Blood Glucose Foundations - Foundations

What is venous testing used for?

To provide a more accurate measurement when bedside values are less than 60 mg/dL or greater than 400 mg/dL.

When is venous testing especially important?

When abnormal bedside readings need confirmation.

What is one purpose of bedside blood glucose testing?

To monitor blood glucose at any time.

What is another purpose of bedside blood glucose testing?

To maintain stable blood glucose and allow early intervention when abnormal values occur.

What else does bedside blood glucose testing evaluate?

The effect of activity on blood glucose.

What does bedside blood glucose testing evaluate after meals?

The effects of meals on blood glucose.

When is blood glucose often checked after meals in the lecture?

About 1 1/2 hours postprandial and at bedtime.

When is blood glucose checked to evaluate insulin or other diabetic medications?

Before meals and at bedtime.

When should bedside blood glucose levels be tested?

Before meals, before bed, with changes in level of consciousness, in emergency situations such as cardio-pulmonary arrest, and per facility policy.

What are appropriate sites for capillary blood glucose monitoring?

The side of a finger or other approved capillary site, with special considerations for infants and poor perfusion.

What is the preferred site for infants?

The outer aspect of the heel.

Why should the site be warmed before puncture?

To encourage good blood flow.

What sites should be avoided for capillary testing?

Previous puncture sites, inflamed areas, bruised areas, edematous areas, infected areas, cyanotic tissue, cold tissue, poorly perfused tissue, and areas with superficial peripheral arteries.

Why should sites be rotated?

To minimize soreness.

What should be reviewed before testing?

The order for testing, instructions for glucometer use, and the equipment.

What should the nurse check about quality control before testing?

That quality control tests are current.

What should the nurse confirm about the glucometer?

That it is in good working order.

What should the nurse confirm about test strips?

That they are appropriate for the glucometer and not expired.

What equipment is gathered for blood glucose testing?

Glucometer, test strips, lancet device and lancets, alcohol pads, gloves, and other supplies as needed.

What is the first step in turning on the glucometer?

Press the power button or insert the test strip.

What may be needed after turning on the glucometer?

Programming the device with client information if applicable.

What should the nurse do when removing a test strip from the container?

Do not touch the test area and recap the container tightly.

What should the code number on the monitor display match?

The code number on the test strip container.

What is the purpose of checking the test strip code?

To ensure the glucometer is calibrated correctly for the strip lot.

How is the blood sample obtained?

Using the lancet to puncture the site and collect capillary blood.

What is the next step after obtaining the blood sample?

Apply the blood sample to the test strip.

What happens after the blood sample is applied?

The display box rotates until the measurement is complete.

How long does it take for the glucose result to display?

Within about 40 seconds.

How accurate are glucometers?

Reasonably accurate, but there may be some variability from one unit to another.

When are glucometers least accurate?

During episodes of hypoglycemia.

What should be done with the used lancet?

Place it in a sharps container.

What should be done after removing gloves?

Perform hand hygiene.

What should be done after testing is complete?

Power off the glucometer, disinfect it, return the equipment to its usual place, and make sure the tray is stocked for the next use.

What should be documented after blood glucose testing?

The result and any subsequent intervention.

What should be done if the client has sliding scale insulin ordered?

Administer insulin according to the ordered scale.

What should be done if results are outside institutional parameters?

Follow facility policy for further intervention.

What is hyperglycemia in this lecture?

Blood glucose greater than 106 mg/dL.

What are causes of hyperglycemia listed in the lecture?

Type 1 diabetes, uncontrolled glucose with oral antidiabetics and/or diet, infection, surgery, corticosteroid use, gestational diabetes not controlled with diet, high-calorie tube feedings or parenteral nutrition, DKA, and HHS.

What treatments are listed for hyperglycemia?

Long-term oral antidiabetics and insulin.

What types of insulin are listed for hyperglycemia treatment?

Rapid-acting, short-acting, intermediate-acting, and long-acting.

What is hypoglycemia in this lecture?

Blood glucose less than 60 mg/dL.

What are causes of hypoglycemia listed in the lecture?

Fasting, excessive exercise or exercise without replacement, diet changes, hormone deficiencies, and excess diabetes medication.

What treatments are listed for hypoglycemia?

D50W and glucagon.

How is D50W given?

By IV push, followed by infusion of D5W.

How is glucagon given?

By subcutaneous, intramuscular, or intravenous route.

How long does glucagon act?

For a short period of action.

What should follow glucagon administration?

An oral or intravenous carbohydrate to prevent recurrence of hypoglycemia.

What is one purpose of bedside glucose testing related to nursing medications?

To evaluate the effectiveness of insulin or other diabetic medications.

What is one reason to check glucose before meals?

To evaluate the effectiveness of insulin or other diabetic medications.

What is one reason to check glucose at bedtime?

