client can lack by 3-6%
  • results in inaccurate dose of insulin
54
Q

What are advantages of using an insulin pen vs. syringes?

A
  • 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

nrsg 202 (11 decks)

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