Blood Glucose Monitoring PDF

Blood glucose monitoring Outlines: 1. Definition of blood glucose monitoring 2. Benefits of blood glucose monitoring 3. Factors affecting self-monitoring blood glucose performance 4. Potential hazard of all self-monitoring blood glucose methods 5. Role of nurse toward potential hazard of all se...

Blood glucose monitoring Outlines: 1. Definition of blood glucose monitoring 2. Benefits of blood glucose monitoring 3. Factors affecting self-monitoring blood glucose performance 4. Potential hazard of all self-monitoring blood glucose methods 5. Role of nurse toward potential hazard of all self-monitoring blood glucose methods 6. Candidates for self-monitoring blood glucose 7. Frequency of self-monitoring blood glucose 8. Blood glucose monitoring procedure Objectives: By the end of the session, the student will be able to: 1. Define blood glucose monitoring 2. List benefits of blood glucose monitoring 3. Discuss factors affecting self-monitoring blood glucose performance 4. Determine potential hazard of all self-monitoring blood glucose methods 5. Demonstrate role of nurse toward potential hazard of all self- monitoring blood glucose methods 6. Determine candidates for self-monitoring blood glucose 7. Mention frequency of self-monitoring blood glucose 8. Apply blood glucose monitoring procedure 30 Definition Blood glucose monitoring is a way of testing the concentration of glucose in the blood self-monitoring of blood glucose (SMBG) measuring of blood glucose level by pt. himself Benefits of BGM  Enable people with diabetes to adjust their treatment regimen to obtain optimal blood glucose control.  Allows for detection and prevention of hypoglycemia and hyperglycemia  Reduce the risk of long-Term diabetic complications.  Blood glucose monitoring helps evaluate effectiveness of medication Factors Affecting SMBG Performance  Visual acuity : some meters can be used by patients with visual impairments  that have audio components.  Fine motor coordination  Cognitive ability  Comfort with technology  Willingness to use it  Cost A potential hazard of all SMBG methods is that the patient may obtain and report erroneous blood glucose values as a result of using incorrect techniques. Some common sources of error include: Improper application of blood (e.g., drop too small) Improper meter cleaning and maintenance (e.g., allowing dust or blood to accumulate on the optic window). This is not an issue in the biosensor type of meter. Damage to the reagent strips by heat or humidity; use of Outdated strips 31 Role of Nurse toward this Hazard  Providing initial teaching about SMBG techniques.  Every 6 to 12 months, patients should conduct a comparison of their meter with a simultaneous laboratory-measured blood glucose level.  The accuracy of the meter and strips should also be assessed with control solutions Candidates for SMBG  Pt who receive intensive insulin treatment ( 2:4 injection / day).  Diabetes management during pregnancy  Unstable DM  Susceptible pt. For DKA and hypoglycemia  Can be used for pt. Not take insulin to observe effectiveness of diet , exercise and oral antidiabetic agent Frequency of SMBG 1. For patients who require insulin, two to four times/daily (usually before meals and at bedtime 2. Three times for pt. who take insulin before each meal to adjust the dose 3. Pt. who take oral antidiabetics Two or three times /week including 2- hour postprandial 4. Once hypoglycemia or hyperglycemia suspected 5. Change in treatment regimen Tips to use BGM; Review the manufacturer's guidelines for specific procedures related to the use of your BGM device. User error is the most common reason for inaccurate reading. Ensure that the BGM device is calibrated and clean before using. Do not use alcohol to clean the machine. 