09.02 Glucose Monitoring

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Overview

  1. Glucose monitoring
    1. When to use blood glucose monitoring
    2. Glucose monitoring pro-tips
    3. Nursing considerations

Nursing Points

General

  1. When to use glucose monitoring
    1. Patient condition
      1. Diabetes
      2. Surgical patients
      3. Infection
      4. Trauma
      5. When it’s ordered
      6. When there’s a suspicion
        1. High blood sugars
        2. Low blood sugars
        3. Non-classic symptoms
  2. Glucose monitoring pro-tips
    1. Glucose monitoring controls
      1. When ordered
      2. Keeps compliance
      3. Reduces errors
    2. Use proper PPE
      1. Use gloves
    3. Use alcohol swabs
      1. Swab and then prick with lancet
      2. Use gauze to wipe away first drop
      3. Then use second drop to measure
    4. Trust your gut
      1. High and low results should be retested for accuracy
      2. If results don’t correspond to patient symptoms, retest
  3. Nursing considerations
    1. High results
      1. Recent food intake
      2. Does the patient know how to properly give insulin, if diabetic?
        1. Is the patient compliant with insulin and testing?
      3. Drugs causing resistance
      4. How high is it?
        1. Is it an emergency?
    2. Low results
      1. Recent food intake
      2. Recent insulin vs food
      3. How low is it?
        1. Less than 70 mg/dL
        2. Is it an emergency?
      4. 15-15 Rule
        1. If CBG is low, give 15 grams of carbs and recheck blood sugar in 15 minutes

Nursing Concepts

  1. Glucose Metabolism
  2. Hormone Regulation
  3. Safety
  4. Nutrition

Patient Education

  1. Educate patient on proper way to conduct glucose monitoring at home
    1. Follow CDC recommendations for reducing infection
  2. Educate patient on following manufacturers instructions for any equipment that they may be using to monitor their blood sugar

Reference Links

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Video Transcript

As you go through your entire nursing career you’re going to check tons of blood sugars. And that’s what we’re going to talk about today.

The first thing that you should think about when you’re checking your blood glucose should be is this the right patient. So these are the type of patients that you’re going to commonly check your blood sugars on. You got your diabetic patients, surgical patients, and patients with infections. You’re also going to check blood sugars pretty commonly on your traumatic patients, and patience on parenteral nutrition like tpn, and also and other patients that you may not think about, and a doctor is asking for it. That might happen in a patient that’s had some sort of recent endocrine disorder that you may not be thinking about, so if there’s an order for it, that’s another time you’re going to check it.

The other time that you should check blood sugars on your patient, or when you are suspicious. I’m going to talk about this a lot in this lesson, and it’s really about starting to hone in on your ability to trust your instinct. Blood sugars are non-invasive, they run very little risk, you can gain a lot of information from them, so you’re never going to harm the patient by being pre-emptive and double-checking your patients blood sugar. So I’m going to really encourage you to be proactive for your patience and if you’re suspicious go ahead and check that blood sugar.

Now when we talked about the machines that we use, we’ll sometimes refer to them as CBG machines. CBG just stands for capillary blood glucose. But it’s your responsibility as the nurse to make sure that your CBG machine has had a blood sugar control done on it relatively recently. The blood sugar controls are a test that you do once a shift or after so many hours to make sure that the machine is working accurately. If it’s not, you could get a false reading and potentially harm your patient. And we want to avoid that. Check with the manufacturer of the machine, and check with your facility to make sure that you’re in compliance and that you’ve been trained on using the machine.

This goes without saying, but I’m going to say it. Always wear gloves and PPE when you’re doing blood sugars. I can’t tell you how many times I’ve seen nurses do blood sugar’s on patients without wearing gloves. You want to protect yourself, you want to protect your patient, so make sure that you’re just always wearing gloves when you’re doing blood sugars.

One thing that I want you to keep in mind is that when you’re doing your blood sugars you’re going to use alcohol swabs to clean the finger. An important thing that you’re going to have to remember about the alcohol swab is that if the alcohol swab touches the blood, it artificially drops the blood sugar. So what you want to do is clean your patients finger with and alcohol swab, let it dry, and then use a Lancet to prick the finger and then wipe away the first drop of blood. The reason you want to do this as you want to remove any possibility of getting that artificially low result. Then you want to test the second drop. That’s going to make sure that you have the most accurate blood sugar measurement.

Lastly always trust your gut when it comes to blood sugars. And when I say that what I mean is if you get a high blood sugar, test it again. If you get a low blood sugar, test it again. If you think something is going on with your patient, then there’s probably is, and if you think that your blood sugar is not matching what’s going on with your patient then you need to do something about it. That means you either need to get another CBG machine, run the controls, or acid provider to order a blood glucose to be sent to the lab to make sure that that measurement is accurate. You are ultimately responsible for your patient, so make sure you’re doing what you can to make sure that that number is accurate.

So what are these blood sugar results mean for you?

