Specimen Collection
Performing Blood Glucose Testing
Select a Skill:
- » Collecting a Midstream Urine Specimen
- » Performing Fecal Occult Blood Testing
- » Performing Gastric Occult Blood Testing
- » Collecting a Sputum Specimen
- » Collecting a Specimen for Wound Culture
- » Performing Blood Glucose Testing
- » Screening Urine for Chemical Properties
Take the Review Test:
Safety
- Ensure that the code on the test strip vial matches the code entered into the glucose meter.
- Moisture on a strip can alter the accuracy of the final test results.
- Be aware that abnormal clotting mechanisms increase the risk of local ecchymosis and bleeding.
- Never reuse a lancet because of the risk for infection.
- Do not use the hand on the side on which a mastectomy was performed as a puncture site.
- If the puncture site is bruised or continues to bleed, apply pressure and notify the health care provider.
- If the patient’s blood glucose level is above or below the target range:
- Continue to monitor the patient.
- Check to see if there are medication orders for deviations in glucose level.
- Notify the health care provider.
- Administer insulin or a carbohydrate source as ordered, depending on the glucose level.
- Be sure that the patient’s caregiver can perform the test if the patient becomes or is unable to manipulate the devices after discharge from the facility.
Equipment
(Roll cursor over items to see labels)
Antiseptic swab
Lancet device
Blood glucose meter
Blood glucose test strips for meter
Clean gloves
2x2 gauze
PrintableDelegation
Assessment of the patient’s condition may not be delegated. When the patient’s condition is stable, the skill of obtaining and testing a sample of blood to measure the blood glucose level may be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- Explain the appropriate sites to use for the puncture, and review when to test the patient’s blood glucose level.
- Specify the expected blood glucose level and when to report an unexpected result to you.
Preparation
- Assess the patient’s understanding of the procedure and the purpose of blood glucose monitoring. Determine if the patient knows how to perform the test and understands its importance in glucose control.
- Review the health care provider’s orders to see how often the patient’s blood glucose level must be measured and whether the procedure must be completed at a specific time. For example, the sample might need to be collected before insulin is administered, while the patient is fasting, after he or she has had a meal, or after certain medications have been administered.
- Determine if any risks exist for performing skin puncture, including the patient’s being on anticoagulant therapy or having a low platelet count or a bleeding disorder.
- Assess the area of the skin to be used as a puncture site. Inspect the fingers or forearms for edema, inflammation, cuts, and sores. Avoid selecting as a puncture site any bruised area or open lesion.
Follow-up
- Reinspect the puncture site for any bleeding or tissue injury.
- Compare the glucose meter reading with the patient’s normal blood glucose levels and previous test results.
- Ask the patient to explain the test results, and ask if he or she is ready to perform the next reading.
- Explain the procedure and its purpose to the patient and/or family, give them an opportunity to practice it, and provide resources and teaching aids.
Documentation
- Record and report any abnormal blood glucose level.
- Describe the patient’s response, including the appearance of the puncture site.
- Describe any explanations or teaching that you provided to the patient.
- Record the procedure used and the resulting blood glucose level measured.
- Document any action taken to correct abnormal values.
Review Questions
1. The nurse has selected a finger as the puncture site to measure the blood glucose level of a female patient with type 2 diabetes mellitus and peripheral vascular disease (PVD). Although all of the actions listed below are appropriate, which one would be of particular benefit to this patient given her medical history?
Reviewing her current medications- Inspecting the selected finger for bruising
- Following standard precautions
Keeping the finger in a dependent position during the puncture
INCORRECT. Reviewing the patient’s current medications is appropriate for all patients for whom blood glucose testing has been ordered, and doing so would have no specific benefit for a patient with the medical history described.
INCORRECT. Inspecting the intended puncture site for bruising is appropriate for all patients for whom blood glucose testing has been ordered, and doing so would have no specific benefit for a patient with the medical history described.
INCORRECT. Standard precautions are followed with all patients and would be of no specific benefit to a patient with the medical history described.
CORRECT. The nurse would keep the finger in a dependent position to encourage blood flow to the intended puncture site. Blood flow to the extremities is compromised in patients with PVD.
2. For which patient can the nurse delegate to nursing assistive personnel (NAP) the task of routine blood glucose monitoring?
- Patient with non–insulin-dependent diabetes for whom steroid therapy has been ordered
- Patient with type 2 diabetes who required insulin coverage at the last testing
- Patient with type 1 diabetes who has had nausea and vomiting for 24 hours
- Patient with type 2 diabetes who has had a closed reduction of a fracture of the right wrist
INCORRECT. This patient’s medication makes the blood glucose unstable, therefore the skill of blood glucose testing may not be delegated to NAP.
INCORRECT. This patient’s need for insulin coverage precludes the delegation of blood glucose testing to NAP.
INCORRECT. This patient’s nausea and vomiting make the blood glucose unstable, therefore the skill of blood glucose testing may not be delegated to NAP.
CORRECT. This is the correct answer. This patient’s condition would affect his or her ability to self-perform blood glucose testing but would not affect his or her blood glucose level. The skill of blood glucose testing may therefore be delegated to NAP.
3. For which situation would the procedure of glucose testing be interrupted?
- The reagent strip code matches the code on the vial.
- An unused lancet is not available.
- The glucose meter beeps.
- A drop of blood forms on the patient’s skin after it is punctured.
INCORRECT. It is expected that the code on the test strip will match the code on the vial.
CORRECT. The unavailability of an unused lancet would preclude proceeding with blood glucose testing. A used lancet can never be reused, because of the risk for infection. The nurse must locate an unused lancet for the procedure.
INCORRECT. Some glucose meters beep when the reading has been completed.
INCORRECT. The formation of a drop of blood is necessary for testing and is the expected result when the skin is punctured with a lancet.
4. A patient with type 2 diabetes mellitus tells the nurse that he has been testing his own blood glucose level six times per day for the past 3 years. What is the most appropriate action for the nurse to take?
- Observe the patient’s testing technique for accuracy.
- Advise the patient that he is not permitted to perform his own blood glucose testing.
- Check with the patient’s health care provider concerning the patient’s self-testing.
- Explain to the patient that a nurse must complete blood glucose testing.
CORRECT. This is the correct answer. It is useful to evaluate the patient’s technique to ensure that he receives accurate results.
INCORRECT. This patient has been self-testing for several years, and there is no reason to advise him not to continue doing so. To the contrary, frequent self-testing promotes optimal blood glucose control, and the nurse should encourage him to continue.
INCORRECT. The patient has given the nurse no reason to consult the health care provider.
INCORRECT. This policy varies among medical facilities.
5. Which action would the nurse carry out first when performing a blood glucose test on a patient with type 1 diabetes mellitus?
- Apply clean gloves to minimize the risk for contamination.
- Assess the patient’s skin for possible puncture sites.
- Ask the patient to wash his or her hands and forearms with warm, soapy water.
- Determine the patient’s preferred puncture site.
INCORRECT. Applying clean gloves would not be the nurse’s initial action.
CORRECT. The nurse’s first action would be to assess possible puncture sites.
INCORRECT. Helping the patient with hygiene would be appropriate, but would not be the nurse’s initial action.
INCORRECT. Asking the patient which puncture site he or she prefers is appropriate, but would not be the nurse’s initial action.
You have completed the Review Questions for this skill. To take the Review again select the Start Over button. To proceed to another skill select from the dropdown menu. Select the Home or Back button to proceed to the next section.