You are on page 1of 6

SKILLS LECTURE

CAPILLARY BLOOD GLUCOSE MONITORING


BLOOD GLUCOSE TESTING/MONITORING

Purposes:
1.
2. Reflects glucose excursion after meals
3.
4.
5.

Different Blood Glucose Testing/Monitoring

1. Urine Testing for Ketones and Glucose


Inexpensive, noninvasive, painless test which has unpredictable results and
cannot be used to detect and measure hypoglycemia
recommended to monitor hyperglycemia and ketoacidosis in people with type
I DM who have unexplained hyperglycemia during illness or pregnancy

2. Fasting Blood Glucose

The client should fast for at least 8 hours


Blood is drawn before insulin or oral antidiabetic agents have been taken
Normal range:

3. Oral Glucose Tolerance Test

Not routinely used except for gestational diabetes


Inconvenient, costly, and time consuming to clients

Instructions for OGTT

o Eat a balanced diet with carbohydrate intake of at least 150 g for a


minimum of 3 days while maintaining normal physical activity
o Carbohydrate restriction, bedrest, acute illness and certain drugs interfere
with the test
o The test is performed in the morning after a 10-12 hour fast
o A fasting blood sample is obtained
o The patient will be asked to drink 300 ml (75 g) of a flavoured beverage
within 5 minutes of the fasting blood sample
o Blood samples are drawn at 30-minute intervals for 2 hours.
o During the test the patient is asked to remain at rest and not be able to
smoke or drink liquids

Report any signs suggesting hypoglycemia, such as weakness, dizziness,


nervousness, and confusion
Normal range (2 hour postload result): < 140 mg/dL (7.8 mmol/L)

4. Glycosylated Hemoglobin Assays

The higher the blood glucose is over time, the more glycosylated hemoglobin
becomes
HbA1c shows the average blood glucose level during the previous 120 days
(2-3 months)

5. Glycosylated serum proteins and albumin


Serum proteins and albumin become glycosylated in the same way that
hemoblobin does
Proteins and albumin turn over in 14 days, thus, can indicate blood glucose
control over a shorter period as compared to HbA1c

6. Capillary Blood Glucose/ Self Monitoring for Blood Glucose


Allows the person with diabetes to monitor and achieve metabolic control and
decrease the danger of hypoglycemia
The finger is pricked and a drop of blood is made to flow over a reagent pad
on a testing strip
Meters measure blood glucose by using:

Continuous blood glucose monitoring

o Has a sensor that is inserted under the skin which continuously sends data to
the transmitter, which sends the information to the pump by radio-frequency
wireless technology
o This data can warn of high or low glucose levels
o May also be a diagnostic device when worn for 3 days revealing patterns of
glycemic control useful

Results are influenced by:


Meters calibration to strip currently in use

Client-specific conditions of hematocrit level, triglyceride level, and presence


of hypotension
Guidelines for infection control:
Infection can be spread by the lancet holder even when the l;ancet itself has
been changed o Small particles of blood can stick to the device and infect
multiple users

Frequency of testing :
Clients with unstable blood glucose levels and those using intensive
treatment regimens require frequent monitoring
Clients with simple treatment need less frequent testing

Nursing considerations :
1. If extremity is pale and cool to touch:

2. If finger is pricked, but even with squeezing of the finger, no drops are being
produced
Restick patient on a finger that doesnt have or with less prominent calluses
3. The earlobe may be used as an alternative site if extremity has injury or
decreased circulation to the hands
4. The outer aspect of the heel is used for infants and young children

6. The first drop of blood is wiped off to prevent inaccurate reading by the
sensor. The first drop of blood is usually more serous and may be contaminated
by disinfectant.
7. Use a dry cottonball to stop bleeding after the test. Using cottonball with
alcohol stings and prolongs coagulation.

Capillary BloodGlucose Dertermination: Procedure with Rationale


1. Check physicians order CBG monitoring is a dependent nursing
intervention
2. Gather equipment facilitates the process
3. Identify patient ensures that appropriate intervention is given to the right
client
4. Explain rationale and procedure to the patient. May instruct client to wash
hands in warm water and soap.
- Explanation lessens patients anxiety and promotes compliance.
- Washing of hands will decrease contamination of specimen/blood. Warm water
promotes vasodilation.
5. Don gloves precautionary measure to prevent acquiring blood borne
diseases in the part of health worker
6. Prepare lancet.
7. Turn on glucose meter
8. Check that code number on the strip matches code number on monitor
screen.

