The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [493]
Postprocedure
9 Dispose of urine sample appropriately in either sluice or toilet. Dispose of urinalysis stick and gloves in correct wastage bin. Ensure cap to urine reagent strips is replaced immediately and closed tightly. To ensure strips are in airtight container according to storage guidelines. C
10 Wash and dry hands. To maintain infection control and prevent crossinfection (Fraise and Bradley 2009, E).
11 Document urinalysis readings and inform medical staff of any abnormal readings. To allow prompt action if change to treatment plan required (NMC 2009, C).
Action Figure 8 Compare urinalysis results and document results on appropriate forms.
Postprocedural considerations
When sending a urine specimen to the laboratory, check that the laboratory form is completed and that all relevant information is included. Take care not to contaminate the outside of the container or the request forms (Bishop 2008).
Reagent strips are a quick and easy method of testing urine and can provide valuable information about a patient’s condition. However, patients should be made aware that further tests and investigations may be required if the urine sample indicates any abnormality (Steggall 2007).
Blood glucose
Definition
Blood glucose is the amount of glucose in the blood (Brooker 2010). See Table 12.8 for normal target ranges, which are expressed as millimoles per litre (mmol/L) (NICE 2004).
Table 12.8 Normal target blood glucose ranges
Children ≤18 years of age Adults >18 years of age
Preprandial blood glucose levels 4–8 mmol/L Preprandial blood glucose levels 4–7 mmol/L
Postprandial blood glucose levels of less than 10 mmol/L Postprandial blood glucose levels of less than 9 mmol/L
Normally blood glucose levels stay within narrow limits throughout the day: 4–8 mmol/L. But they are higher after meals and usually lowest in the morning.
Anatomy and physiology
Blood glucose is regulated by insulin and glucogon. Insulin is synthesized and secreted from the beta cells within the islets of Langerhans found in the pancreas (Wallymahmed 2007). It is produced in response to high blood glucose levels (i.e. after meals) promoting the uptake and storage of sugar by fat and muscle tissue as glycogen (Crosser and McDowell 2007). Glucagon is secreted by the alpha cells in response to low blood glucose levels and results in the release of stored sugar back into the blood (Wallymahmed 2007). These processes maintain the blood glucose stability within the body (homoeostasis) (Crosser and McDowell 2007).
Diabetes mellitus (DM) is a heterogeneous disorder characterized by chronic hyperglycaemia due to lack of insulin or complete insulin deficiency or the body’s resistance to it (Blake and Nathan 2004, WHO 2006). There are two main types of DM: type 1 and type 2. Type 1 is believed to be triggered by an autoimmune process causing destruction of the beta cells in the pancreas, which produce insulin, resulting in complete loss of insulin production. Type 2 diabetes is characterized by a resistance to insulin (Thornton 2009).
People with type 1 or type 2 diabetes will have total or partial disruption to this normal metabolic regulatory system. Type 1 diabetes normally occurs in the younger population (Gillibrand et al. 2009) and means that they will need replacement injected insulin to compensate (Crosser and McDowell 2007). Type 2 diabetes is strongly linked to obesity, age and family history (Gillibrand et al. 2009) but can also be a result of steroid use and pancreatic cancer (Schwab and Porter 2007). Both these can result in hyperglycaemia (high blood glucose) which may cause degenerative changes affecting the kidneys, nerves and eyes (Wallymahmed 2007), resulting in blindness, renal failure and neuropathies. Further complications including coronary artery and peripheral vascular disease, stroke, renal disease, central and peripheral nerve damage, amputations and blindness are also serious consequences of uncontrolled blood glucose (Gillibrand et al. 2009, WHO 2006).
A diagnosis of diabetes can primarily