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Student Name:Chandra Murali

BLOOD GLUCOSE MONITORING

Required Reading for Blood Glucose:


Perry, A. and Potter, P. (2014). Clinical Nursing Skills and Techniques, 8th ed., Mosby.
pp. 1085-1090.
Required Reading for Insulin Administration:
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2014). Brunner and Suddarths
Textbook of Medical Surgical Nursing (13th ed., Vol. 2, pp. 1428 - 1439). Philadelphia, PA:
Wolters
Kluwer Health / Lippincott Williams & Wilkins.

STUDY GUIDE QUESTIONS:


1. Blood glucose levels can be obtained by venipuncture or capillary puncture. Identify why
capillary puncture is a preferred method for obtaining a blood glucose level.
To reduce the frequency of needle sticks alleles painful and the end of the
punetuns method makes it possible for patient to preform this procedure

2. Reflectance meters are more commonly used to check blood glucose. How do the different
brands of reflectance meters differ?
Amount of blood needed is different testing speed overall size ability to store
test results in memory card of the meter and cost of the strips

3. What is an HbA1c test?


It evaluates the amount of glucose available in the blood steam over the 120
day life span of a red blood cell. It provides an alleviate long term index of a
patients blood glucose level drawn by venous puncture.

4. What specific conditions might need to be met before or after collecting the Blood Glucose
blood sample?
-Appropriate sites for use of puncture and when to obtain blood glucose.
- Diet intake of carbs and of concentrates glucose preparations often blood
glucose
levels.

5. Identify factors the nurse should consider when selecting a site for obtaining a blood
sample?
Avoid areas of brushing and open lesions. Avoid using the hand and the side of
the mestletms

6. Who determines the frequency/schedule for blood glucose measurements and what are
some of the factors in that decision?
Healthcare provider/order

7. The nurse is caring for a patient with Insulin Dependent Diabetes Mellitus (IDDM). The lab
result for the HbA1C is > 9%. Identify a Nursing Diagnosis for this patient.
Ineffective health management.

8. Identify the equipment needed to check the blood glucose level of a patient.
- blood glucose meter
-blood glucose test strips
-clean gloves
-cotton ball
-lancet
- antiseptic swabs
-paper towels

9. Blood Glucose Monitoring is commonly delegated to assistive personnel. Identify the


information the nurse should instruct the assistive personnel to report.
Blood glucose level and unexpected glucose levels

10. After removing a test strip, why should the nurse immediately reseal the vial of test strips?
it protects tips from accidental discoloration caused by exposure to air or light.

11. For meters that require a code, what would happen if the code on the test strips did not
match the code on the meter?
Then it would not work

12. What is the preferred puncture site for an adult and why?
lateral side of finger,it is less sensitive to pain.

13. Why shouldnt the finger be milked or massaged prior to obtaining the capillary blood
sample?
it increases blood flow to area before puncture smiling may hemolyze specimen
and introduce excess tissue fluid.

14. Briefly, summarize the steps in obtaining a Blood Glucose Level by capillary puncture:
Clean patients finer with a antiseptic swab hold area to be punctured in
depended position. hold tip of lancet device against area of skin
press release button. Remove devise. Gently squeeze/massage finger until
blood draws forward.

15. Generally, the normal range for Blood Glucose is 70-110 mg/dL. What should the nurse do
if the Blood Glucose level is above 110 mg/dL?
-Continue to monitor patient.
-Check for med orders for deviations in glucose levels.
-notify health care provider

16. Generally, the normal range for Blood Glucose is 70-110 mg/dL. What should the nurse do
if the Blood Glucose level is below 70 mg/dL?
-Continue to monitor patient.
-Check for med orders for deviations in glucose levels.
-notify health care provider

17. What should be documented?


Glucose levels, patient respond, appearance of puncture site,
explanation/teaching provided.

INSULIN ADMINISTRATION

Required Reading:
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2014). Brunner and Suddarths
Textbook of Medical Surgical Nursing (13th ed., Vol. 2, pp. 1428 - 1439). Philadelphia, PA:
Wolters
Kluwer Health / Lippincott Williams & Wilkins.

