Testing blood for glucose imbalance is an important aspect of caring for a MHSU with dia- betes, or for screening for diabetes in your MHSU group. Exposure to blood, even in minute quantities, is a risk. Thus for health and safety it is important that infection control measures are followed regarding disposal of sharps and clinical waste.
Testing blood glucose will provide an indication of the MHSU’s blood glucose levels. This will enable practitioners to evaluate the success of any lifestyle changes or medication given Table 4.19 the International Classification of adult underweight,
overweight, and obesity according to BMI
Classification
BMI (kg/m2)
Principal cut-off points Additional cut-off points
Underweight <18.50 <18.50
Severe thinness <16.00 <16.00 Moderate thinness 16.00–16.99 16.00–16.99
Mild thinness 17.00–18.49 17.00–18.49
Normal range 18.50–24.99 18.50–22.99
23.00–24.99 Overweight
Pre-obese Obese Obese class I Obese class II Obese class III
≥25.00 25.00–29.99
≥30.00 30.00–34.99 35.00–39.99
≥40.00
≥25.00 25.00–27.49 27.50–29.99
≥30.00 30.00–32.49 32.50–34.99 35.00–37.49 37.50–39.99
≥40.00 Source: WHO (2006a)
Table 4.20 Procedure for measuring BMI
Step Action Rationale
1 Prepare equipment
Ensure you have functioning scales, a height measurement tool, a BMI calculation chart or a calculator to make the calculation, pen to record reading and documentation
to ensure effective monitoring and prompt recording of reading
2 Explain procedure
Outline your intended actions to gain consent and reassure the MHSU
3 Ensure privacy Carry out procedure in a suitable clinical environment
to show respect and preserve dignity
4 Weigh MHSU ask MHSU to remove shoes and outer clothes and stand, or sit, on scales. Ensure scales are set to 0
to obtain an accurate measurement of weight (kilograms)
5 Measure MHSU’s height
MHSU can put clothes on again. ask MHSU to stand erect beside the height measure*
to gain an accurate measurement of height (metres) and then convert to m2
6 Calculate BMI Use either a visual measure from a chart or a BMI calculator
to arrive at MHSU’s BMI 7 Record and
document your findings
Complete appropriate chart For comparison with past or future readings
8 Communicate findings 1
Inform MHSU of the outcome and be prepared to answer any queries they may have
to reassure the MHSU
9 Communicate findings 2
report any abnormalities to the nurse in charge
In case immediate intervention is required or for continuity of care
10 Communicate findings 3
record findings in the MHSU’s case notes So that other members of the team are aware of them
*If MHSU cannot stand erect (e.g. a frail elderly person), then a demispan measurement can be used (Perry 2007). Here height is calculated by measuring one arm outstretched from the base of the middle/ring fingers to the sternal notch using a non-stretch tape measure. Height is calculated for women: height in cm = (1.35 × demispan cm) + 60.1; for men: height in cm = (1.4 × demispan cm) + 57.8 (Perry 2007).
Table 4.21 Healthy waist-to-hip ratio
Ratio Women Men
Ideal <80 cm (32 inches) <94 cm (37 inches) High 80–88 cm (32–35 inches) 94–102 cm (37–40 inches) Very high >88 cm (35 inches) >102 cm (40 inches) Source: NHS Choices (2013b)
to regulate blood glucose levels. Diabetes.co.uk (2013) suggest the range for a normal blood glucose level is 4.4–6.1 mmol/L (see Table 7.9, Chapter 7).
Blood glucose testing should be done in line with the MHSU’s care plan. Depending on the severity, this might be done typically before and after meals (e.g. in Type 1 diabetes), before and after breakfast, lunch and the evening meal. In T2D, blood glucose testing may not be required, may be required infrequently (e.g. weekly) or may be required daily. Again this depends on the presence of other risk factors such as having a co-morbid illness.
Normally MHSUs will monitor their own blood glucose levels. When well, the role of the nurse will be to review the MHSU’s blood glucose levels in the MHSU’s own record. When MHSUs are unwell, this may need to be facilitated by the practitioner, as they may not have the concentration or dexterity to perform it. However, promoting MHSU independence will be a key therapeutic aim in the nursing care plan.
Equipment
Blood glucose is tested using a glucometer. It is important that both practitioner and MHSU are trained in how to use the glucometer correctly. Glucometers usually have a standard dispos- able lancet and testing strips. It is important that the equipment used is that recommended by the manufacturer.
Procedure for a blood glucose reading
Table 4.22 explains the procedure for taking a blood glucose reading using a glucometer. The MHSU should select the finger to be used. It is important that this is varied, as repeated pricks in the same finger can compromise the skin.
Remember to vary the site of blood testing so that skin does not become calloused from overuse at one site. The index finger or thumb are generally not used for this procedure, as these get used daily and continuous use may impair pinching movement. All MHSUs should decontaminate hands with soap and water. They should not use alcohol rub, as this may con- taminate the testing strip.
