RISK FOR UNSTABLE BLOOD GLUCOSE
Definition:
At risk for variation of blood glucose/sugar levels from the normal
range.
Risk factors:
·
Deficient
knowledge of diabetes management
·
Developmental
level
·
Dietary
intake
·
Inadequate
blood glucose monitoring
·
Lack
of acceptance of diagnosis
·
Lack
of adherence to diabetes management
·
Physical
activity level
·
Physical/mental
health status
·
Pregnancy
·
Stress
·
Weight
gain or loss
Expected outcomes:
The patient will
·
Be
free from symptoms of hypoglycemia/hyperglycemia.
·
Have
serum glucose to the prescribed desired range.
·
Verbalize
understanding of how to control blood glucose level.
Interventions and
Rationales:
Determine:
Assess patient for symptoms of low serum glucose level and maintain a
patient airway if indicated. A low serum glucose may not be detected in
some patients until moderate to severe central nervous system impairment
occurs, which can lead to a compromised airway and cardiac arrest.
Assess for the underlying cause (e.g., inadequate dietary intake; illness such
as nausea, vomiting, or diarrhea; and too much insulin) to help patient
prevent future episodes and adapt treatment strategies and lifestyle changes.
Monitor or instruct patient to monitor glucose levels with a glucometer at
regular intervals to identify and respond early to fluctuations in
glucose levels that occur outside normal parameters.
Assess family understanding of prescribed treatment regimen. The
family plays an important role in supporting the patient.
Assess patient’s knowledge of hypo/hyperglycemia to ensure adequate
management and prevent future episodes.
Monitor
for signs and symptoms of hyperglycemia (polyuria, polydipsia, polyphagia,
lethargy, malaise, blurred vision, and headache). Early detection
ensures prompt intervention and management.
Assess for the underlying cause of elevated serum glucose level,
including inadequate dietary intake, illness, and poor medication management to
prevent future episodes and develope treatment strategies such as changes in
lifestyle.
Perform:
Perform immediate finger stick with a glucometer to determine glucose level,
which will guide treatment strategies. Administer insulin,
as prescribed, to treat elevated blood glucose levels.
Provide patient with glucose tablets or gel if he or she is conscious and
has ability to swallow. Administer intravenous glucose if patient is
unconscious or cannot swallow. Immediate treatment in the form of oral
or intravenous glucose must be administered to reverse the low serum glucose
level. If patient becomes nauseated, turn patient on side to prevent
aspiration.
Protect patient from injuries, such as falls. Symptoms of low serum glucose
place patient at risk for injury especially when driving and performing other
potentially dangerous activities.
Evaluate serum electrolyte levels. Administer potassium, as prescribed. With
elevated blood glucose levels, potassium and sodium levels may be low, normal,
or high, depending on the amount of water loss. Consider performing
serum testing for HgbA1c (glycosylated hemoglobin A3C level) to
evaluate average blood glucose levels over a period of approximately 2–3 months
and to assess the adherence and effectiveness of the treatment regimen.
Inform:
Teach patient and family self-management of hypoglycemia and hyperglycemia
including glucose monitoring at regular intervals to treat abnormal
glucose levels early and medication management, nutritional intake,
exercise, and regular follow-up visits with the physician to ensure
adequate understanding and management of the treatment regimen to prevent
future hyperglycemic events. Patient and family teaching may include
referrals to a diabetic educator, diabetic education classes, and a dietician.
Manage:
Consult physician if signs and symptoms persist. Changes in prescribed
medications may be needed, such as with oral hypoglycemic agents or insulin
dosing. Call for emergency medical services if patient is unstable
outside the hospital.
Reference:
Oldroyd, J., et al. (2006). Randomized controlled trial evaluating
lifestyle interventions in people with impaired glucose tolerance. Diabetes
Research and Clinical Practice, 72(2), 117–127.
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