STUDY GUIDE QUESTIONS:


18. Identify medical conditions where the diabetic patient might need insulin even though they
normally control their diabetes through diet or oral anti-diabetic medications.
Illness, infection, pregnancy, surgery, other stressful events

19. Identify the basis for categorizing insulins (time course of action)?
Onset peak duration of action

20. The patient with insulin dependent diabetes will have a regimen for controlling their
diabetes. The patients regimen will have two components.
20.1 The first component is treating fluctuations in blood glucose levels related to dietary
intake (as monitored by Blood Glucose Monitoring). Blood glucose fluctuations are
treated with either Rapid or Short Acting Insulin (not both). Complete the chart:

Rapid Acting Insulin Short Acting Insulin


Agents: Agents: Error in text:
lispro Humulin R (not
aspart Humalog R)
glulisine

Onset: 10-15min, 5- Onset: 1 1/2 -1 h


15min, 5-15min
Peak: 1h, 40-50min, 30- Peak: 2-3h
60min
Duration: 2-4h, 2-4, 2h Duration: 4-6h

20.2 The second component of an insulin regimen provides a gentle gradual decrease in
blood glucose levels throughout the day. The patient will either use an intermediate
acting insulin or a very long acting insulin (not both) for glucose control throughout
the day. Complete the chart:

Intermediate Acting Very Long Acting Insulin


Insulin
Agents: Lente no longer Agents: glargine detemir
sold in U.S.

NPH

Onset: 2-4h, 3-4h Onset: 1h


Peak: 4-12h, 4-12h Peak: no peak
Duration: 16-20h 16-20h Duration: 24h

21. In looking at the agent names and the onset, what dangers should the nurse consider when
administering insulin?
read the label cordially and be sure that they covered type of insulin is
administered.

22. It would seem logical that a patients blood glucose level would drop during sleep because
the patient is not ingesting food. Why does the patients blood glucose actually rise during
sleep?
At 3am, blood glucose levels being to rise the result from nocturnal sugars in
growth hormone secretion which creates a greater need for insulin in the early
morning hours.

23. Insulin pens (page 1431) are very convenient for patients. What are the advantages of
insulin pens?
Most useful for patients who need to inject only with type of insulin at a time or
those who can use the premixed insulin.

24. Insulin pumps (page 1431) offer subcutaneous infusion of insulin. How often should the
patient change the subcutaneous needle/catheter?
Every 3 days

25. The insulin pump allows for administration of a continuous basal rate of insulin. Can the
insulin pump deliver a calculated dose to cover carbohydrate consumption?
yes

Skip to page 1438.


26. Where are the vials of Insulin typically stored?
In the fridge

27. Insulin syringes must be matched to insulin concentration.


1mL syringe, 100 unit
0.5 mL syringe, 150 unit
0.3 mL syringe, 130 unit

28. When mixing two types of insulin, what does the ADA recommend?
The regular insulin needs to be drawn up first.

29. What are the options for patients who have difficulty mixing insulins?
Use pre-mixed insulin

30. Which injection site has the fastest absorption rate?


abdomen

31. As you learned in question 20.1, rapid or fast acting insulin are used to treat the patients
blood glucose levels. Sliding Scale Insulin is one method although diabetic
management is progressing towards a combination of calorie count and sliding scale. A
typical sliding scale is below.
31.1 What is the most insulin that would be given? 15 units

SLIDING SCALE
Glucose Reading Sliding Scale
Glucose < 60 mg/dL Hypoglycemia protocol, Call MD.
Glucose 70-180 mg/dL No Insulin
181-200 mg/dL 3 units Regular Insulin
201-250 mg/dL 6 units Regular Insulin
251-300 mg/dL 9 units Regular Insulin
301-350 mg/dL 11 units Regular Insulin
351-400 mg/dL 13 units Regular Insulin
Greater than 400 mg/dL 15 units Regular Insulin and call
physician
31.2 Using the Sliding Scale above, list the Insulin doses for the following situations:
1100 Blood glucose 211 mg/dL. Insulin dose: 6units regular insulin
0600 Blood Glucose is 48 mg/dL. Insulin dose: call MD, hypoglycemia protocol
0600 Blood Glucose is 258 mg/dL. Patient is NPO for surgery at 1000. Insulin dose:
9 units regular insulin
Student Name:Chandra Murali

SKILL CHECKLIST BLOOD GLUCOSE MONITORING

NEEDS MORE
PROFICIENT PRACTICE
Gathers supplies needed to
obtain Blood Glucose Level
by Capillary Puncture.
Confirms test strip code to
monitor code.
Performs hand hygiene,
dons gloves
Confirms patient I.D.
Selects correct site for
capillary puncture.
Punctures skin using
appropriate technique.
Correctly places blood
droplet on meter strip.
Applies pressure to
puncture site and evaluates
test site.
Interprets results.
Uses blood safety
precautions.
Documents Blood Glucose
results.

SKILL CHECKLIST INSULIN ADMINISTRATION

NEEDS MORE
PROFICIENT PRACTICE
Performs hand hygiene.
Given a sliding scale and
blood glucose level,
accurately prepares
Regular Insulin in correct
dose.
Prepares Insulin.
For meal coverage.
For basal dose.
Mixing insulins.
Insulin pen
Checks Insulin dose with a
second nurse.
Performs hand hygiene.
Performs six rights of
medication administration.
Provides patient privacy.
Verbalizes understanding of
site selection
Administers Insulin sub-Q in
correct site.
Documents Insulin
administration.

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