WPC :"T78ԝ̉Fe[!4wޢY]F8q,\$#dE7UJem'|xcDL7=1g!9{$7 ]N}fΖ&0YrҀG4MB6:K$32Vb=`9.W,T@P)/r ȹ/E%wHH! B/C4E=U*ݾJ ʷp.]LmPoQNҫq_](EQJ^F䃝T`AF"bɭЭZ@bg;ޕu54 zL´8_Wn6U?Ko ݽ٥kӬ[Ē[VU6 %r n 04/ Nc U:e w 4 1 ^ > J mL #c UN, 72z 1u 72! 0^cS 1 72= 1o 72( 0Pf`^bE 0PT 0^Va 1^S 72^2AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA Bs<\  `(Roman 10cpiX' Lab #10: Glucose Testinglab10&sq  0 .   3|x<\  `(Roman 10cpiXx\  @ X@( U$  ,@AZ"Arial Regular٩L;(5hCEKQW]cioAutoList11.1.1.1.1.1.1.1.;2<  UHPE438C7 (HP Officejet J6400 series)0(9 Z6Times New Roman Regular 1.3#37=CIQYag1.a.i.(1)(a)(i)1)a)i)(;3$2#  0  .3  0  (EhCEKQW]cioAutoList21.1.1.1.1.1.1.1.1.(UhCEKQW]cioAutoList31.1.1.1.1.1.1.1.1. )   _HHAU) xddEHWH!A X Exercise12:BedsideGlucoseTesting((3$ U!    T )   HH *   _HH  (  1  ((3$ U!   0AA.Normal  5+ ` hp x 55+ ` hp x 5   T *   HH!TABLE A8 CSY_ekqw}Numbers 2Numbers1.1.1.1.1.1.1.1. T )   HH$#1. T *   HH' (  HH d U!   _XXHH XXDXXX XXXD8XDXXdd8EXERCISE12:0 BEDSIDEGLUCOSETESTING#XXDX #X $ $  XbsXXXXDTextbook:0  Chapter14Elderly,HomeandLongtermCareCollections~&$$ Skills:0  0$$15pointsV$$ _     P  _Objectives:0  .$$ 0   $$ ! ! (Uh83"3"  32Uh  1  .3  0    Define diabetesmellitus.3݌ $$ Ќ  "3"  32Uh  2  .3  0    Compareandcontrast:Type1Diabetes,Type2Diabetesandgestationaldiabetes.3݌  $$ Ќ  "3"  32Uh  3  .3  0    Listthelimitationsofthebedsideglucosetestprocedure.3݌ $$ Ќ  "3"  32Uh  4  .3  0    Statethenormalvaluesforbloodglucoselevels.3݌ r $$ Ќ  "3"  32Uh  5  .3  0    Brieflydescribetheglucosetolerancetestincludingpatientinstructions.3݌ ^ $$ Ќ  "3"  32Uh  6  .3  0    Brieflydescribethe2hourpostprandialglucosetestincludingpatientinstructions.3݌J $$ Ќ  "3"  3 2Uh  7  .3  0    Statethepurposeofperformingbedsideglucosetesting.3  ݌6 $$ Ќ  "3"  3 2Uh  8  .3  0    Statetheprincipleofthereactionwhichoccursontheglucoseteststrip.3  ݌z"$$ Ќ  "3"  3 2Uh  9  .3  0    Describethesystemformonitoringqualityassuranceinbedsideglucosetesting.3 % ݌f$$ Ќ  "3 "  3 2Uh  10  .3  0    Performandrecordthecalibrationandnormalcontrolsolutionforthetest.3 > ݌R$$ Ќ  "3 "  3'2Uh  11  .3  0    Evaluatethecalibrationandnormalcontrolsolutionusingpredeterminedcriteriatodetermineifthe > testcanbeperformedonthepatient.3'T݌*$$ Ќ  "3 "  32Uh  12  .3  0    Performacapillarypunctureusinganautomaticbloodsamplerdesignedforcapillaryglucosetesting.3݌$$ Ќ  "3 "  32Uh  13  .3  0    Performaquantitativemeasurementofglucoseonwholebloodusingadevicemanufacturedfor  patienthomeuseandbedsidetesting.3݌$$ Ќ   (5h88  ZOXXbsDiscussion#XbsXZO#  n  Diabetesmellitus isadisorderofcarbohydratemetabolismcausedbyalackofinsulinornonfunctional X insulinandcharacterizedbyhighbloodglucoselevels.Thisisacomplicateddiseasethatmaycausemore D complicationsforthepatientthanjustanincreasedbloodglucoselevel.Personswithdiabetesmellitusoften 0 developblindness,kidneyfailure,and/orcirculatoryproblemsthatresultintissuedamageandpossible t amputation. Hyperglycemia isthesignalthatapersonpossiblehasdiabetesmellitus.Commonlythepatient ` isdeficientininsulinproductionbythepancreasorininsulinfunction.Insulinisthehormoneprimarily L responsibleforregulatingbloodglucoselevels.Whenitisabsentornonfunctionaltheglucoselevelsinthe 8   bloodrisedangerously. $!!  