ATI Chapter 52: Specimen for Glucose Monitoring – Flashcards
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Blood glucose testing
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is preferred method of monitoring blood glucose levels
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Urine testing
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not an effective measure of glucose level as glucose levels must be greater than 180 mg/dL before glucose appears in urine
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Clients who are able & willing to continue monitoring independently can learn how to self monitor blood glucose levels. Required abilities include:
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-Alertness or ability to comprehend & give a return demonstration of process -Adequate finger dexterity -Adequate visual acuity
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Blood Glucose Testing
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For blood glucose testing of clients who have diabetes mellitus, a glucometer or blood glucose meter is used with small test strips to "read" the blood sample. These systems require proper calibration, storage of supplies, & matching a lot numbers Indications- regular testing is necessary for clients who have diabetes mellitus to manage the disease by maintain safe blood glucose levels
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Interpretation of Findings
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-Usually, a blood glucose lever greater than 250 mg/dL indicates hyperglycemia* -Blood glucose level less than 70 mg/dL indicated hypoglycemia* -Poor storage of glucose strips can lead to falsely high & low readings. Typically, these test strips come in vial to store at room temperature or as directed by the manufacturer
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Procedure
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Check clients record & prescription for: -Frequency & type of test; testing times vary based on goals of management & the complexity of client's hypoglycemic medication schedule -Results from previous tests-norms & ranges -Actions to be taken based on results *Review client's medication profile -Note anticoagulant usage -Note times & does of hypoglycemic agents -Note use of steroids or medications that can elevate blood glucose levels *Gather materials & prepare the equipment -Blood glucose meter, meter & reagent strip compatible with meter, washcloth with soap, gloves, sterile lancet, cotton boll -Review meter & manufacturers instructions -Check strip solution's expirations date -Calibrate meter & run a control sample per facility/agency protocol. This is usually performed when new bottle of test strips is opened -Explain procedure to client -*Evaluate selected puncture site for: integrity of skin, compromised circulation or other condition -Perform hand hygiene & put on gloves
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Intraprocedure
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-Select site from which to collect blood sample Outer edge of a fingertip (most common) or ear lobe (alternate site) -Rotate sites with each testing area to avoid ongoing tenderness at the site -Wrap site in warm, moist towel to enhance circulation if indicated -Cleanse the site with warm water & soap & allow drying. Alcohol can interfere with results & should be avoided -Pierce skin using sterile lancet (or lancet injector device) -Place drop of blood on test strip Follow procedure outlined by manufactures of blood glucose meter for applying blood to strip. If necessary, gently milk finger to squeeze out a drop. Forceful milking or squeezing can cause lysis of blood cells. Do not touch site directly to stimulate bleeding. Do not smear blood onto strip, as this can cause an inaccurate reading -Allow meter to process the reading. (Time varies with meter) -Apply cotton ball over puncture site -Note reading; turn off the meter, & dispose of cotton ball, test strip, & gloves
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Postrocedure
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Perform hand hygiene, document meter's reading & check prescription for medication or treatment actions & implement as indicated
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Urine Glucose Testing
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Glucose in urine can be measured with urinalysis strips & glucose reading scale Indications: urine glucose testing is usually performed at home by clients who have diabetes mellitus at times of acute illness or stress to identify presence of ketones
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Interpretation of Findings of Urine Glucose Testing
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If test is positive for ketones, it indicates uncontrolled blood glucose
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Procedure of Urine Glucose Testing
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if testing urine, evaluate client's ability to urinate -Verify order for frequency & actions to be taken based on results -Gather materials & prepare the equipment: sterile urine sample bottle, urinalysis strips & container with glucose reading scale, gloves -Check strip's expiration date -Explain procedure to client -Perform hand hygiene & put gloves
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Intraprocedure of Urine Glucose Testing
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Assist client as needed with urine sample collection -Dip reagent strip into urine sample -Compare the strip's color change with ranges on container within the instructed time (usually 1 to 5 seconds) -Document the results
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Postprocedure of Urine Glucose Testing
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Dispose of remaining urine sample, test strip, & gloves -Perform hand hygiene -Check prescription for medication or treatment actions & implement as indicated
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A nurse is assessing a client's ability to learn self-monitoring of blood glucose using a glucometer. Which of the following abilities should the nurse confirm that the client has before proceeding with teaching? (Select all that apply.) A. Finger dexterity B. Visual acuity C. Color vision D. Basic literacy E. Demonstration ability
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A, B, E
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A client has an admission blood glucose reading of 260 mg/dL and no documented history of diabetes mellitus. While the nurse reviews the client's medication history, which of the following types of medications should alert the nurse to the possibility that the client has developed an adverse effect of pharmacologic therapy? (Select all that apply.) A. Diuretics B. Corticosteroids C. Oral anticoagulants D. Opioid analgesics E. Antipsychotics
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A, B, E
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A nurse is teaching a client who just found out she has type 1 diabetes mellitus how to check her blood glucose levels. Which of the following instructions should the nurse give the client for transferring her blood onto the reagent portion of the test strip? A. Smear the blood onto the strip. B. Squeeze the blood onto the strip. C. Touch the puncture to stimulate bleeding. D. Hold the test strip next to the blood on the fingertip.
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D
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A nurse attempts to collect a capillary blood specimen via finger stick to test the glucose level of a client who has diabetes mellitus. The nurse is unable to obtain an adequate drop of blood for the reagent strip. Which of the following actions should the nurse take? A. Puncture another finger to obtain a capillary specimen. B. Test the client's urine with a urine reagent strip. C. Wrap the client's hand in a warm, moist cloth. D. Perform a venipuncture to obtain a venous sample.
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C
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A nurse is teaching self-monitoring of blood glucose (SMBG) to a client who has diabetes mellitus. Which of the following instructions should the nurse include? (Select all that apply.) A. Perform SMBG once daily at bedtime. B. Wipe his hand with an alcohol swab. C. Hold his hand in a dependent position prior to the puncture. D. Place the puncturing device perpendicular to the site. E. Prick the outer edge of his fingertip for the blood sample.
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C, D, E
