Tag Archives: nursing

Treating Severe Hypoglycaemia

Patient is unable to self-treat. If conscious, and able to swallow safely, patient should be given one of the following:

  • 100ml Lucozade
  • 150ml non-diet fizzy drink
  • 200ml smooth orange juice
  • 5-6 dextrose tablets
  • 4 jelly babies
  • 7 jelly beans
  • 2 tubes glucose gel

Repeat as required and stay with patient until recovered.

If patient is unconscious, he should be put in recovery position, glucagon can be injected if trained to do so. Otherwise dial 999 for ambulance.

Symptoms of Diabetes

(Guide only, type 2 diabetes can be asymptomatic for years)

Symptoms Type 1 Diabetes Type 2 Diabetes
Onset Fast (days/weeks) Slow (months/years)
Thirst √ often profound √
Polyuria/nocturia √ √
Bedwetting in children √  -
Lethargy/tiredness √ √
Mood changes/irritability √ √
Weight loss √++ √+/-
Visual disturbances √ √
Thrush infections (genital) - √
Recurrent infections (boils/ulcers) - √
Hunger √ √
Tingling/pain/numbness in extremities - √
Occasionally abdominal pain √ -
Confusion If advanced √ Especially in the elderly
Incontinence - √ Especially in the elderly
Glucosuria √ May be absent especially in the elderly or if there is a high renal threshold
Ketones in urine or blood May be present (ketoacidosis) Likely to be present

Thanks to Practice Nurse 41 8

Symptoms of TIA

Definite Probably Not Alarm symptoms (may require admission)
Slurring Dizziness Known AF; or high stroke risk
Clumsiness Confusion Recurrent TIAs; more than 2 in last 2 weeks
Tingling/numbness General weakness Patient on anticoagulant. May need brain scan
Visual disturbance ABCD2 score of 4 or more

Thanks to Practice Nurse 41 8

Treating Mild Hypoglycaemia

To raise blood glucose, take one of the following:

  • 100ml Lucozade
  • 150ml non-diet fizzy drink
  • 200ml smooth orange juice
  • 5-6 dextrose tablets
  • 4 jelly babies
  • 7 jelly beans
  • 2 tubes glucose gel

If blood glucose is still below 4mmol/l after 10 mins, or if patient doesn’t feel better, repeat one of the above treatments.

When feeling better, eat some starchy food such as a sandwich or a banana, monitoring blood glucose afterwards.

Coeliac Disease

This is an autoimmune condition triggered by the consumption of gluten found in wheat, barley, rye and occasionally oats. Frequently there is confusion of a patient’s symptoms, sometimes leading to a diagnosis of IBS or wheat intolerance. Untreated celiac disease can lead to increased risk of osteoporosis and small bowel cancer.

Symptoms of celiac disease include:

  • Nausea
  • Bloating
  • Flatulence
  • Constipation
  • Diarrhoea
  • Weight loss
  • Fatigue
  • Joint or bone pain
  • Mouth ulcers
  • Dematitis herpetiformis (a skin condition associated with coeliac disease)

Coeliac disease is diagnosed first of all with a blood test for immunoglobulin A or tissue transglutaminase amtonpdoes (tTGA). If this proves inconclusive. Endomysial antibodies may also be tested for, and later with an endoscopy and biopsy of the duodenum.

Gluten-free food including pasta, flour, biscuits, crackers and even breads and pizza bases are available on prescription.

Interpretation of ABPI

  • 1.3 or above may indicate arterial disease or calcification. Seek advice from tissue viability nurse
  • 1.0-1.3 normal arterial flow. Regular compression is probably safe, if not otherwise contraindicated
  • 0.8-1.0 Mild arterial disease, but sufficient for compression if not otherwise contraindicated
  • 0.5-0.8 Moderate arterial insufficiency. Seek advice from tissue viability nurse; reduced compression may be appropriate following specialist advice

Korotkoff Sounds

  • Phase I – the initial appeance of faint, repetitive tapping sounds that grandually increase in intensity for at least two consecutive beats (the systolic blood pressure)
  • Phase II – a brief period during which the sounds soften and acquire a swishing quality. In some patients the sounds may even disappear briefly. This is known as an auscultatory gap
  • Phase III – the return of sharper sounds, which may even be stronger than those in Phase I
  • Phase IV – distinct, abrupt muffling sounds that become soft and blowing in quality
  • Phase V – all sounds finally disappearing (the point of diastolic blood pressure)

Thanks to Nursing in Practice 62 (2011)

Type I Diabetes

Type I diabetes occurs when there is a loss of insulin secretion ability due to automimmune destruction of the beta cells in pancreatic tissue. Patients generally present with the symptoms of hyperglycaemia including ketoacidosis.