Type1diabetes waspreviouslycalledinsulindependentdiabetesmellitus(_IDDM_)orjuvenileonsetdiabetes. " # Type1diabetesdevelopswhenthebody'simmunesystemdestroyspancreaticbetacells,theonlycellsinthe #!$ bodythatmakethehormoneinsulinthatregulatesbloodglucose.Thisformofdiabetesusuallystrikes $"% childrenandyoungadults,whoneedseveralinsulininjectionsadayoraninsulinpumptosurvive.Type1 %l#& diabetesmayaccountfor5%to10%ofalldiagnosedcasesofdiabetes.Riskfactorsfortype1diabetes &X$' includeautoimmune,genetic,andenvironmentalfactors. 'D%(  Type2diabetes waspreviouslycallednoninsulindependentdiabetesmellitus(_NIDDM_)oradultonset t)'* diabetes.Type2diabetesmayaccountforabout90%to95%ofalldiagnosedcasesofdiabetes.Itusually d* (+ beginsasinsulinresistance,adisorderinwhichthecellsdonotuseinsulinproperly.Astheneedforinsulin P+(, rises,thepancreasgraduallylosesitsabilitytoproduceinsulin.Type2diabetesisassociatedwitholderage, <,)- obesity,familyhistoryofdiabetes,priorhistoryofgestationaldiabetes,impairedglucosetolerance,physical (-*. inactivity,andrace/ethnicity.AfricanAmericans,Hispanic/LatinoAmericans,AmericanIndians,andsome .+/ _ AsianAmericansandPacificIslandersareatparticularlyhighriskfortype2diabetes.Type2diabetesis X increasinglybeingdiagnosedinchildrenandadolescents. D  Gestationaldiabetes isaformofglucoseintolerancethatisdiagnosedinsomewomenduringpregnancy.  GestationaldiabetesoccursmorefrequentlyamongAfricanAmericans,Hispanic/LatinoAmericans,and   AmericanIndians.Itisalsomorecommonamongobesewomenandwomenwithafamilyhistoryofdiabetes.  Duringpregnancy,gestationaldiabetesrequirestreatmenttonormalizematernalbloodglucoselevelstoavoid  complicationsintheinfant.Afterpregnancy,5%to10%ofwomenwithgestationaldiabetesarefoundtohave x type2diabetes.Womenwhohavehadgestationaldiabeteshavea20%to50%chanceofdevelopingdiabetes  d inthenext510years.  P   TheGlucoseToleranceTest   (  Theglucosetolerancetest(GTT)isdoneonindividualswhoarebeingscreenedfordiabetesmellitusor X   hypoglycemia .Thephlebotomistplaysaverycrucialroleintheadministrationofthistest.Usuallythe D  patientreceivesasetofinstructionsaboutwhattoeatandawarningtoavoidstressfulexerciseinthedays 0  leadinguptotheGTT.However,itisoftenthephlebotomistwhogivesthepatientinstructionsaboutdieting  andfasting.Thepatientshouldeatawellbalanceddietfor3daysbeforethetest.Generally,thepatientis  allowedwaterandisactuallyencouragedtodrinkwaterduringthefastandtest,butnothingelseisallowed,  includingcoffeeandtea.Smokingisalsodiscouraged.Theseinstructionsmustbedeliveredinaclearand  understandablemanner.Patientsshouldbeencouragedtoaskquestionsiftheydonotunderstandthe t instructions.Ifthephlebotomistdoesnotperformthispatienteducationfunctionproperly,muchvaluable ` timemaybewasted. L Afterapatienthasfastedforatleast12hours,abloodsampleiscollectedusingroutinecollectionprocedures. |$ Thebloodmaybecollectedinaplaintubeorinatubeespeciallydesignedtopreserveglucoselevels.Ifa h