To monitor ongoing glucose control and evaluate treatment effects.

What is one reason to check glucose with a change in consciousness?

A change may reflect abnormal blood glucose.

What is one reason to check glucose in an emergency situation?

Blood glucose can be altered during emergencies such as cardio-pulmonary arrest.

What should happen if the strip code does not match the monitor display?

The strip should not be used until the code matches the container.

Why is proper supply storage important in bedside testing?

Bedside testing is heavily reliant on proper supply storage.

Why is capillary testing site choice important in poor perfusion?

Poorly perfused tissue may give less reliable results.

What special site is preferred for a baby?

The outer aspect of the heel.

What should not be done to the test strip?

Do not touch the test area.

What is the main documentation focus after a low blood glucose result?

Document the result and the intervention performed.

What is the main documentation focus after a high blood glucose result?

Document the result and follow the institution’s policy for intervention.

What is one nursing action after finishing blood glucose testing?

Disinfect the glucometer.

What is one nursing action before testing begins?

Review the order for testing.

What is one nursing action to help prevent errors with the glucometer?

Confirm the strip is appropriate and unexpired.

What is one nursing action to help prevent contamination?

Do not touch the test area of the strip and place the used lancet in a sharps container.

What is the most accurate way to confirm an abnormal bedside glucose value?

Venous testing.

When should abnormal bedside glucose results be confirmed by venous testing?

When values are less than 60 mg/dL or greater than 400 mg/dL.

What is one key difference between bedside and venous testing?

Bedside testing is quick and performed at the bedside; venous testing is more accurate for extreme values.

Which result is within the fasting normal range shown in the lecture?

A glucose of 90 mg/dL.

Which result should trigger follow-up confirmation in the lecture?

A glucose of 45 mg/dL or 420 mg/dL.

What is the nursing goal of early intervention in blood glucose testing?

To address abnormal blood glucose before it worsens.

What is the nursing goal of reassessment after an intervention?

To determine whether the intervention worked.

What is the bedside test used for in relation to meals?

To evaluate the effects of meals on blood glucose levels.

What is the bedside test used for in relation to activity?

To evaluate the effect of activity on blood glucose levels.

What is the overall goal of capillary blood glucose testing?

To maintain stable blood glucose and guide safe nursing interventions.

NCLEX: A client’s finger-stick blood glucose is 48 mg/dL. What is the best next step from the lecture?

Confirm with venous testing if needed and treat hypoglycemia per protocol.

NCLEX: A client’s bedside glucose is 418 mg/dL. What should the nurse anticipate?

A more accurate venous measurement to confirm the abnormal bedside reading.

NCLEX: Which site is most appropriate for an infant’s glucose check?

The outer aspect of the heel.

NCLEX: Which action is correct before inserting a test strip?

Check that the strip code matches the monitor and the container.

NCLEX: Which action should the nurse take after a test is complete?

Dispose of the lancet in a sharps container and perform hand hygiene.

NCLEX: A client is confused and diaphoretic. What bedside test is most appropriate?

Capillary blood glucose testing.

NCLEX: A client is due for insulin before dinner. When should the glucose be checked?

Before meals.

NCLEX: A client is on sliding scale insulin and the result is outside facility parameters. What should the nurse do?

Follow institutional policy for further intervention.

NCLEX: Which treatment is used for severe hypoglycemia and is given IV push?

D50W.

NCLEX: Which medication can be given subcutaneously, intramuscularly, or intravenously for hypoglycemia?

Glucagon.

NCLEX: After glucagon is given, what should be given next to prevent recurrence?

An oral or intravenous carbohydrate.

NCLEX: Which result best supports a normal bedside fasting glucose from the lecture?

A value between 74 and 106 mg/dL.

NCLEX: Which finding is a reason to test blood glucose right away?

A change in level of consciousness.

NCLEX: Which site should be avoided for a capillary puncture?

A bruised, infected, or edematous area.

NCLEX: Why is glucose testing often done at bedtime?

To help evaluate evening control and monitor for abnormalities.

NCLEX: What is the best reason to warm the site before puncture?

To encourage good blood flow.

NCLEX: What should the nurse do if the test strip container code and meter code do not match?

Do not proceed until the codes match.

NCLEX: What is the safest place for used lancets?

A sharps container.

NCLEX: What is the best teaching point about hypoglycemia causes?

It can happen with fasting, excess exercise, diet changes, hormone deficiencies, or too much diabetes medication.

NCLEX: What is the best teaching point about hyperglycemia causes?

It can occur with infection, surgery, corticosteroids, tube feedings, DKA, HHS, and uncontrolled diabetes.

NCLEX: What is the main reason bedside glucometers may be less accurate?

There is some variability between units, and they are least accurate during hypoglycemia.

NCLEX: Which action is part of finishing the task after blood glucose testing?

Disinfect the glucometer and return it to its usual place