Blood glucose monitoring and Nursing Care

Blood Glucose Meters

Diabetic children commonly perform capillary punctures several times daily

to measure their blood glucose with a small instrument.

Preparation: Clean Gloves

1-The procedure is explained to child and family.

2- The nurse demonstrates the procedure as needed and observes the child or family on return demonstration.

3- The diabetic child is taught over time how to safely perform repeated blood glucose tests and How to maintain materials.

EQUIPMENT AND SUPPLIES

• Reagent strips

• Blood glucose meter

• Alcohol swab

PROCEDURE: Clean Gloves
1- Child and any assistants wash hands.
RATIONALE: This procedure removes surface contaminants to reduce chance of infection.
2-  Assistants wear gloves.
3- Clean finger to be used with alcohol if desired, but not necessary for diabetic with repeated tests (Figure 6-3).
RATIONALE: With repeated testing, alcohol can cause drying and cracking of the skin. Washing with soap and water removes most surface contaminants
4- Milk the finger gently or warm hand if cold.
RATIONALE: This practice encourages blood circulation to the fingertip so that the sample can easily obtained.
5- Quickly puncture the fingertip with the lancet.
6- Apply a drop of blood to the reagent strip.
7- Place the strip into the glucose meter and read instrument as instructed

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Venipuncture

Venipuncture, is used to obtain a sample for complete blood count , blood culture , sedimentation rate, blood type and crossmatch blood clotting times, drug screen, ammonia level, or fibrinogen level.

SKILL 6-4 Performing a Venipuncture
PREPARATION
1. Choose the appropriate site. The veins of the antecubital fossa or forearm are usually the best choice because of their accessibility; however, the dorsum of the hand or foot.)

EQUIPMENT AND SUPPLIES

• Tourniquet

• 20- to 27-gauge needle with attached syringe (slightly larger than volume of blood needed)

• Large-bore (19-gauge) needle

• Appropriate blood collection tubes.

PROCEDURE: Clean Gloves

1- Apply gloves.

2- Place a tourniquet proximal to the desired vein to distend it. If necessary, hold the extremity be­low heart level, gently rub or tap the vein, or apply a warm compress to promote dilation of the vein (Figure 6-5A).

3- Locate the vein by inspection (wiping with alcohol will make the vein shine) or palpation.

4- Once the vein has been located, clean the skin with alcohol or povidone-iodine, using an out­ward circular motion (Figure 6-5B). Let dry.

5- With the non-dominant hand, hold the skin taut, gently pulling with the thumb just under the site of the puncture.
6 – Puncture the skin with the needle, beveled up at a 15-degree angle and directed toward the vein. When blood appears in the tube, gently pull back on the syringe (Figure 6-5C).
7 – Release the tourniquet after all the blood has been collected. Remove the needle at the same angle used for entry and apply pressure to the site with gauze (alcohol will sting).
8- Have the assistant or parent maintain pressure for a few minutes until the bleeding has stopped, at which point an adhesive bandage can be placed. Meanwhile, remove the needle from the syringe and discard
9 – Attach the large-bore (19-gauge) needle, and expel blood into the appropriate collection tubes as soon as possible.

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