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Blood Glucose Monitoring

Blood Glucose Monitoring. NUR 302 Developed by: Susan L Shelton RN, MSN, CNM Revised by: Jill Ray RN, MSN. Blood Glucose Monitoring. Measures blood glucose levels for monitoring control of diabetes mellitus. Test results direct Diet Amount and type of medication Exercise prescription

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Blood Glucose Monitoring

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  1. Blood Glucose Monitoring NUR 302 Developed by: Susan L Shelton RN, MSN, CNM Revised by: Jill Ray RN, MSN

  2. Blood Glucose Monitoring • Measures blood glucose levels for monitoring control of diabetes mellitus. • Test results direct • Diet • Amount and type of medication • Exercise prescription • Helps prevent diabetic emergencies by prompt detection & treatment of hypo- & hyperglycemia

  3. Generalizations • Performed usually ac and hs…what does that mean? • Why should the BGL be assessed before a meal? • Each facility has a slightly different procedure. You will have to be validated at ea facility for this procedure. • Know the Normal values for blood glucose. • Report values outside of the range of normal ASAP…very important as immediate intervention is usually indicated. • You will usually repeat the test if you get a value outside of the range of normal. • Know the values at which the monitor you are using is no longer accurate: GMC less than 40 and greater than 300). • If the BGL if less than 90 you MUST intervene immediately. Don’t wait on your clinical instructor to come to you…find her or another RN. • See p. 1476 and 1477 for very good instructions re: this procedure.

  4. Whoa, Nelly….What is Diabetes???? • Inability of the pancreas to either produce enough insulin or the body’s inability to utilize the insulin it has. • Insulin is the substance that converts glucose to a form that is usable by the body. • Thus, low insulin equal high glucose circulating in the blood but not utilized by the cells.

  5. Hypoglycemia Low blood sugar hyperinsulinemia Hyperglycemia Elevated blood sugar Inadequate insulin Hypoglycemia vs.Hyperglycemia

  6. Hypoglycemia • Sweating • Tachycardia • Palpitations • Nervousness • Tremors • Weakness • Headache • Mental confusion • Fatigue

  7. Hyperglycemia • Thirst • Polyuria • Polyphagia • Weakness • Fatigue • Headache • Blurred vision • Nausea • Vomiting • Abdominal cramping

  8. So What…?Complications of Abnormal Blood Glucose • Heart attack • Cerebrovascular accident • Kidney dysfunction • Blindness • Nerve damage

  9. *Elkin et. al (2004, 3rd Ed.), Table 14-1, p.361 Goals for Glucose Control

  10. Blood Glucose MonitoringASSESSMENT • Client’s understanding • Health history • Specific conditions of specimen collection • Site selection • Client’s ability to self-test • Presence of signs & symptoms glucose alteration • Calibration of equipment

  11. “Expected outcomes focus on minimizing tissue damage with finger stick, achieving accurate results, and maintaining glucose levels within goal range.” Equipment Glucometer Gloves Antiseptic swab Cotton ball or gauze Sterile lancet Paper towel Sharps box Test strips Blood Glucose MonitoringPLANNING

  12. Blood Glucose MonitoringIMPLEMENTATION • Wash hands • Position site lower than heart • Gather supplies and turn on meter • Select site and cleanse • Position lancet firmly against site and pierce skin • Collect sample • Read results

  13. Blood Glucose MonitoringIMPLEMENTATION • Once results are available, • Appropriate intervention for the value obtained, then: • dispose of used supplies • document results • turn meter off (enter comments as indicated)

  14. Hypoglycemic Protocols • All hospitals will have these • Need to be familiar with this for your facility before you begin to do this procedure. • Note that you must be supervised by an RN, and can only perform those skills that you have been validated for in the skills lab.

  15. Blood Glucose MonitoringEVALUATION • Observe site for bleeding or bruising • Compare client readings with normal values • Ask client to discuss procedures & test results • Observe client performing self-testing

  16. Blood Glucose MonitoringBut, what if…? • Puncture site continues to bleed • Glucose meter malfunctions • Result is above or below normal value • Client expresses misunderstanding of procedure or results

  17. Blood Glucose MonitoringDOCUMENTATION • SAMPLE: • 0730 Blood glucose 110. No insulin required. • 1200 Blood glucose 240. Regular insulin (4 units) given subcutaneously per sliding scale order. **Some facilities have a flowsheet and others note results on MAR.

  18. Gwinnett Hospital System Title: Precision PXP Glucose Meters Competency Statement: Demonstrates management of the Precision PXP glucose meter for patient testing in a safe and effective manner. Learning Resources: Precision Xceed Pro (PXP)Manual- Abbott Co. 2007

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