Increase in Diabetic Blood Sugars - Essay Example

Increase in Diabetic Blood Sugars Diagnosing diabetes is a meticulous process and if nursing are not familiar with the nuances of laboratory procedures and the accuracy of the measuring instruments, they may be found lacking in professional skills in clinical situations. It is therefore essential that they are properly trained in the diagnosis of diabetes and are knowledgeable about the identification of predisposing factors for diabetes. A simulation based training module can assist in overcoming this situation. Introduction Monitoring of blood sugar (glucose) is an important aspect in the life of a diabetic patient, maybe suffering from Type I or type II Diabetes. In the former, insulin dosage has to be carefully titrated in order to keep an optimum level of glucose in blood so that associated complications are not triggered. In the latter, quantity and type of food intake have to be optimized and required medication/s taken in order to keep the blood glucose level at an appropriate level. However, as this monitoring has to be done on an almost daily basis, either by the patient himself/herself, or by the attending healthcare professional, it becomes cumbersome for both as the frequent jabs are irritating and accuracy of the measuring instrument and reagents are critical factors. It therefore becomes essential for a trained nursing professional to be thoroughly competent in the art so that no errors occur while monitoring and taking care of diabetic patients. In the past such tests used to involve detailed and laborious time consuming procedures in the laboratory in which the results took some time to be delivered. However, with the recent advent of auto analyzer technologies and portable blood glucose monitoring instruments, it has become a relatively easy task. The operation of such instruments however need to be error free and mastered individually by every nursing practitioner. Problem Statement It has been observed that student nurses’ involved in ADN Programs are susceptible to medication errors due to paucity of training and lack experience in handling instruments during initial years of their practice. It therefore becomes essential to familiarize and train them thoroughly in the art of handling diagnostic and medication equipment which they are going to encounter in their respective areas of practice. A nurse educator should therefore ensure that the students’ under her supervision are exposed to all nuances of the area of practice they are being trained in. This study will endeavor to uncover any lacunae in the student nurses being trained for handling diabetic patients. Purpose of the Study To ensure that the students are well versed with the technical intricacies of handling diabetic patients and confident of handling diagnostic equipment in order to monitor blood glucose levels. Evaluation of their skills after exposure to a simulated scenario for monitoring blood glucose levels. Significance of the Study Well trained nurses are the lifeline of diabetic patients as they are the ones supervising them directly. A hypoglycemic crisis can be life threatening and unbridled hyperglycemia can lead to other medical complications. Apt and accurate handling of monitoring equipment can therefore be a life saving practice. Research Question(s) 1. To find out whether the student nurses’ are capable of handling diagnostic and monitoring equipment and taking informed decisions while handling diabetic patients. 2. To check the awareness of student nurses’ about the importance of risks due to medication error/s and their sequel while monitoring diabetic patients after exposure to a simulated scenario. Literature Review Diabetes is diagnosed by its typical symptoms and confirmed by measurement of plasma glucose. Measurement after 8-12 hours of fasting (fasting plasma glucose [FPG]), or 2 hours after ingestion of a concentrated glucose solution (oral glucose tolerance testing [GTT]) are the tests employed for diagnosis (Crandall, 2007). Type I diabetes is primarily insulin dependent as the sufferer primarily loses the functioning of the pancreas, an endocrine gland responsible for secreting insulin into the bloodstream. Type II diabetes develops from a combination of two factors - peripheral insulin resistance, in combination with varying degree of defects in secretion of insulin from the pancreas (Khardori, 2011). Most obese persons suffering from Diabetes Type II invariably satisfy these two criteria which usually results in diabetes which goes undiagnosed. In diabetes Type II, the glycoprotein receptor sites for insulin on the outer membrane of target cells are unresponsive to insulin, resulting in glucose not being taken up into the cells. Blood glucose levels remain high leading to hyperglycemia and in the absence of treatment may lead to glucose toxicity and death. The major changes in type II diabetes are development of erratic blood glucose varying from hypo to hyperglycemia, heightened predisposition to infections, peripheral nephropathy and retinopathy which may result in symptoms of blurred vision leading to blindness (Khardori, 2011). In patients aged 65 and over, instance of undiagnosed diabetes Type II are frequent and the prevalence level of undiagnosed diabetes is 6.9% in the US (Selvin et al, 2006). In the elderly, presence or severity of diabetes associated disorders varies within populations in which the onset of diabetes is at the middle-age stage as compared to those who are diagnosed at a later stages, the latter being classified as cases of elderly onset of diabetes (Selvin et al, 2006). The therapeutic glycemic control measures are poor in the ‘elderly-onset’ patients (Selvin et al, 2006). Fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) are two established screening tests for early detection of diabetes and a study conducted on 392 subjects for their efficacy revealed that diagnosis could be established in 22.4% of the participants (Kim et al, 2008). The FPG could detect the disease in only 55.7% of the patients within the current standard of its cut-off detection values of 6.1% for FPG and 6.1 mmol/l, respectively. In obese people, high tryglycerides’ level and a large waist size can often be obstacles in conducting the glucose tolerance test, as the traditional test can often yield impaired results while diagnosing diabetes in such people (Meigs et al, 2004). Capillary POCT (finger-prick point-of-care test) has been determined as a poor predictor of dysglycaemia and impaired glucose tolerance, which are indicators for establishment of new diabetes diagnosis, as compared to venous blood laboratory analysis which yields better results (Rush et al, 2008). IV. Theoretical Framework V. Limitations VI. Methodology Research Design Setting Population, Sample, Participants Protection of Human Subjects (IRB) Instruments and Materials Data Collection Procedures Data Analysis Strategies References Crandall, J. P. (2007). Diabetes Mellitus, Retrieved July 15, 2011 from: http://www.merckmanuals.com/professional/sec13/ch169/ch169a.html#v988173 Khardori, R., 2011, Type 2 Diabetes Mellitus, Retrieved July 15, 2011 from: http://emedicine.medscape.com/article/117853-overview Kim, K. S., Kim, S. K., Lee, Y. K., Park, S. W., & Cho, Y. W. (2008). Diagnostic value of glycated haemoglobin (HbA1c) for the early detection of diabetes in high-risk subjects. Diabetic Medicine, 25(8), 997-1000 Meigs, J. B., Williams, K., Sullivan, L. M., Hunt, K. J., Haffner, S. M., Stern, M. P., & ... Wilson, P. F. (2004). Using Metabolic Syndrome Traits for Efficient Detection of Impaired Glucose Tolerance. Diabetes Care, 27(6), 1417-1426 Rush, E. E., Crook, N. N., & Simmons, D. D. (2008). Point-of-care testing as a tool for screening for diabetes and pre-diabetes. Diabetic Medicine, 25(9), 1070-1075 Selvin, E., Coresh, J. and Brabcati, F.L., 2006, The burden and Treatment of Diabetes in Elderly Individuals in the U.S., Diabetes Care 29:2415-2419 Read More