-Provides accurate result.


9. Massage site of finger toward puncture site. Promotes blood circulation in
the area
10. Cleanse area with alcohol, dry thoroughly- infection control
11. Hold lancet perpendicular to skin and prick patients finger lateral to the
fingertip. - edge of fingers have few nerve endings
12. Wipe away first drop of blood. First drop of blood is usually more serous
and may be contaminated with alcohol or disinfectant
13. Apply adequate drop of blood to test strip. Inadequate blood can give
erroneous result.
14. Apply pressure to puncture site with a dry cotton ball. Prevents bleeding
15. Read blood glucose results.
16. Turn meter off, dispose supplies
17. Remove gloves and wash hands. Universal precaution
18. Document results and report abnormal results. documentation provides
basis of future plans and proper referral warrants immediate intervention

COLOSTOMY CARE

Creation of a temporary or permanent opening (stoma) in the abdomen for


temporary or permanent passage of stools

Types:

Ileostomy
Colostomy
Sigmoidostomy
Transverse colostomy
Descending colostomy
Ascending colostomy

Nursing responsibilities:
1., empty pouch when it is 1/3 - 1/2 full
2. advise to avoid foods that stimulates elimination
3. instruct to check peristomal skin every pouch system change
4. reduce patient anxiety
5. promote positive self-image
6. odor control
7. gas control
8. Teach on cleaning and changing ostomy pouch - 1/8 larger that the stoma
9. Teach colostomy irrigation
PURPOSE TO RE-ESTABLISH REGULARITY OF BOWEL ELIMINATION WHEN
NECESSARY
( AN ILEOSTOMY IS NOT IRRIGATED SINCE IT PRODUCES LIQUID EFFLUENT DUE TO
THE PORTION OF THE COLON RESECTED .)
RATIONALE :
TO MANAGE REGULAR BOWEL ELIMINATION .
TO EVACUATE STOOL FROM COLON .
TO PREPARE COLON FOR RE ANASTOMOSIS

IV THERAPY:
It is the insertion of a needle or Catheter/ Cannula into a vein, based on the Physicians
written prescription. The needle or catheter is attached to a sterile tubing and a Fluid
container to provide medications and Fluids

FACTORS TO CONSIDER FOR IV THERAPY


- Duration of therapy
- Cannula size
- Condition of the vein/skin
- Type of solution
- Patients level of consciousness
- Patients activity
- Patients age
- Dominant arm
- Clinical status of patient

Purpose: - To maintain Hydration and or correct dehydration in patients unable to


tolerate sufficient volumes of oral fluids/medications.
- Parenteral Nutrition
- Administration of drugs. Ex. Chemotherapy, antibiotics
- Transfusion of blood or blood products

Complications:
Infiltration/ Extravasation seepage of the IV Fluid out of the vein and into
the surrounding interstitial spaces. Characteristics: Edema, pain and Coolness
at site, may or may not have blood return
Phlebitis an inflammation of the vein that can occur either form mechanical
or chemical trauma or local infection. Phlebitis can cause the development of
a Clot (thrombophlebitis)
Circulatory Overload/Speed shock- results form rapid administration of IV
fluid.
Air Embolism
Catheter Embolism
Infection at Venipuncture site
Systemic infection/ pyrogenic infection
Allergic reaction
Pulmonary congestion brought about by rapid administration of IVF

Fluid rescusitation for burn patients


Parkland's Formula:
Fluid Requirements = TBSA burned (%) x Weight (kg) x4 mL (RL)
Administer of fluid requirements in 1st 8 hours, then administer the 2nd
half of fluid requirements over the next 16 hours.

Blood transfusion
Introduction of whole blood or blood components into the venous circulation
Blood type
Blood typing
Cross matching
Nursing responsibilities
Check blood for:
Date of expiration
Leaks
Abnormal color
Clots
Excessive air
Bubbles and cloudiness septicemia
Administer within 30 minutes
Do not refrigerate
Check vital signs and lung sounds

Transfusion Reactions

Allergic reactions; HIVES, ITCHING, ANAPHYLAXIS


STOP TRANSFUSION
Febrile reaction fever develops during transfusion
Fever, malaise, chills, headache
Hemolytic reaction incompatibility of blood product infused
Facial flushing
Fever, chills,
Headache
Low back pain
Shock

Circulatory overload
Too much blood administered
Dyspnea
Dry cough
Pumonary edema