Blood Glucose Monitoring

timing of checking, test/results, perform a demonstration

Patient Education: Stress the importance of the ___________________ blood glucose levels, particularly in patients with diabetes mellitus. To advance the patient's education, ask him or her to explain the _________________, and to ___________________________ of the procedure. Encourage questions and answer them as they arise.

hyperglycemia- high blood glucose hypoglycemia- low blood glucose

Point-of-care capillary blood glucose testing also allows for a quick response to episodes of high blood glucose (also called _________________) or low blood glucose (also called __________________).

70 to 110 mg/dL

Normal adult blood glucose levels typically fall in the ______ to _______ range.

1) obtaining a drop of capillary blood by skin puncture using a single-use. 2) auto-disabling lancet 3) applying a drop of blood to a specially prepared chemical reagent strip.

Point-of-care measurement of blood glucose requires: 1) 2) 3)

age, physical stressors and activity, meal times and foods consumed, insulin administration, and medications

Normal blood glucose values may vary by _______ and may depend on the patient's ___________________ and ______________, _________________ and _______________________, __________________________, and _____________________.

1) Antiseptic swab Cotton ball or gauze 2) Sterile single-use, auto-disabling lancet or bloodletting device 3) Heel-warming device, optional (for children) 4) Blood glucose meter 5) Blood glucose reagent strips (brand determined by meter used) 6) Gloves 7) Gauze and tape or self-adhesive bandage 8) Manufacturer recommended cleaning and disinfection supplies for meter

List the Supplies needed in order to perform Blood Glucose Monitoring 1) 2) 3) 4) 5) 6) 7) 8)

"low" or "high."

Meters report a wide range of blood glucose values. If a value falls outside of a preset range, the meter reads ________ or ________.

1) venipuncture cannot be performed to reduce the frequency of venous needlesticks 2) for self-management of diabetes mellitus.

Obtaining capillary blood by skin puncture is an alternative when: 1) and 2)

C. Milked the finger for blood Rationale: If the family member milked the finger for blood, more education is needed. When obtaining blood from a finger stick, the finger should not be milked as this may cause inaccurate results. The rest of the actions are appropriate.

A nurse is teaching a family member how to obtain blood from a finger stick for glucose testing. Which action by the family member indicates the need for further education? A. Held the finger in a dependent position prior to puncture B. Punctured the side of the finger C. Milked the finger for blood D. Held the lancet perpendicular to the puncture site

1) puncture site 3) Ask the patient to discuss any concerns about the procedure. 4) Assess, treat, and reassess pain.

Monitoring and Care: 1) Reinspect the ________________ for bleeding or tissue injury. 2) Compare the glucose meter reading with normal blood glucose levels and the patient's previous test results. 3) Ask the patient to discuss any concerns about the procedure. 4) Assess, treat, and reassess pain.

A. Ask the child which puncture site he or she prefers Rationale: When performing a blood glucose test on a young child, allowing the child to choose the puncture site (from among approved sites) lessens anxiety. Asking the child's mother would not make the procedure more successful. The site cannot be cleansed until it is chosen. Giving the child juice may alter the test results.

A nurse prepares to perform a blood glucose test on a young child. Which action should the nurse take before choosing the puncture site? A. Ask the child which puncture site he or she prefers B. Ask the child's mother where to puncture C. Cleanse the site and puncture quickly D. Give the child orange juice before the procedure

A. Verify the correct patient using two identifiers. Rationale: After donning gloves, the nurse should verify the correct patient using two identifiers. The other actions should take place after the patient has been properly identified.

A patient is going to have a blood glucose test. Which action should the nurse take next after entering the patient's room and donning gloves? A. Verify the correct patient using two identifiers. B. Disinfect the meter per the manufacturer's instructions. C. Ensure that the patient agrees to treatment. D. Explain the procedure to the patent.

C. Teach using the same meter the patient will use at home. Rationale: When possible, the patient should be taught with the same meter that he or she will be using at home. The nurse should ask the patient to explain the test and the results and perform a return demonstration of the procedure. The caregiver can be included in the teaching if he or she will be assisting the patient. The patient should be provided with information on where to obtain assistance if the meter malfunctions and should be given a user manual, but the nurse should ensure that all steps are covered before discharge. The patient should not be referred to the Internet. It is standard to refer the patient to the user manual because it provides information specific to the meter the patient is using.

