BLOOD GLUCOSE MONITORING

ASSESSMENT
Steps Rationale
1. Identified patient using two Ensures correct patient.
identifiers, compared identifiers with
MAR.
2. Assess patient's understanding of Data set guidelines for nurse to develop
procedure and purpose of blood teaching plan.
glucose monitoring, determine if
patient understood how to perform
test and its importance in glucose
control.
3. Determined if specific conditions Dietary intake of carbohydrates and
needed to be met before or after ingestion of concentrated glucose
sample collection. preparations alter blood glucose levels.
4. Determined if risks exist for Abnormal clotting mechanisms increase
performing skin puncture. risk for local ecchymosis and bleeding.
5. Assessed area of skin to be used as Sides of fingers and heels are
puncture site; inspected fingers and commonly selected because they have
forearms for edema, inflammations, fewer nerve endings. If the patient has
cuts, and sores; avoid areas of diabetes mellitus, do not do a heelstick.
bruising and open lesions; avoid Measurements from alternative sites are
hand on side of mastectomy. meter specific and may differ from
traditional sites. Puncture site should
not be edematous, inflamed, or recently
punctured because these factors cause
increased interstitial fluid and blood to
mix and increase risk for infection.
6. Reviewed health care provider's Health care provider determines test
orders for time or frequency of schedule on basis of patient's
measurement. physiological status and risk for glucose
imbalance.
7. Assessed ability of patient to perform Patient's physical health may change
testing at home and to handle skin- (e.g ., vision disturbance, fatigue, pain,
puncturing device if necessary. disease process), preventing him or her
from performing test.
PLANNING
1. Identified expected outcomes.
2. Explained procedure and purpose to Promotes understanding and
patient and family, offered cooperation.
opportunity to practice testing
procedures, provided resources and
teaching aids.
IMPLEMENTATION
1. Performed hand hygiene, instructed Reduces transfer of microorganisms.
adult to perform hand hygiene, Reduces presence of microorganisms
rinsed and dried. and any food residue on patient's hand.
Food residue can contaminate blood
drop and cause a false reading. Warmth

2. Positioned patient appropriately.
3. Removed reagent strip from vial and
cap, checked code on test strip vial,
used proper test strips.
4. Inserted strip into meter, did not
bend strip.
5. Removed unused reagent strip from
meter; placed on clean, dry surface
with test pad facing up.
6. Matched code on screen with code
from test strip vial, confirmed codes.
7. Performed hand hygiene, applied
clean gloves, prepared lancet device
properly.
8. Obtained blood sample:
a. Wiped finger or forearm with
antiseptic, chose appropriate area
for puncture site.
b. Hold area to be punctured in
dependent position, do not massage
finger site.
c. Hold tip of lancet against area of
skin chosen for test site, pressed
release button, removed device.
d. Squeezed fingertip until round
blood drop forms.
9. Obtained test results:
a. Ensured meter was still on,
brought test strip to drop of blood,
ensured adequate sample was
obtained.
b. Read glucose test result on the
screen.
promotes vasodilation at selected
puncture site. Handwashing establishes
practice for patient when performing test
at home.
Ensures easy accessibility to puncture
site. Patient assumes position when
self-testing.
Protects strips from accidental
discoloration caused by exposure to air
or light. Code on test strip vial must
match code entered into glucose meter.
Some machines need calibration; others
require zeroing of timer. Each meter is
adjusted differently.
Reduces risk for contamination by
blood.
a. Removes resident microorganisms.
Too much alcohol can cause blood to
hemolyze. Ensures free flow of blood
following puncture. Lateral sides of
fingers are less sensitive to pain.
b. increases blood flow to area before
puncture. Milking or messaging may
hemolyze specimen and introduce
excess tissue fluid, causing inaccurate
readings.
c. Placement ensures that lancet enters
skin properly.
d. You need an adequate-size drop to
activate monitor and obtain accurate
results. Excessive squeezing of tissues
during blood sample collection may
contribute to pain, bruising, scarring,
and hematoma formation.
Exposure of blood to test strip for
prescribed time ensures proper results.
a. Blood enters strip, and glucose
device shows message on screen to
signal that you have obtained
enough blood.
10. Turned meter off; disposed of test Meter is battery powered. Proper
strip, lancet, and gloves in proper disposal reduces risk for needle stick
receptacle. injury and spread of infection.
11. Performed hand hygiene. Reduces spread of microorganisms.
12. Discussed test results with patient, Promotes participation and compliance
encouraged questions and with therapy.
participation.
EVALUATION
1. Inspected puncture site for bleeding Site is a possible source of discomfort
and tissue injury. and infection.
2. Compared glucose meter reading Determines if glucose level is normal.
with normal levels and previous
results.
3. Asked patient to explain how to Results of test may cause anxiety.
obtain blood glucose reading. Patient needs to understand range of
glucose values to maintain blood
glucose management.
4. Identified unexpected outcomes.
RECORDING AND REPORTING
1. Recorded procedure and glucose
level in appropriate log, took action
for abnormal range.
2. Described patient response in notes.
3. Described explanations or teaching
provided in notes.
4. Described evaluation of patient
learning.
5. Recorded and reported abnormal
blood glucose levels.