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 Helps prevent diabetic emergencies by prompt detection & treatment of hypo- & hyperglycemia

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.

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.

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

Hypoglycemia Sweating Tachycardia Palpitations Nervousness Tremors Weakness Headache Mental confusion Fatigue Overhead slide

Hyperglycemia Thirst Polyuria Polyphagia Weakness Fatigue Headache Blurred vision Nausea Vomiting Abdominal cramping Overhead slide—remember with hyperglycemia, you may see an overlap in symptoms. With hyper, there is increased circulating sugar, but it cannot readily get into cells. With hypo-, there is just not sugar there.

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

Goals for Glucose Control *Elkin et. al (2004, 3rd Ed.), Table 14-1, p.361 Goals for Glucose Control Normal Goal Intervention needed Fasting Glucose <115 <120 <80 or >140 Postparandial <140 <180 >180 Bedtime Glucose 100-140 <100 or >160 Glycosylated Hemoglobin <6% <7% >8% The glycosylated hemoglobin is also called Hemoglobin A1C; this gives practitioners and clients an idea of BG control over the past 2-3 months—essentially an average. Note that these levels may change with alterations in diet, exercise, general health. What would you expect for someone who begins an exercise regimen? What about a diabetic who is ill?

Blood Glucose Monitoring ASSESSMENT 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 Understanding of procedure, purpose, importance of monitoring. Health history includes medications the pt is taking—some meds may alter bld glucose levels. Also consider factors that would alter your approach to specimen collection—bleeding disorders and amt of pressure applied.

Blood Glucose Monitoring PLANNING “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 Monitoring IMPLEMENTATION 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

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

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.

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

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

Blood Glucose Monitoring DOCUMENTATION 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. Remember U is NOT permitted per JACHO. You must write “units”

Performance Criteria – Critical Behaviors 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 Performance Criteria – Critical Behaviors Criteria Met Criteria Not Met CONTROL TEST 1. Press ON/OFF to turn on meter. Select #2-Control Test. 2. Scan Operator ID. Scan Control Solution lot #. Scan strip lot #. Make sure expiration dates are on control bottles. Use Expiration labels in meter box. Controls are good for 90 days once opened 3. Open test strip foil packet, insert “lined” end of strip into meter through the yellow port protector opening. Gently mix control solution and apply solution by touching the drop of control to the white target area at the tip of the test strip while meter is in a horizontal position the entire time. KEEP YELLOW PORT PROTECTOR ON AT ALL TIMES 4. Monitor will start reading and beep when completed. 5. Pass/Fail will appear on the screen . Failed controls must be documented with a Comment Code ; #1- Repeat Test. Controls must Pass before proceeding to Patient Testing. See Troubleshooting below. TROUBLESHOOTING OUT OF RANGE CONTROLS: 1. Check for air bubbles in nozzle of control solution or on test strip. 2. Check room temp. or humidity. 3. Check storage of strips (39 – 86 F) 4. Ensure bottles of control solution not opened > 90 days and not expired. Check solution level. 5. Repeat test – contact lab if results continue to FAIL.

1. Washes/cleanses hands. Wears gloves. PATIENT TESTING 1. Washes/cleanses hands. Wears gloves. 2. Select #1 – Patient Test. Scan Operator ID. 4. Scan the Account # on the patient’s armband. Scan strip lot #. 6. Select sample type (capillary/arterial or venous). 7. Open test strip foil packet and insert “lined” end of strip into meter through the opening on yellow port protector. AGAIN, KEEP YELLOW PORT PROTECTOR ON AT ALL TIMES 8. Cleanse puncture site with alcohol, allow to dry, and wipe away first drop of blood with cotton ball. 9. Apply free flowing blood sample by holding the finger to the white target area at the tip of the test strip. The blood is drawn into the target area. 10. Monitor will start reading and beep when results are ready. ( A “▼ or ▲” will appear in front of a value that is out of range; <60 or >400 for Adults; <40 or >200 for neonates/newborns, a Comment Code must be entered). All panic values are immediately repeated using the same puncture site, if possible, for verification of initial result. If result is still critical, enter appropriate Comment Code. See unit specific instructions for hypoglycemic/hyperglycemic protocols. 11. Discard contaminated material in a biohazard disposal container. 12. Knows normal adult glcucose reference range at GHS is 60-99 mg/dL 13. Knows basic troubleshooting of patient test results (possible ↓ results w/ severe dehydration, DKA,HHNS,ect) 14. Knows why and how often the meter must be DOCKED in the docking stations State process for blood glucose monitoring of patient in isolation