A patient newly diagnosed with diabetes will be discharged home with a blood glucose monitor. Which technique is the best method of providing education on the use of the machine? A. Teach the caregiver how to use the monitor. B. Provide the patient with a user manual. C. Teach using the same meter the patient will use at home. D. Refer the patient to the Internet for meter malfunctions.

1) Glucose level 2) Time that sample was obtained 3) Appearance of puncture site 4) Action taken if result was abnormal, including recording and reporting of abnormal blood glucose levels 5) Unexpected outcomes and related nursing interventions 6) Patient and family education

After Blood Glucose Testing, What should be documented? 1) 2) 3) 4) 5) 6)

1) bleeding or tissue damage. 2) expected range 3) documented 4) Patient meets education goals for demonstrating procedure. 5) Patient explains meaning of test results.

After Blood Glucose Testing, the expected outcomes include: 1) the puncture site shows no evidence of ___________ or _____________. 2) Blood glucose level is normal or in ___________________ for patient. 3) Sample is collected from, and results are _______________ for, correct patient. 4) Patient meets education goals for demonstrating procedure. 5) Patient explains meaning of test results.

1) bruised or continues to bleed. 2) blood sample 3) above or below 4) Glucose meter malfunctions. 5) Patient expresses misunderstanding of procedure and results.

After Blood Glucose Testing, the unexpected outcomes include: 1) Puncture site is ______________ or __________________. 2) Inability to obtain adequate ______________________ for testing. 3) Blood glucose level is __________ or __________ target range. 4) Glucose meter malfunctions. 5) Patient expresses misunderstanding of procedure and results.

A. Wipe away the first droplet of blood with cotton ball. Rationale: After piercing the skin for blood, wipe away the first droplet of blood with a cotton ball or gauze not alcohol. The first drop of blood may be contaminated with the alcohol used for disinfection, which may provide an inaccurate result. This is done prior to gently squeezing the finger and placing the blood on the reagent strip.

After piercing the skin for blood, which action is performed next? A. Wipe away the first droplet of blood with cotton ball. B. Wipe away the first droplet of blood with alcohol pad. C. Place the first droplet of blood on the reagent strip. D. Gently squeeze the finger for blood.

reflectance meter

After the drop of blood is applied to the reagent strip, a ____________________ provides a measurement of the blood glucose level.

inaccurate results, milk, wick management and death.

Alert: Failure to follow manufacturer guidelines pertaining to glucose meter use may cause ___________________. Alert: Do not ___________finger or ___________ blood onto the reagent strips as this may cause inaccurate results. Alert: Failure to recognize inaccurate results can lead to errors in ______________ and _______________.

biosensor, diabetes mellitus

Alternative blood glucose monitoring devices: Continuous interstitial glucose meters use a very small, fine _________________ inserted through the abdomen or the back of the arm that transmits continuous readings of interstitial glucose levels to a monitor or a computer. Continuous interstitial glucose meters support the patient with _________________________________ who requires assessment of glucose trends and patterns.

puncture site

Alternative blood glucose monitoring devices: Some meters allow for an alternative _______________________, including the forearm, palm, and thigh.

1) hand hygiene 3) two identifiers. 4) procedure, purpose. 5) diabetes mellitus 6) hypoglycemia, hyperglycemia 7) before or after 8) low platelet count, anticoagulant therapy, bleeding disorders. 9. integrity of the skin 9a. fingers 9b. palm, forearm, 9c. bruising and open lesions. 10. time or frequency

Assessment for Blood Glucose Monitoring: 1) Perform __________________ before patient contact. 2) Introduce yourself to the patient. 3) Verify the correct patient using ________________. 4) Assess the patient's understanding of the ________________ and its _______________. 5) For a patient with ___________________, determine whether he or she understands how to perform the test and realizes the importance of glucose monitoring. 6) If the patient has not been diagnosed with diabetes, consider any history of _______________ or ___________________ and related symptoms. 7) Determine whether conditions (e.g., fasting after meals, after certain medications, or before insulin doses) must be met ___________ or ____________ sample collection. 8) Determine if any risks exist for performing capillary puncture (e.g., _____________________, __________________, ______________________). 9. Assess the ______________________ being used as the puncture site. 9a. Inspect ____________, toes, or heels. 9b. Consider alternative sites (e.g., ________, ___________, thigh), if the meter will provide accurate readings from these sites. 9c. Avoid areas of _________ and _______________. 10. Review the practitioner's order for the ________ or _________________ of measurements. 11. For performing the test at home, assess the patient's ability to perform self-measurement.