Type I diabetes is the most common form in young people (affecting aout 0.5% of the population); bringing with it the potential for problems such as retinopathy, neuropathy, nephropathy and vascular disease.

Small amounts of insulin are produced by the pancreas throughout the day to ensure cells have access to glucose, and suppress the release of stored glucose from the liver. During fasting periods, glucagon is released to ensure glucose supplies for brain function.

Carbohydrates are digested in order to provide glucose, which results in the release of insulin titrated to the supply of glucose to use and store glucose in suitable quantities.

Insulin needs to be replaced in type I diabetes patients to ensure 24 hour cover. Boluses may also need to be prescribd to match carbohydrate intake at mealtimes. Often this can be suitably treated with a twice daily insulin if the patient’s daily routine is predictable, for patients whose lifestyle is more varied, titrated insulin may be required perhaps involving a pump or more frequent injections.

Carbohydrate awareness is important for those with type I diabetes because it is carbohydrates that affect blood glucose levels, and therefore patients need to be aware of the carbohydrate values of the foods they consume. This is particularly important for those titrating their insulin.

One of the ways insulin titration is done is through ‘dose adjustment for normal eating’ (DAFNE) which was designed for those with type I diabetes and can contribute to an improved quality of life and satisfaction for patients. Research shows that patients on DAFNE treatment are less likely to be admitted to hospital with ketoacidosis or hypoglycaemia, and also the treatment can make huge cost savings for providers. It consists of a 38 hour training course delivered in a group session based around competency skills. The scheme is successful in promoting understanding of diabetes, awareness of implications regarding diet, and the skills and knowledge required to count carbohydrates and titrate insulin accordingly with the use of DAFNE algorithms.

Leg Ulcers

In venous leg ulcers, the incompetency of venous valves means there may be backflow in the veins of the lower leg which results in venous hypertension. This can cause fluid to accumulate in the tissues, developing oedema.

Brown haemosiderin staining is caused by the breakdown of red blood cells which become trapped in the skin. Induration occurs from fibrosis of the subcutaneous layer which may result in a classic ‘champagne leg’. Other venous symptoms are varicose eczema, oedema, ankle flare (distended veins in medial ankle area) pain (with relief on elevating the limb), varicose veins, ulcers in gaiter or malleolus regions.

Risk factors of venous ulceration are: DVT, varicose veins, swollen oedematous legs, multiple pregnancies, lower leg fracture, thrombophlebitis, previous leg ulceration, previous vascular or orthopaedic surgery.

Arterial signs include: reduced or absent pedal pulses, history of intermittent claudication, reduced ABPI, deep punched out ulcers on toes, heels or foot, necrosis or gangrene, loss of hair to the limb, shiny, pale hairless skin on shin, dusky coloured foot, cool to touch, thickened toe nails, pain in feet and blanching when elevated, delayed capillary refill.

Risk factors for arterial ulcers include ischaemic heart disease, smoking, hypertension, diabetes mellitus, TIA/CVA, MI or angina, rheumatoid arthritis or previous arterial surgery.

Compression bandaging used in treatment of venous leg ulcers is designed to aid venous return. Laplace’s law is that the pressure applied to the limb is determined by the width of the bandage, the degree of overlap and degree and technique of stretch applied (usually both 50%) but this is dependent on the ankle being smaller than the calf. Shortstretch bandaging is different in that it is applied at 100% stretch.

  • 80% of leg ulcers are venous
  • Venous ulcers are caused by chronic venous insufficiency; pooling in the leg leads to venous congestion, leading to fluid being forced out of the vessel and into the surrounding tissues as oedema.
  • Erythrocytes leaking through into the tissue can stain the leg, a symptom of chronic venous disease.
  • Oedema can also be caused or exacerbated by renal or cardiac conditions, and therefore their involvement needs to be ascertained as part of care planning.

The Forgetting: Alzheimers; Portrait of an Epidemic – David Shenk

A remarkably well-written book, as the author says, his intention was to: ‘on the one hand, catalogue the horrors of Alzheimr’s, and on the other, relay the hopeful story of the race to cure the disease,’ however, throughout the book, not only does he write about how the disease and the research into its cure progresses, but also how he changed his thinking as he immersed himself in the communities of sfferers, caregivers, and scientists. It’s a clever book, but it’s friendly and readable. It makes an interesting subject even more compelling.

Paediatric Febrile Seizures

These generally occur in children between the ages of 6 months and 5 years. They are associated with pyrexia in children without epilepsy or other cause, and without intercranial infection.
A simple seizure is characterised as generally tonic-clonic without focal features and usually lasting less than 15 minutes, and not recurring within 24 hours.
Complex febrile seizures last longer than 15 minutes, have focal symptoms and often recur within 24 hours. These sometimes may develop later into febrile status epilepticus. Sometimes anticonvulsants may be required such as lorazepam.