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Postprocedural considerations

Immediate care

If a true abnormal blood glucose result is detected then the appropriate action should be taken according to medical advice and hospital policy.

Education of patient and relevant others

Diabetes mellitus is a longterm, often lifelong condition affecting all aspects of a person’s life. Ninetyfive percent of diabetes care is selfcare and all people with type 1 and type 2 diabetes should have access to selfmonitoring. The nurse has a role in educating and promoting selfmanagement of diabetes and advising patients on the type and frequency of monitoring based on individual clinical need so that patients can monitor and adjust their own treatment (Diabetes UK 2008). NICE and the Department of Health also recommend that people are given annual updates to ensure they are still able to perform tests accurately and learn about any new developments (DH 2008, NICE 2004, NICE 2008). Healthcare professionals should advocate a healthy lifestyle for patients with diabetes, including regulating blood pressure, lowsugar diet and exercise (NICE 2008).

Neurological observations

Definition

Neurological observations relate to the assessment and evaluation of the integrity and function of an individual’s nervous system (Rowley and Fielding 1991).

Anatomy and physiology

The nervous system coordinates all body functions, enabling a person to adapt to changes in internal and external environments. It has two main types of neurones: the conducting cells and neuroglia, the supportive cells.

The central nervous system

The central nervous system consists of the brain and spinal cord (Bickley and Szilagyi 2009).

The brain

The brain has four regions: the cerebrum, the diencephalon, the brainstem and the cerebellum. The cerebral hemispheres contain the greatest mass of brain tissue. Each hemisphere is subdivided into frontal, parietal, temporal and occipital lobes, as seen in Figure 12.26.

Figure 12.26 The brain.

Reproduced from Tortora and Derrickson (2009).

Each lobe has a particular function.

The frontal lobe is the primary motor area of the cerebrum which influences personality and abstract reasoning. It also controls the skeletal muscle influencing voluntary movement.

The parietal lobe is the primary sensory area which integrates the senses of touch and pain.

The occipital lobe integrates visual stimuli and is primarily responsible for sight.

The temporal lobe is responsible for olfactory (smell) and auditory (sound) areas (Clark 2005).

The spinal cord

This is a cylindrical mass of nerve tissue encased within the bony vertebral column, extending from the medulla to the first or second lumbar vertebra. It contains important motor and sensory nerve pathways that exit and enter the cord through anterior and posterior nerve roots and spinal and peripheral nerves. The spinal cord also mediates reflex activity of the deep tendon reflexes from the spinal nerves.

The spinal cord is divided into five segments: cervical, from C1 to C8; thoracic, from T1 to T12; lumbar, from L1 to L5; sacral, from S1 to S5; and coccygeal (Bickley and Szilagyi 2009) (see Figure 12.27).

Figure 12.27 External anatomy of the spinal cord and the spinal nerves (posterior view).

Reproduced from Tortora and Derrickson (2009).

The peripheral nervous system

The peripheral nervous system consists of the 12 pairs of cranial nerves and the spinal and peripheral nerves. Most of the peripheral nerves contain both motor and sensory fibres (Bickley and Szilagyi 2009).

The cranial nerves

Twelve pairs of special nerves called cranial nerves emerge within the skull or cranium. Cranial nerves II–XII arise from the diencephalon and the brainstem (see Table 12.9). Cranial nerves I and II are actually fibre tracts emerging from the brain. Some cranial nerves are limited to general motor or sensory functions, whereas others are specialized, producing smell, vision or hearing (I, II, VIII) (Bickley and Szilagyi 2009).

Table 12.9 The functions of the cranial