extreme range, emergency

Because a "low" or "high" reading usually occurs only when blood glucose is in an _______________________, either of these readings must be treated as an __________________.

reason for the test, an explanation of each step involved in obtaining the blood glucose measurement, and a description of the sensations the patient may feel during the test

Before performing the Blood Glucose Test, you should provide the patient/family member with information about blood glucose monitoring, including the ___________________________, an explanation of each step involved in ______________________________________________________, and a ________________________________________ the patient may feel during the test.

testing supplies, same meter

Before performing the Blood Glucose Test, you should provide the patient/family member with information on where the patient with diabetes mellitus can obtain _____________________, if applicable. When possible, teach with the __________________ the patient will use at home.

what to do and whom to contact

Before performing the Blood Glucose Test, you should provide the patient/family member with information on where to obtain assistance if the glucose meter malfunctions. Instruct the patient on _____________ and _______________ if the glucose reading is out of range or if the meter malfunctions.

1) overall size, 2) amount of blood needed for each test, 3) testing speed, 4) ability to store test results in memory, 5) cost of the meter, 6) cost of reagent strips.

Blood Glucose Meters may differ in several ways, including: 1) 2) 3) 4) 5) 6)

B. Have the patient hold a heat pack. Rationale: To help facilitate obtaining the blood specimen from an elderly patient, warm the fingertips. An ice pack will cause vasoconstriction making it harder to obtain the blood specimen. Lowering the hand, not elevating it will aid in obtaining the blood. A longer lancet needle in an elderly patient may cause too much damage to the fingertips.

Prior to puncturing an elderly patient's finger for a droplet of blood, the patient warned you it is difficult to obtain blood. Which action will aid in obtaining a droplet of blood? A. Have the patient hold an ice pack. B. Have the patient hold a heat pack. C. Have the patient elevate their hand. D. Use a lancet with a longer needle.

13) Clean the site with an antiseptic swab and allow it to dry completely. ---> Rationale: Alcohol from the swab may cause blood to hemolyze. 14) Obtain a blood sample. 14a. Remove the cover of the lancet or bloodletting device. Hold the lancet perpendicular to the puncture site and pierce the finger quickly in one continuous motion. Do not force the lancet. 14b. If using a single-use, auto-disabling lancet device with an automatic blade retraction system, place the bloodletting device firmly against the side of fingertip or other selected site and push the release button, causing the needle to pierce the skin. --->Rationale: Using a single-use, auto-disabling device reduces the possibility of accidental needlesticks, preventing exposure to blood-borne pathogens. 15) Wipe away the first droplet of blood with a cotton ball or gauze as indicated. --->Rationale: The first drop of blood may be contaminated with the alcohol used for disinfection, which may provide an inaccurate result. Newer meters no longer require the first drop to be wiped away. Always refer to the manufacturer's instructions for specific directions because all meters are slightly different. 16) Gently squeeze the finger without touching the site until a sufficient droplet of blood has formed. Repuncture at a new site if the drop is not large enough to ensure accurate test results. ---> Rationale: An adequate-size droplet is needed to activate the meter and obtain accurate results. Excessive squeezing of tissues during blood sample collection may contribute to pain, bruising, scarring, hematoma formation, or dilution of the sample with serous fluid. Reusing the same puncture site allows blood that is already clotting to interfere with results.

Procedure for Blood Glucose Monitoring (Cont): 13) 14) 15) 16)

17) Apply the blood sample to the reagent strip per the manufacturer's instructions. (Some devices require the blood sample to be applied to the reagent strip before inserting the strip into the meter, whereas others require inserting the reagent strip into the meter before applying the blood sample.) --->Rationale: Different meters require different amounts of blood. As blood enters the strip, the glucose device may signal if more blood is required or enough blood is obtained.

