Intro to Nursing - Blood glucose

AACE goal is to achieve and maintain A1C of what %?

6.5% or less

ADA goal is to achieve and maintain an A1C of what %?

7% or less

Hypoglycemic Protocols

All facilities will have these; be familiar with the one at your facility before you do this procedure. For example: BG 60-100 mg/dL and patient Symptomatic and is Conscious, Cooperative and Able to Swallow Immediate Action/Treatment: Give 15 Grams carbohydrate: 4 oz juice or regular pop OR 1 TBSP jelly or sugar OR 3 glucose tablets OR 1 tube Dextrose Gel Repeat : Repeat BG and re-treat q15 min until BG > 100 OR symptoms resolved Follow-up Treatment: Add order to check BG at 0200 one time If more than 1 hr until next meal/snack, also give 15 gms of carbohydrate*: * 3 graham crackers OR * 6 saltine crackers OR * 8 oz skim milk If more than 2 hrs until next meal/snack. also add protein: * ½ sandwich OR * 3 graham crackers with one TBSP peanut butter Notify provider responsible for glucose management ASAP and certainly PRIOR to administering the next insulin or oral diabetes agent for medication and glucose monitoring orders

What are the causes/onset of hypoglycemia?

Causes- Too l little food or skip a mea, too much insulin or diabetes pills, more active than usual Onset- Often sudden; may pass out if untreated

What are causes/onset of hyperglycemia?

Causes- too much food, too little insulin or diabetes pills, illness or stress. Onset- Often starts slowly, may lead to a medical emergency if not treated.

Accu-chek inform

Controls - every 24 hours - Hi - more than the machine can read - Lo - less than what the machine can read Test liquid expires 3 months after opening OR the stated expiration date on the bottle When the Accu-check shows HI/LO It is above the limits of the meter The patient's BG should be rechecked It should be confirmed with a laboratory sample.

Fasting plasma glucose test (FPG) results should be-(list scores for diabetes, pre-diabetes and normal)

Diabetes - 126 mg/dL or greater pre-diabetes - 100-125 mg/dL normal- less than 100 mg/dL

SMBG Test results assist to direct:

Diet Amount and type of medication Exercise

What are the symptoms of hyperglycemia? What can you do?

Extreme thirst, need to urinate often, dry skin, hungry, blurry vision, drowsy, slow-healing wounds. check blood glucose and then call your health care provider. Call your HCP if your blood glucose levels are higher than normal for 3 days and you don't know why.

additional information

For additional information review Skill 44-4 Blood Glucose Monitoring in Perry/Potter pgs. 1035-1039. Hospitals in the community use ACCU-CHEK Inform systems which allow wireless transfer of patient data.

What is the gold standard evaluating for glycemic control ?

HbA1c

Purpose of blood glucose testing

Helps prevent diabetic emergencies by prompt detection & treatment of hypoglycemia or hyperglycemia

Blood Glucose Monitoring EVALUATION

Observe site for bleeding or bruising Compare patient readings with normal values Ask patient to discuss procedures & test results Observe patient performing self-testing

Blood Glucose Monitoring PLANNING

Outcomes focus on minimizing tissue damage with finger stick and achieving accurate results. Also explain procedure to patient/family and allow patient/family the opportunity to practice/perform own testing procedures. Equipment Antiseptic swab Cotton ball or gauze Sterile lancet Paper towel Sharps box Glucometer Test strips Gloves

Blood Glucose Targets for Non - Diabetic Adults:

Pre-meal or fasting: 60-100

Blood Glucose Targets for Diabetic Adults:

Pre-meal or fasting: 80-130 2 hours post-meal: 80-180 Bedtime: 80-140

Rules of the The Joint Commission

Requires that each institution defines the extent to which lab results are used Establishes the guidelines for protocols in a health care facility

What is the blood glucose monitoring assessment?

Review patient chart (including health history and order) Specific conditions of sample collection (including time and frequency) Patient /family understanding Patient /family ability to self-test Site selection & assessment (including any puncture risks) Presence of signs & symptoms glucose alteration Calibration of equipment Control test completion (every 24hrs)

Self monitored blood glucose (SMBG)

Self monitored blood glucose (SMBG) protocols vary

What are the symptoms of hypoglycemia? What can you do?

Shaky, fast heartbeat, sweating, dizzy, anxious, hungry, blurry vision, weakness or fatigue, headache, irritable, diaphoresis, confusion, loss of consciousness. Check blood glucose, treat it, check blood glucose again

Blood Glucose Monitoring IMPLEMENTATION

Wash hands & apply gloves Gather supplies Select site, use lateral side of fingertip, not central tip Position site in dependent position, cleanse site Position lancet firmly against site, pierce skin, dispose of lancet in sharps Wipe away first drop of blood with cotton Lightly squeeze for large drop and collect sample Read results Once results are available, Intervene appropriately for the value obtained, according to the facility protocol, then: Dispose of used supplies Document results