CPD reflective account ALAMY
hyperglycaemia, but more crucially to detect persistent hyperglycaemia, when the patient’s blood glucose level remains high 48 hours after stroke. Nurses should consider patients with persistent hyperglycaemia to be at increased rise of diabetes. Delayed hyperglycaemia, which occurs a few days after an acute stroke, is also associated with increased risk of diabetes.
Nutrition
Blood glucose and stroke A CPD article improved the care Lucy Ward can provide for patients who have recently experienced stroke I work in an emergency assessment unit, and have worked in several stroke units. Reading the CPD article updated my knowledge of the care of patients who have had a stroke, particularly in relation to blood glucose monitoring and management. I was aware that diabetes was a risk factor associated with stroke; nevertheless, it was interesting to learn that people with no history of diabetes are at risk of derangements in blood glucose in the acute phase of stroke. I was surprised to read that a poor outcome in ischaemic stroke and a greater risk of a transformation to haemorrhage following thrombolytic therapy may occur in one quarter of adults who do not have diabetes but who have a high blood glucose level when admitted. It was valuable to be reminded that in the emergency department evaluation of a person experiencing a stroke, assessment of blood glucose must precede initiation of intravenous thrombolytic treatment.
NURSING STANDARD
On the ward where I work, checking a patient’s blood glucose level is part of the admission process, regardless of diabetes status. However, if the result is within 4-11mmol/L and the patient is not diabetic or on steroids, or there is no acute clinical need, blood glucose monitoring is not regularly performed. This is despite international guidelines recommending that the blood glucose of people with acute stroke should be monitored frequently. It is important to check blood glucose regularly after acute stroke to detect transient
This reflective account is based on NS725 Laird E (2014) Blood glucose monitoring and management in acute stroke care. Nursing Standard. 28, 19, 52-56.
The associated risks of acute stroke and hypoglycaemia, because of reduced consciousness and oral intake, were described in the article. Because inadequate nutritional intake can compromise recovery from stroke, the nurse should perform swallow assessments to identify patients affected by dysphagia and have a care plan for patients who are unable to swallow safely or whose consciousness level is reduced. Having read the CPD article, I am more knowledgeable about the role and importance of blood glucose monitoring when caring for patients who have recently experienced stroke. I have also informed other members of the healthcare team about the importance of blood glucose monitoring when managing a patient with acute stroke to prevent hyperglycaemia and/or hypoglycaemia and the associated complications caused by extreme blood glucose levels NS Lucy Ward is a staff nurse at Jersey General Hospital in St Helier, Jersey
Write your own reflective account You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. Turn to page 51 for this week’s article and on page 62 you can find out how to present and submit your reflective account.
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hyperglycaemia, but more crucially to detect persistent hyperglycaemia, when the patient’s blood glucose level remains high 48 hours after stroke. Nurses should consider patients with persistent hyperglycaemia to be at increased rise of diabetes. Delayed hyperglycaemia, which occurs a few days after an acute stroke, is also associated with increased risk of diabetes.
Nutrition
Blood glucose and stroke A CPD article improved the care Lucy Ward can provide for patients who have recently experienced stroke I work in an emergency assessment unit, and have worked in several stroke units. Reading the CPD article updated my knowledge of the care of patients who have had a stroke, particularly in relation to blood glucose monitoring and management. I was aware that diabetes was a risk factor associated with stroke; nevertheless, it was interesting to learn that people with no history of diabetes are at risk of derangements in blood glucose in the acute phase of stroke. I was surprised to read that a poor outcome in ischaemic stroke and a greater risk of a transformation to haemorrhage following thrombolytic therapy may occur in one quarter of adults who do not have diabetes but who have a high blood glucose level when admitted. It was valuable to be reminded that in the emergency department evaluation of a person experiencing a stroke, assessment of blood glucose must precede initiation of intravenous thrombolytic treatment.
NURSING STANDARD
On the ward where I work, checking a patient’s blood glucose level is part of the admission process, regardless of diabetes status. However, if the result is within 4-11mmol/L and the patient is not diabetic or on steroids, or there is no acute clinical need, blood glucose monitoring is not regularly performed. This is despite international guidelines recommending that the blood glucose of people with acute stroke should be monitored frequently. It is important to check blood glucose regularly after acute stroke to detect transient
This reflective account is based on NS725 Laird E (2014) Blood glucose monitoring and management in acute stroke care. Nursing Standard. 28, 19, 52-56.
The associated risks of acute stroke and hypoglycaemia, because of reduced consciousness and oral intake, were described in the article. Because inadequate nutritional intake can compromise recovery from stroke, the nurse should perform swallow assessments to identify patients affected by dysphagia and have a care plan for patients who are unable to swallow safely or whose consciousness level is reduced. Having read the CPD article, I am more knowledgeable about the role and importance of blood glucose monitoring when caring for patients who have recently experienced stroke. I have also informed other members of the healthcare team about the importance of blood glucose monitoring when managing a patient with acute stroke to prevent hyperglycaemia and/or hypoglycaemia and the associated complications caused by extreme blood glucose levels NS Lucy Ward is a staff nurse at Jersey General Hospital in St Helier, Jersey
Write your own reflective account You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. Turn to page 51 for this week’s article and on page 62 you can find out how to present and submit your reflective account.
Visit the RCN Learning Zone The RCN Learning Zone is a FREE online service to help RCN members with their continuing professional development and professional portfolio management. The RCN Learning Zone can be found at www.rcn.org.uk/members/learningzone.php august 27 :: vol 28 no 52 :: 2014 61
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 26, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