Procedure for Blood Glucose Monitoring (Cont): 17)

18) Obtain the test results.--->Rationale: The blood glucose test result appears on the screen in mg/dl. (milligrams per deciliter, is a measurement that indicates the amount of a particular substance in a specific amount of blood.) Some devices signal when the test is completed.

Procedure for Blood Glucose Monitoring (Cont): 18)

19) If the glucose meter displays "low" or "high" instead of a numeric result, repeat testing. If the meter again displays "low" or "high," notify the practitioner immediately. Abnormal values must be evaluated immediately and appropriate treatment initiated per the organization's practice. --->Rationale: The blood glucose test result assists the health care provider in identifying trends and patterns in glucose levels and is useful for the management of insulin therapy and corrective management. 20) Provide absorbent gauze or apply an adhesive bandage if needed to control bleeding at the puncture site or if the patient desires. 21) Turn the meter off. 22) Clean and disinfect the meter per the manufacturer's instructions. 23) Assess, treat, and reassess pain. 24) Discard supplies, remove gloves, and perform hand hygiene. 25) Document the procedure in the patient's record.

Procedure for Blood Glucose Monitoring (Cont): 19) 20) 21) 22) 23) 24) 25)

7) Check the code and expiration date on the reagent strip container. Remove a reagent strip from the container and then tightly seal the cap.--->Rationale: The code on the test strip vial must match the code entered into the glucose meter. Expired strips are not guaranteed to give an accurate reading. Tightly sealing the cap protects the strips from accidental discoloration from exposure to air or light. 8) Turn the glucose meter on, if necessary. ---> Rationale: Some meters are activated when the reagent strip is inserted and therefore do not have an on and off switch. 9) Ensure that the blood glucose meter is calibrated correctly per the manufacturer's instructions. --->Rationale: Some devices must be calibrated; others require the timer to be zeroed. Each meter is adjusted differently. Calibration ensures an accurate reading. 10) Enter or scan the patient's identifying information into the meter per the manufacturer's instructions. ---> Rationale: Some devices communicate patient information into laboratory records or the electronic health record using a unique identifier. 11) Choose the puncture site. 11a. Ensure that the puncture site is vascular. 11b. For an adult, select the lateral side of the finger; avoid the central tip of the finger, which has a denser nerve supply. If the meter allows, also consider using the forearm, thigh, or fleshy part of the hand. 12) Hold the finger being punctured in a dependent position

Procedure for Blood Glucose Monitoring (Cont): 7) 8) 9) 10) 11) 12)

1. Perform hand hygiene and don gloves. 2. Verify the correct patient using two identifiers. 3) Explain the procedure to the patient and ensure that he or she agrees to treatment. 4) Clean and disinfect the meter per the manufacturer's instructions. 5) Remove gloves, perform hand hygiene, and don clean gloves. 6) Instruct or assist the patient with performing hand hygiene with soap and warm water. -->Rationale: Hand hygiene promotes skin cleansing and vasodilation at the selected puncture site. Hand washing establishes practice for the patient when the test is performed at home. A patient who has just eaten may have sugar on his or her hands, which would produce a false high reading.

Procedure for Blood Glucose Monitoring: 1) 2) 3) 4) 5) 6)

wiping away the first drop of blood with gauze and using the second drop

Some meters recommend ______________________________________________________ and __________________________________________________ for the test while others recommend using the first drop of blood.

C. Notify the practitioner The meter reads "low" when the blood glucose level is below its detectable threshold. This must be considered a critical value. The nurse should immediately report the value and the patient's hypoglycemic symptoms to the practitioner. Together with the "low" test results and the patient's symptoms, the nurse should suspect hypoglycemia, which is not an indication for insulin. There is no indication that the meter must be recalibrated. Documenting the result would be premature because documentation of critical values must also include the nurse's interventions to address the value.

The nurse enters a patient's room to perform a routine preprandial (before lunch) blood glucose test and finds the patient is emotionally labile (lack of emotional expression), sweating, and shaking. The nurse performs the blood glucose test and the meter reads "low." Which action should the nurse take? A. Prepare to deliver insulin B. Document the result C. Notify the practitioner D. Recalibrate the meter

D. Repuncture a new site If the nurse is unable to obtain an adequate sample size, it is necessary to repuncture at a new site to ensure accurate test results. Excessive squeezing of the tissues may contribute to pain, bruising, scarring, or hematoma formation. The nurse should not reuse the same puncture site because clotting will interfere with results. It is not appropriate to skip the testing and wait until the next morning.