plaintubeiscollecteditiscriticaltogetitbacktothelabsotheserumcanbeseparatedfromtheredblood T cells.Iftheserumisallowedtositonthecellsglycolysisbythecellswilloccur,causingafalselydecreased @ glucoselevel. , Afterthefastingsampleiscollected,thepatientisdirectedtoconsume100gmofglucoseasquicklyas  possible,ofteninliquidform. Itiscriticaltonotethetimeofglucoseconsumptionandofallsubsequent  venipunctures. Bloodisthencollected30minutes,1hour,2hours,3hours,etc.,upto5hoursafter   consumingtheglucose.Ateachvenipunctureaurinespecimenmayalsobecollected.  x! Itisveryimportanttocollectthespecimenatthedesignated.Whenlabelingthesampleincludeallitems "P # routinelycollectedplusthetimeintheseries"1hour","2hour"andsoon. ##  X Asmalldropofcapillarywholebloodiscollectedbyskinpuncturefromthefingerorheel(ininfants).Fresh B bloodobtainedbyvenipuncturemayalsobeused.However,venousandcapillarybloodmaydifferinglucose . concentrationbyupto70mg/_ dL_ ,dependingontimeofbloodcollectionafterfoodintake.Besuretocheck  themanufacturer'srecommendationsastheyrelatetoanticoagulants.Someproceduresrequirebloodwithout  ananticoagulant,otherproceduresarenotaffectedbyanticoagulants.Asforanybloodcollectionprocedure,  appropriatesafetyproceduresmustbefollowedanddisposalofcontaminatedwastemustbepartofthequality  controlandsafetyguidelines.Thepuncturesiteshouldbecleansedand thoroughly driedbeforeobtaining  r thebloodsample.Thesebedsideproceduresarehandyforquickscreeninginahospitaloroutpatientsetting.   b   Alwaystestbloodsamplesasnearaspossibletothetimeofsamplecollection.Bloodglucoseconcentration  :  inwholeblooddecreasesovertime,glucosemeasurementsofstoredsampleswillnotequatewiththeir ~ &  concentrationsatthetimeofcollection.Thebloodglucosedeterminationshouldbeperformedwithin10 j  minutesofspecimencollectiontominimizeglycolysis. V   ZOXXbsQualityControl#XbsXZOE#  . Itis extremelyimportant tomaintainandprovidearigidqualitycontrolandtrainingprogrampriorto  implementingtheseprocedure.Varianceinmethodologyandlackofqualitycontrolonreagentsand  equipmentcanleadto seriousmedicalconsequences forpatientsbeingtested.Carefuladherenceto  manufacturer'sinstructionsaswellasathoroughevaluationofthemonitoringdevices,coupledwithstrict  adherencetodailyqualitycontrolprocedures,willensureamoreaccurateandprecisescreeningtool. x Qualitycontrolinvolvestestingtheequipmentbyutilizingcontrolsolutionsofknownvalues.Most P manufacturersmakeahigh,lowandnormalsolution.Thesesolutionsaretestedjustasiftheywereapatient < solution.Thevaluesarethencomparedwiththemanufacturer'svalues.Iftheexpectedvaluesareobtained, ( patienttestingcanbedone.Iftheexpectedvaluesarenotobtainedthesystemisnotfunctioningproperly l and theequipmentcannotbeused untiltheproblemisidentifiedandcorrected.Controlresultsthatfall X outsideoftheexpectedrangemayindicateproceduralerror,teststripdeterioration,metermalfunction,or H extremesintestingprocedure.Oncetheproblemisidentified,thecontrolsmustberepeated.Iftheresults 4 arenowinrangetheequipmentcanbeusedforpatienttesting.Ifcontrolscontinuetobeoutofrange,notify   themanufacturerforassistanceandpossiblerepair.Documentationofthesecontrolresultsandactiontaken    whenproblemsariseisanintegralpartofacompletequalityassuranceprogram.  !  ZOXXbsLimitationsoftheProcedure#XbsXZOL#  "x # 1.0  Theteststripsaredesignedtobetestedwithwholeblood,serumorplasma cannot beused.$b"%$$ 2.0  Donotusepreservativesthatcontainfluoride.%N#&$$ 3.0  Extremesinhematocritcanaffectresults.Highhematocrits(above60%)areknowntodecrease &:$' glucosemetermeasurements,converselylowhematocrits(below25%)cancauseincreasedglucose ~'&%( measurements.j(&)$$ 4.0  Checkwithmanufacturerastowhetherornottheequipmentcanbeusedonneonates.Some V)&* equipmentisnotdesignedforbabies.B*'+$$  -+/ 5.0  Bloodglucoseresultsobtainedmaybesignificantlylowerthattrueconcentrationsifexcessivewater X lossanddehydrationoccurs.Severedehydrationcanleadtomanyserious,lifethreateningmedical D complications.0$$ 0  Thelossofexcessivewaterupsetsthebody'schemicalbalancewhichaffectsthebloodinmanyways.  Oneveryimportanteffectisthattheliquid(plasma)portionofthebloodwillbegreatlyreducedwhich  makesthebloodthicker.Thismaycausethemetertogiveinaccuratelylowbloodglucoseresults.$$   Thefollowingaresomeofthefactorswhichcouldleadtodehydration:  ` 0  a.0$$vomitingordiarrhea L $$ 0  b.0$$prescriptiondrugs,e.g.,diuretics 8 $$ 0  c.0$$inabilitytorecognizeorerespondto"thirst"sensations| $ $$ 0  d.0$$sustaineduncontrolleddiabetesh  $$ 6.0  Reducingsubstancessuchasascorbicacid,etc.whenoccurringinnormalbloodconcentrationsdonot @  significantlyaffecttheresults.However,abnormallyhighconcentrationsinbloodwillcause ,  inaccuratelylowresultsforreflectancemethods,thesedonotinterferewithbiosensormethods.$$ 7.0  Reagentstrips mustnot beusedbeyondtheirprintedexpirationdateandvialsmustbeusedwithin  aspecifiedperiodoftimeafteropening.$$  ZOXXbsExpectedValues#XbsXZOQW#  \ Thetargetbloodglucosevalueappropriateforthepatientshouldbeestablishedbythephysicianor F prescribinghealthcareprofessional.Targetbloodglucoselevelsassociatedwithwellcontrolleddiabetesare 2 asfollows: v 0  *Fasting60130mg/DlN$$ 0  *Aftermeals(1hour):Lessthan180mg/_ dL_ :$$ 0  *Aftermeals(2hours):Lessthan150mg/_ dL_ &$$   ߽ XXbs    EXERCISE12:BEDSIDEGLUCOSETESTING#XbsX  ߽Z# X  Phlebotomist_________________________________Date________________ ~& PatientName________________________________ V 0  0$$ APerformed.$$ 0  0$$BNeedsImprovement $$ 0  0$$CNotPerformed  $$ _____1.0  Appropriatelypreparestheglucosemeter. $$ _____2.0  Statestheproperprotocolfortheperformanceofqualitycontrolprocedures. r $$ _____3.0  Readsinstructionsofappropriateinstrumentandautomaticbloodsamplerpriortoproceeding. ^ $$ _____4.0  Selects,preparesandorganizesequipment.J $$ _____5.0  Washeshands,donsgloves,greetsandidentifiespatient.6 $$ _____6.0  Explainsproceduretothepatient.Interviewspatientconcerningpreparationpriortospecimen z" collection.f$$ _____7.0  Selectspuncturesite,massagesandwarmssiteasnecessary,cleansessite,allowssitetodry R completelyandperformspuncture.>$$ _____8.0  Appropriatelysqueezesfingertoformfirstdropofblood.