If you get a high test result, retested again. The other thing that you should do is consider any recent food and take the patient ad. If you get a high result and make sure that they haven’t just really eaten recently because that will affect the result. also make sure that your patient is actually giving themselves any insulin that they need, and then they’re doing it properly. The last thing you want to do is have a patient that giving self insulin wrong, and their insulin is just not working. Another thing you want to think about if you get high results is, is the patient on any sort of insulin resistant drugs. If they are on those drugs, it could be leading to those High results.

Do the thing you want to think about is, how high is the actual blood sugar? If we’re aiming for a hundred and ten, and it’s a hundred and fifteen, then that’s not that high. But if we’re aiming for a hundred and ten, and it’s 400, that’s a big difference. That also lead you to think is this an emergency? Is the blood sugar high enough to affect the patient in a negative way, and is there something I can do in the meantime to work on that.

It’s nearly the same thing with low results. But one thing I want you to keep in mind is that I want you to think about this…does your patient match up to the blood sugar. Just because the blood sugar is low doesn’t mean that automatically retest it. But if your patient looks hypoglycemic, meaning they’re cold or clammy, or maybe really sweaty, then don’t hesitate and don’t wait for an order…act pretty quickly. Treat the patient and not just the number .The other thing you want to think about with low results is have they had recent insulin that peaked before the food they ate hit their system. That means that the insulins working faster than the blood sugar is, so we really need to figure out which way to go. Also, follow the 15-15 rule. This is how it works. So if your patient’s sugar is less than 70, then give them 15 grams of carbs, usually sugar…so 4 ounces of juice and then recheck in 15 minutes. That’ll tell you if you’re headed in the right direction. There’s definitely more info in the diabetes lesson, so go check that out.

I encourage you guys to go check out all of the endocrine lessons on diabetes and hypoglycemic and hyperglycemic management, those are going to give you more insight into the necessary steps in managing the excessively high and excessively low blood sugars, and what to anticipate.

For today in our nursing Concepts, we really focused on glucose metabolism and safety for the patient. Also we wanted to keep hormone regulation in mind as another nursing concept.

So let’s recap on some key points.

So when should you check your blood sugars in your patients? Well think about their illness, injury, or disease, like infection, diabetes, or trauma.

Always do your controls on your CBG machines. That’ll make sure that you actually reduce any opportunity for error.

Always retest when you have high or low readings, or even if you’re suspicious of something else going on with the patient.

Which leads me to my next point about being proactive. If you are concerned that your patient has a blood sugar issue, reach out to your provider and ask them for either blood sugar monitoring, or a sample to be sent to the lab.

And lastly trust your gut. If you think that your tests are not accurate, retest them, get a new machine, or send that blood off to the lab to have it analyzed for accuracy. You want to make sure that whatever you do for your patient is based on a real accurate results.

That’s it for our lesson on glucose monitoring. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

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  • Question 1 of 9

A client is being seen in the emergency department for anxiety, confusion, and behavioral changes. The client’s heart rate is elevated and the blood glucose is 48 g/dL. The nurse administers a dose of glucagon and a continuous infusion of IV dextrose. Which of the following interventions should the nurse perform next?

  • Question 2 of 9

The nurse is admitting a diabetic client. The nurse asks questions about diet and discovers that the client avoids sugary foods, but eats rolls and bread at every meal. Which of the following responses by the nurse is correct?

  • Question 3 of 9

A client who is in the hospital requires total parenteral nutrition for management of malnutrition. After two days on the TPN solution, the nurse checks the clients blood glucose levels and the result is 181 mg/dL. Which action of the nurse is most appropriate?

  • Question 4 of 9

A 41-year-old client has been diagnosed with type 2 diabetes. The nurse is teaching the client about how to perform self-monitoring of blood glucose (SMBG) at home. The nurse instructs the client about how to use a lancet to obtain a blood sample. Which technique would the nurse most likely include?

  • Question 5 of 9

A nurse is assessing a diabetic client at the healthcare clinic who has a log of glucose levels and insulin dosages for the past month. The nurse notes that the client has had high levels of blood glucose every morning, requiring increased dosages of insulin first thing in the morning when compared to other times of day. Which of the following suggestions would most likely assist the client to have better readings of morning blood glucose levels?

  • Question 6 of 9

A client uses Novolin R, a short-acting insulin, to control his blood glucose levels. The client is reviewing the principles of glucose control with the nurse and asks about when he should take his insulin in relation to meals. Which response from the nurse is most accurate?

  • Question 7 of 9

A 44-year-old diabetic client is undergoing surgery for a hysterectomy. The client is a type 1 diabetic who requires regular monitoring of blood glucose levels and insulin administration on a sliding scale. Which information should be given to the client about controlling blood glucose levels throughout surgery?

  • Question 8 of 9

A nurse is assessing a client with a history of diabetes. The client tells the nurse that she does not feel well. The nurse checks her blood glucose levels and gets a result of 51 mg/dL. What signs or symptoms would the nurse expect to see with this blood glucose level? Select all that apply.

  • Question 9 of 9

A 65-year-old client is in the hospital for surgery for a colon resection. The client requires total parenteral nutrition, which is administered through a central venous catheter. The nurse notes that the client has a red area of induration around the catheter exit site. The client’s latest blood glucose result is 176 mg/dL and a current temperature of 38 degrees celsius. Which of the following conditions should the nurse suspect?

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