Box 4.9 Case example
Carlos is a 38-year-old male with a history of schizophrenia. He is currently receiving olan- zapine 7.5 mg twice daily. He smokes 40 cigarettes daily, engages in no physical activity, and has a poor diet. He has t2D and takes metformin 500 mg with meals three times a day.
He requires blood glucose monitoring. What do you do?
Assessment and diagnosis
Carlos has t2D, which requires monitoring during his respite stay in hospital.
Plan
to monitor Carlos’s t2D as per his current care plan, which involves:
• Diet and lifestyle factors.
• Metformin 500 mg three times a day.
• Daily blood glucose testing and recording.
Implementation
For continuity of care, Carlos’s current care plan for his t2D needs to be monitored during his respite stay:
• Carlos needs to monitor his blood glucose twice daily: (1) before breakfast and (2) before going to sleep.
Table 4.22 Procedure for a blood glucose reading
Step Action Rationale
1 Prepare equipment
Select glucometer, disposable lancet, testing strips, gauze, disposable gloves, sharps box, pen, chart for recording result
to ensure effective and safe monitoring and prompt recording of reading
2 Decontaminate hands
Nurse: Wash hands or use alcohol rub
MHSU: Wash hands as alcohol rub may contaminate reading
Both MHSU and staff decontaminate as MHSU’s skin will be punctured;
this promotes infection control and minimizes cross-infection
3 Explain procedure Outline your intended actions to reassure the MHSU and gain consent 4 Ensure MHSU is
sitting
Make sure the MHSU is comfortable and prepare them for a small jab
In case the MHSU experiences an unpleasant feeling following the finger prick
5 Check and prepare equipment
Check expiry dates of test strips, check glucometer is working, i.e. note battery strength, insert disposable lancet
to ensure a proper reading and that proper test strips are being used
6 Prick outer part of MHSU’s finger once
to draw a drop of blood Wearing the disposable gloves, ensure you are firm but not forceful as only a drop of blood is required. Gently squeeze the site to obtain a bigger droplet if required
7 Cover the test strip pad with some blood
Insert the test strip into the glucometer
Wait the required time for the reading
8 Dispose of used equipment
Use proper sharps box and clinical waste bags
For infection control purposes 9 Record and
document your findings
Ensure you are familiar with the standard way of recording this measurement
the appropriate chart should be completed accurately for comparison with past or future readings
10 Communicate findings 1
Inform MHSU of the outcome and be prepared to answer any queries they may have
to reassure the MHSU
11 Communicate findings 2
report any abnormalities to the nurse in charge
In case immediate intervention is required or for continuity of care 12 Communicate
findings 3
record findings in the MHSU’s case notes
So that other members of the team are aware of them
13 Decontaminate hands again
Wash hands or use alcohol rub to promote infection control and minimize cross-infection
• Help promote Carlos’s independence by encouraging him to keep to his own testing rou- tine. Carlos should keep his glucometer and other equipment with him. However, testing should occur in the clinical room where used equipment can be safely disposed of. Staff should observe Carlos while he is doing the test and recording the reading.
• Carlos should keep a record of his blood glucose readings. Staff should physically check that he is doing this on a regular basis.
• Staff should keep a note of the blood glucose readings in Carlos’s case notes.
• Carlos takes metformin 500 mg twice daily along with meals. Staff should dispense medication as per NMC (2008) guidelines and ensure that Carlos takes the medica- tion.
• Staff should observe Carlos for both positive and negative side-effects of medication.
• Staff should liaise with Carlos’s diabetic nurse specialist and share information as appro- priate.
Carlos has a reduced calorie diet that he needs to maintain. However, this has proved very challenging and he frequently has problems maintaining it.
• Staff should liaise with the dietitian regarding Carlos’s diet and explore ways of maintain- ing it.
• Carlos should be referred to occupational therapy for advice on food preparation.
• Carlos should have his blood pressure, pulse, BMI, and waist-to-hip ratio recorded and monitored.
• Staff should give Carlos health education and promotion advice.
• Staff should encourage Carlos to be physically active during the day.
• Carlos should be referred to a smoking cessation therapist for advice on how to reduce/
stop his smoking.
• Staff should discuss the benefits of stopping smoking with Carlos and introduce him to the idea of nicotine replacement therapy (Nrt).
• Staff should observe Carlos for both positive and negative side-effects of poor diet.
• Night staff should be aware of the care plan to reduce Carlos snacking inappropriately at night and to promote continuity of care.
• Carlos’s care plan should be regularly monitored to determine progress.
Evaluate
• Daily evaluation will be conducted at the end of each shift. this will include monitoring baseline observations, blood glucose levels, medication compliance, and dietary intake.
• the care plan will be re-evaluated if Carlos experiences any serious complications, e.g.
hypoglycaemia or diabetic ketoacidosis.