*$$ _____9.0  Appropriatelyappliestheblooddroptothereagentstripaccordingtothemanufacturer's  directionstoinitiatetimingofthereaction.$$ _____10.0  Measurestheglucosecontentonthestripaccordingtotheinstrumentmanufacturer's  directions.$$ _____11.0  Providesappropriatepostpuncturecaretothepatient.n$$ _____12.0  Disposesofallmaterialsandsuppliesintheappropriatecontainers.Z$$ _____13.0  Inspectspuncturesite,appliesbandageifnecessary.F$$ _____14.0  Removesgloves,washeshands.2$$ *U"ddd Xdd Xdd XH$H$,dd ,dd +  b b  Timeofpatientslastmeal  n   n Calibrationstrip(placeacheckifacceptable)  F    F! NormalControlSolution   n"    n# Manufacturersvaluefornormalcontrolsolution  F"$   F"% PatientsGlucoseresults  #n!&  #n!'  Basedontheresultsofthecalibrationcanthismachinebeused?YESNO %v#( Basedontheresultsofthenormalcontrolcanthismachinebeused?YESNO &b$)  Arethepatientresults:NORMALABNORMAL  (:&+  .+1  > XXbsEXERCISE12:0 P BEDSIDEGLUCOSETESTINGSTUDYQUESTIONS#XbsX >g# XP $P $ Name___________________________Date_____________________ h Points:25 @  #( 98 "3"  3h2   1  .3  0    Whatisthecauseofdiabetesmellitus(1point)?3hh݌$$ Ќ  "3"  3i2   2  .3  0    Whatisthefunctionofinsulin(1point)?3ii݌ \ $$ Ќ  "3"  3j2   3  .3  0    DescribethedifferencebetweenTypeIandTypeIIdiabetesmellitus(2points).3jj݌($$ Ќ  "3"  3k2   4  .3  0    Briefly describetheinstructionsgiventopatientstopreparethemfortheglucosetolerancetest(_ GTT_ ) L (2points).3kk݌<$$ Ќ  "3"  3Gm2   5  .3  0    Forwhatperiodoftimedoesapatientfastbeforethe_ GTT_ Ԁ(0.5point)?3Gmtm݌,)-$$ Ќ   -+/ _ "3"  3n2   6  .3  0    DescribethetimeintervalsofthespecimensdrawnduringaGTTandhowtheseshouldbelabeled X (2points).3nn݌D$$ Ќ  "3"  3o2   7  .3  0    Whatmustbedoneifapatientsvomitswithinthefirst30minutesoftheGTT(1point)?3op݌| $ $$ Ќ  "3"  3q2   8  .3  0    Brieflydescribethepostprandial(PP)glucosetest(2points).3qDq݌$$ Ќ  "3"  3*r2   9  .3  0    Brieflydescribethe2hourpostglucosedrinktest AND statetheadvantagesthistesthasoverthePP < glucosetest(2points).3*rWr݌,$$ Ќ  "3 "  3s2   10  .3  0    Describetheadvantageforpatientstomonitortheirglucoseathome(1point).3ss݌<'$($$ Ќ   -X+/ Ї"3 "  3t2   11  .3  0    Whatisthetimelimitfortestingbloodspecimensforglucoseaftercollection. Why isthislimitset X (1point).3tt݌H$$ Ќ  "3 "  3'v2   12  .3  0    Whyisqualitycontroloftheglucosemetersoimportant(1points).3'vTv݌ d$$ Ќ  "3 "  3;w2   13  .3  0    Brieflydescribethequalitycontroltestingtobedoneeachday(1points).3;whw݌D $$ Ќ  "3 "  3Xx2   14  .3  0    Listfour(4)factorswhichmaycausecontrolresultstofalloutsideoftheexpectedrange(2points).3Xxx݌L$$ Ќ  "3"  3y2   15  .3  0    Listthreelimitationsoftheglucosetestingprocedureusingtheglucosemeter(1.5points).3yy݌$$ Ќ  "3"  3z2   16  .3  0    Listthreefactorswhichmayleadtodehydration(1.5points).3zz݌<'$($$ Ќ   -X+/ Ї"3"  3{2   17  .3  0    Howwilldehydrationaffectthetestresults(1point).3{|݌X$$ Ќ  "3"  3|2   18  .3  0    Listtheexpectedvaluesofthebloodglucoseforeachofthefollowing(1.5points):3|}݌$$ Ќ    *Fasting__________________ t 0  *Onehourafterameal____________________ L $$ 0  *Twohoursafterameal___________________| $ $$