During a home visit, the client with diabetes mellitus tells the nurse that she is having a very difficult time obtaining blood for glucose monitoring. Which intervention does the nurse use to help the client maintain tight glycemic control?
1. Asks provider to order a different monitoring device
2. Instructs client to position the lancet on side of finger
3. Teaches client to find a good site and use it repeatedly
4. Tells client to run warm water over the hand before testing
2
2 and 1. The nurse eliminates all client-related factors that potentially interfere with glucose monitoring such as technique, dexterity, vision, or lack of knowledge. Re-gardless of the device being used for glucose testing, if the client has difficulty im-plementing the procedure, changing devices is potentially futile if the same mistakes are repeated. Thus, the nurse assists the client with proper lancet positioning on the side of the finger to obtain enough blood for glucose monitoring. If the client lacks experience with the lancet, has a long history of glucose monitoring that causes ac-cumulation of scar tissue at puncture sites, or avoids deep punctures because of pain, the client requires teaching to refine and reinforce the proper technique for obtaining a blood droplet.
3. Repeated use of a site increases the rate of scar tissue formation.
4. The nurse avoids suggesting warm water because clients with diabetes often have neuropathies and vasculopathies as complications of hyperglycemia, so the client is likely to have impaired tissue perfusion and sensation to extremities. The client cannot risk burning the skin because diabetics have impaired healing that increases the risk of infection and tissue loss from necrosis.
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