MEASURING CAPILLARY BLOOD GLUCOSE

Rachel Joy R. Rosale, RN, RM, MAN

History of Glucose Monitoring

1500 BC High glucose identified by ants going to a persons urine 1400 BC Physicians tasting urine to diagnose diabetes water tasters used to diagnose up until 17th Century 1776 Sugar identified in the urine by Matthew Dobson Early 1800s 1st chemical tests to detect sugar in the urine 1915 Benedicts reagent is used as a test for glucose in urine 1941 Clinitest tabs are available; you can heat uring and get a quantitative glucose value 1962 Dextrostix measure blood glucose! Compare test strips to the color chart printed on the side of the test strip container 1967 First Glucose Meter Ames Reflectance Meter

Meters Continue to Improve

Smaller More accurate Less blood required Faster results

Purposes:
To determine and monitor blood glucose level of clients at risk for hyperglycemia or hypoglycemia.

To promote blood glucose regulation by the client.

To evaluate the effectiveness of insulin administration.

Glucose Studies:
A. Fasting Blood Sugar - help diagnose DM and hypoglycemia; requires the client on NPO. B. Random Blood Sugar - can be done without fasting.

Equipment:
Blood glucose meter (glucometer) Blood glucose reagent strip compatible with the meter 2x2 gauze Warm cloth or other warming device** Antiseptic swab Disposable gloves Sterile lancet Lancet Injector

Equipment

Nursing Considerations:
For Infants Common site: outer aspect of the heel For Children Allow the children to select the site, if possible. Praise the child after the procedure, for cooperating. For the Elderly Promote better circulation to obtain sufficient sample.

Implementation:
1. Introduce self. Identify client. Explain the procedure. 2. Hand hygiene and appropriate infection control measures. 3. Provide privacy. 4. Prepare the necessary equipment.
* Calibrate the meter as per manufacturers instruction.

5. Select and prepare the site. Choose: Avoid: * Vascular site * Near bone structures

*Cleanse area with antiseptic and allow to dry completely.

6. Obtain blood specimen. Don gloves. Prick the site with a lancet/needle. Gently squeeze the puncture site until sufficient amount of blood forms. Hold the strip under the puncture site and allow blood to cover the entire square. Apply pressure to the skin puncture site. 7. Let the strip dry for a period, depending on the manufacturers instruction.

8. Measure the blood glucose. 9. Document the procedure and the results on the clients record.* 10. Check for orders for sliding scale insulin based on the results. Administer insulin as prescribed.

Evaluation:
Compare results with normal blood glucose level, assess the status of the puncture site (bleeding precautions), and motivation of the client to perform the procedure independently. Compare with previous readings and relate with clients current health condition. Refer to the physician, if necessary. Do follow-up teaching.

OXYGEN ADMINISTRATION
Rachel Joy R. Rosale, RN, RM, MAN

Equipment:
O2 Supply Humidifier with distilled water or tap water Nasal cannula and tubing/ Prescribed face mask of the appropriate size Tape Padding for the elastic band

Implementation:

1. Introduce self and verify the clients identity. Explain the procedure. 2. Perform hand hygiene. 3. Provide privacy. 4. Set up the equipment and humidifier. 5. Turn on the O2 at prescribed rate and ensure functioning. 6. Apply using the appropriate O2 delivery device.

Oxygen Therapy
Administration of O2 greater than that found in the environment Indicated for clients with _____________ ____________________ is more important than the liter flow per minute Prescribed by the physician Nurse may initiate therapy

Oxygen Therapy
May be dispensed from a cylinder or piped-in system Needs to be humidified Observe safety precaution

 Low Flow Systems

Oxygen Delivery Systems

Gas is delivered via small bore tubing at a rate shown on the flowmeter Room air is inhaled along with O2 FiO2 varies Used for clients with RR below 25 and a regular and concentrate rate Contraindicated to clients who require carefully monitored concentrations of oxygen Examples:

 High Flow Systems

Oxygen Delivery Systems

Supply all of the gas required during ventilation in precise amounts regardless of the clients respiratory status The ratio of room air to oxygen is regular and does not vary with the clients respiration Precise and consistent in controlling FiO2 Examples:

Nursing Considerations
1. Assess color and vital signs, before and during treatment. 2. Place an Oxygen in Use sign at the clients bedside or room door. 3. Assess for presence of chronic lung problems. 4. Humidify the oxygen if indicated.

General Procedures
Assemble the equipment. Check doctors order. Assess baseline respiratory status of the client. Position to a semi-Fowlers. Ensure safety. Introduce self, verify clients identity. Explain the procedure. Do handwashing. Provide privacy. Set up the equipment. Turn on O2 at prescribed rate. Apply the appropriate O2 delivery device. Assess the client regularly. Inspect the equipment on a regular basis. Document findings.

Nasal Cannula
Nasal prongs Most common and inexpensive low flow device Delivers _________ of oxygen at flow rates of ________ Lpm Comfortable Permits some freedom of movement Well-tolerated by clients Mgt: Place the cannula over the clients face. If the cannula will not stay in place, tape the sides properly. Pad the tubing and band over the ear and cheekbones as needed. Assess the client regularly.

Simple Face Mask Low Flow System Delivers ________ % at ________ Lpm Partial Rebreathing Mask Low Flow System Delivers ________ % oxygen concentration at flow rates of ________ Lpm The reservoir bag allows the client to rebreath the ________ of the exhaled air in conjunction with oxygen The bag must not totally deflate

Mgt: Guide the mask toward the clients face. Fit the mask to the contours of the face. Secure the elastic band around the clients head so that the mask is comfortable but snug. Pad the band behind the ears and over bony parts. Assess patients skin for dampness, chafing or drying and treat at needed.

Face Mask

 Non Rebreathing Mask

Low Flow System Delivers ________ % oxygen concentration at flow rates of ________ Lpm The client breathes only the source gas from the bag The bag must not totally deflate

Face Mask

Mgt:
Remove mucus or saliva from the mask Assess the client closely Ensure that the valve and flaps are intact and functional with every breath Valves should open during expiration and close during inhalation

 Venturi Mask
Delivers O2 concentration precise to 1% and is often used for clients with COPD Oxygen concentrations vary from 24% to 40% or 50% depending on the brand at liter flows of ________ Lpm Comes with jet or humidification adapters

Face Mask

Mgt: Monitor client closely to ensure an accurate flow rate for specific FiO2 Keep the office for the Venturii adapter open and uncovered to ensure adequate oxygen delivery Ensure that the mask fits snugly and that tubing is free of kinks because the FiO2 is altered if kinking occurs Assess the client for dry mucous membranes; humidity or aerosol can be added to the system

 Replaces O2 masks when masks are poorly tolerated by clients Can also provide varying concentration of oxygen Frequently inspect skin for dampness and chafing and dry an treat as needed Mgt: Frequently inspect skin for dampness and chafing and dry an treat as needed

Face Tent