32  For patients with cold hands, let the hand hang down below the level of the heart so that blood can flow to the fingertips. Use the side of the finger rather than the underside as it has fewer nerve endings (therefore is less painful) and Correlate the BGM device reading with the clinical assessment of the patient. Use universal precautions during the entire procedure. Procedure Equipment Blood glucose meter Disposable gloves Lancet/lancing device 2” × 2” gauze or clean tissue Test strip Cotton ball* Alcohol wipe Procedure Nursing action Explain procedure to the pt. Hand washing Prepare equipment Prepare the finger to be lanced by having the patient wash hands in warm water and soap. Dry thoroughly. an alcohol wipe may be used to cleanse the finger. Alcohol must dry thoroughly before finger is lanced. Don disposable gloves. Turn on the glucose meter and match a code number on the strip bottle to the code registered on the meter Insert the strip test into the meter Prick the patient’s finger lateral to the fingertip using lancet/lancing device 33 Obtaining a drop of blood large enough to satisfy the requirements of the testing strips being used Apply the blood carefully to the strip test area and remain the blood on the strip till the result The lanced finger is covered with gauze or a tissue until bleeding subsides. Documentation of reading and notify doctor the result 34  Foot Care for Diabetic Patient Introduction From 50% to 75% of lower extremity amputations are performed on people with diabetes. More than 50% of these amputations are thought to be preventable, provided patients are taught foot care measures and practice them on a daily basis (ADA, Preventive Foot Care in People With Diabetes, 2010). Complications of diabetes that contribute to the increased risk of foot problems and infections include the following: neuropathy Loss of sensation to Sensory neuropathy pain &pressure Muscular atrophy Motor neuropathy Change in foot shape Decreased sweating Autonomic neuropathy So skin become dry & fissured 35  Peripheral vascular disease poor circulation in lower extremities Poor wound healing Development of gangrene  Immunocompromise: as hyperglycemia Impaire the ability of leukocytes to destroy the bacteria and Poorly controlled diabetes reduce the resistance to some infections Pathogenesis Begin with: 1. soft tissue injury of the foot 2. formation of a fissure between the toes or in an area of dry skin 3. Pt with insensitive foot don’t feel injury that may be : Thermal ( using a warm pad or walking bare foot on heat concern) Chemical ( burning of foot by caustic agent ) Traumatic ( wearing ill-fitted shoes , injuries while cutting nails) 4. If pt. not inspect his foot routinely the injury or fissure may go unnoticed the first sign is redness , swelling , drainage due to cellulitis and gangrene High risk patient to develop foot ulcer  Duration of diabetes more than 10 years  Age older than 40 years  History of smoking  Decreased peripheral pulses 36   Decreased sensation  History of previous foot ulcers or amputation Foot Care Tips 1. Take care of your diabetes. 2. Work with your health care team to keep your blood glucose level within a normal range. 3. Inspect your feet every day;  Look at your bare feet every day for cuts, blisters, red spots, and swelling.  Use a mirror to check the bottoms of your feet or ask a family member for help if you have trouble seeing.  Check for changes in temperature.  The interior surfaces of shoes should also be inspected for any rough spots or foreign object 4. Wash your feet every day.  Wash your feet in warm, not hot, water.  Dry your feet well. Be sure to dry between the toes.  Do not soak your feet.  Do not check water temperature with your feet; use a thermometer or elbow. 5. Keep the skin soft and smooth:  Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes. 6. Trim your toenails each week or when needed.  Trim your toenails straight across and file the edges with an emery board or nail file. 7. Wear shoes and socks at all times.  Never walk barefoot. 37   Wear comfortable shoes that fit well and protect your feet.  Feel inside your shoes before putting them on each time to make sure the lining is smooth and there are no objects inside. 8. Protect your feet from hot and cold.  Wear shoes at the beach or on hot pavement.  Wear socks at night if your feet get cold. 9. Keep the blood flowing to your feet.  Put your feet up when sitting.  Wiggle your toes and move your ankles up and down for 5 minutes, 2 or 3 times a day.  Do not cross your legs for long periods of time.  Do not smoke 10. Check with your health care provider.  Have your health care provider check your bare feet and find out whether you are likely to have serious foot problems. Remember that you may not feel the pain of an injury.  Call your health care provider right away if a cut, sore, blister, or bruise on your foot does not begin to heal after one day.  Follow your health care provider’s advice about foot care.  Do not self-medicate or use home remedies or over the- counter agents to treat foot problem 38