The nurse has punctured the patient's finger to obtain a blood droplet for glucose monitoring. Which action should the nurse perform next if not enough blood is obtained from the site? A. Repeat the procedure the morning B. Repuncture the current site C. Squeeze the site until enough blood is obtained D. Repuncture a new site

C. Puncture the outer aspect of the heel with an approved lancet that punctures less than 2.4 mm deep Rationale: To avoid osteochondritis dissecans, the family should be taught to puncture the outer aspect of the heel with an approved lancet that punctures less than 2.4 mm deep. An approved auto-disabling lancet designed to puncture less than 2.4 mm to prevent piercing too deeply should be used. The inner aspect of the heel contains less subcutaneous fat and offers less protection for the underlying bone; therefore, the outer aspect should be used. For infants who have blood drawn frequently, complications should always be assessed.

The nurse is educating the family of an infant on how to perform a heel puncture correctly to prevent osteochondritis dissecans. The family should be instructed to perform which action? A. Puncture the inner aspect of the heel with a standard lancet that punctures 4 mm deep B. Puncture the inner aspect of the heel with an approved lancet that punctures less than 2.4 mm deep C. Puncture the outer aspect of the heel with an approved lancet that punctures less than 2.4 mm deep D. Puncture the outer aspect of the heel with a standard lancet that punctures 4 mm deep

D. Holding the finger in a dependent position Rationale: Blood flow is increased to the area before puncture by holding the finger in a dependent position. In adults, the side of the finger has a less dense nerve supply than the tip. The lancet should be held perpendicular to the puncture site for adequate blood flow. Warm, moist compresses (not cool compresses) increase blood flow. The central tip of the finger has a dense nerve supply and should not be punctured; doing so would cause pain.

The nurse is having difficulty extracting blood from a finger stick for an adult patient's blood glucose test. To increase the blood flow from the finger-stick location, which intervention should the nurse attempt first? A. Holding the lancet at a 45-degree angle B. Wrapping the finger in a cool, moist compress C. Puncturing the central tip of the finger D. Holding the finger in a dependent position

1) Fingertips should be warmed to help facilitate obtaining the specimen. 2) Some older adults have vision or dexterity problems that interfere with performing self-finger sticks.

When performing Blood Glucose Testing, What considerations should be taken for Gerontological patients (geriatrics)?

1) Patients can use glucose meters routinely in their homes. 2) Patients should be encouraged to attend a diabetic support group if needed. 3) Visual acuity may affect a patient's ability to perform self-testing at home.

When performing Blood Glucose Testing, What considerations should be taken for Home care?

1) Young children should be allowed to choose among approved puncture sites. 2) The heel and great toe may be used as puncture sites in infants. 3) For preterm infants who must have blood drawn repeatedly, localized complications in the heels should be assessed. 4) For neonates, the heel should be warmed before obtaining the specimen. 5) An approved, single-use, auto-disabling lancet that does not puncture deeper than 2.4 mm and that punctures the outer aspect of the heel should be used to avoid osteochondritis dissecans. Infection or abscess of the heel and necrotizing osteochondritis dissecans are serious complications of a heel-stick puncture in infants. 6) Young children should be allowed to demonstrate the technique with a family member, as appropriate for developmental level and skill. Incorporating a play activity should be considered for further understanding. 7) Colorful adhesive bandages should be used for comfort and distraction if not contraindicated because of skin condition, allergy, or other reason.

When performing Blood Glucose Testing, What considerations should be taken for pediatric patients?

Obtaining capillary blood by skin puncture

___________________ is less painful than venipuncture, and the ease of the skin puncture method makes it possible for patients and families to perform this procedure.

more than 126 mg/dL

a blood glucose level of ______________, is considered hyperglycemic.

59 mg/dL (i.e. less than 60)

a blood glucose level of ______________, is considered hypoglycemic.

Blood Glucose Monitoring

reveals individual patterns of blood glucose changes to aid with meal and activity planning and medication timing.

venipuncture

the puncture of a vein as part of a medical procedure, typically to withdraw a blood sample or for an intravenous injection.