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Journal of Neuroscience Nursing:
doi: 10.1097/JNN.0b013e31819ed14b
CE Test

Performance Improvement Measures in Achieving Glycemic Control in the Acute Brain Injury Population

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Back to Top | Article Outline


GENERAL PURPOSE OF THE CE ACTIVITY: To describe the implementation of a glycemic control protocol, predicted upon evidenced-based research, in a 14-bed neuroscience trauma surgical intensive care unit.

LEARNING OBJECTIVES: After reading this article and taking this test, you will be able to:

1. Discuss a review of the literature regarding tight glycemic control in the critically ill.

2. Describe the methodology and results of the performance improvement measure presented and its implications for nursing practice.

1. Which statement about hyperglycemia is true?

a. Hyperglycemia in the critically ill is a concern only for patients with a past medical history of diabetes.

b. Hyperglycemia has not been researched in the medical patient population.

c. Hyperglycemia is an independent risk factor in both the surgical and medical patient populations.

d. Hyperglycemia in the critically ill brain-injured population is only significant in patients with comorbidities.

2. Tight glycemic control in the critically ill has been shown to

a. increase morbidity and mortality.

b. increase wound healing.

c. increase infection rate.

d. increase mechanical ventilation time.

3. In patients who have recently experienced major head injuries, hyperglycemia is associated with

a. brain tissue acidosis.

b. brain tissue alkalosis.

c. fluid retention.

d. loss of cardiovascular tonus.

4. According to Taylor et al. (2006), which statement about glycemic control protocols is true?

a. Physician-managed protocols are more effective than nurse-driven protocols.

b. Nurse-driven protocols are more effective than physician-managed protocols.

c. Nurse-driven protocols result in increased episodes of hyperglycemia.

d. Nurse-driven protocols led to decreased time spent on insulin infusions.

5. In the performance improvement (PI) measure described, tight glycemic control was defined as a whole blood glucose of

a. < 130 mg/dL.

b. 90 mg/dL to 130 mg/dL.

c. 90 mg/dL to 110 mg/dL.

d. 70 mg dL to 110 mg/dL.

6. A major concern for the PI measure was that

a. staff would not be able to recognize hypoglycemia.

b. staff would not be able to recognize hyperglycemia.

c. using the protocol would increase frequency of hyperglycemia.

d. staff would not recognize critical values.

7. Dangerously low values were reported in the performance improvement collection data

a. if glucose results were < 90 mg/dL.

b. when staff obtained a low value on a repeat test.

c. after obtaining a low value on a repeat test and verification by the APN.

d. only if adverse effects were noted.

8. According to the protocol, confirmation of low value results consisted of

a. retesting the glucose by using a glucometer.

b. retesting the glucose by drawing a venous sample.

c. either glucometer or venous sample.

d. simultaneous glucometer and venous sample.

9. According to Kinsley (2003), patients with a mean serum glucose range of 100-119 mg/dL had a mortality rate of

a. 9.6%.

b. 12.2%.

c. 37.5%.

d. 42.5%.

10. The protocol called for a continuous insulin infusion if

a. time on mechanical ventilation was expected to exceed 24 hours.

b. the patient had any glucose level > 150 mg/dL.

c. the patient had two consecutive glucose levels > 120 mg/dL.

d. the patient needed management of increased intracranial pressure.

11. Prior to use of the protocol, 25 gm of D50W was ordered for

a. all glucose levels < 70 mg/dL.

b. symptomatic glucose levels < 70 mg/dL.

c. symptomatic glucose levels between 70 mg/dL and 90mg/dL.

d. all glucose levels < 90 mg/dL.

12. The major barrier to strict glycemic control protocols in the critically ill brain-injured population is

a. inadequate numbers of glucometers.

b. the variation of glucose levels for arterial, capillary, and venous draws.

c. hypoglycemia.

d. hyperglycemia.

13. Implementation of a tight glycemic control protocol will result in cost savings related to all of the following except

a. reduced ventilator utilization.

b. reduced infections.

c. reduced time in critical care.

d. reduced supplies for monitoring glucose levels.

14. Limitations of this study included

a. the concurrent nature of the study.

b. the retrospective nature of the study.

c. inter-rater reliability for interpretation of hypoglycemic events.

d. lack of education provided to the clinical nursing staff.

15. Which statement about this protocol is true?

a. This study proved to have some safety concerns.

b. The nursing staff had difficulty recognizing the defined critical levels.

c. Further research is needed to determine the long-term effects on patient outcomes.

d. There was some difficulty in the follow-up for dangerously low hypoglycemic values.

16. According to the protocol, all of the identified patients have blood glucoses monitored every

a. 1 hour.

b. 4 hours.

c. 6 hours.

d. shift.

17. When transitioning from continuous insulin infusion to subcutaneous insulin, the protocol calls for

a. administering Lantus insulin at 10 PM.

b. stopping the insulin infusion at 8 AM.

c. treating blood glucoses >130 mg/dL with sliding scale coverage.

d. monitoring blood glucoses after each meal and at bedtime.

18. For the NPO patient with a blood glucose ≤ 40 mg/dL,

a. administer 12.5 gm of D50W by IV push.

b. administer 25 mL of D50W by IV push.

c. administer 25 gm of D50W by IV push.

d. administer 15 gm of glucose gel.

19. Which of the following is true about care of a patient on insulin drip?

a. Use 100 units of Aspart insulin in 100mL of D5W.

b. Use 100 units of regular human insulin in 100 mL of D5W.

c. Use 100 units of regular human insulin in 100 mL of normal saline.

d. Check blood glucose levels every 2 hours until stable.

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© 2009 American Association of Neuroscience Nurses