NAME____________________________



-228600-11430000NAME ____________________________DATE _____/_____/_____SKILL PERFORMANCE EVALUATIONMEDICATION ADMINISTRATIONFINGER STICK BLOOD GLUCOSE TESTING PERFORMANCE OBJECTIVESDemonstrate proficiency in recognizing the indications, contraindications, and criteria for administration of oral glucose administration and finger stick blood sugar testing for a patient having an altered level of consciousness and a suspected history of diabetes. EQUIPMENTSimulated patient, oxygen tank with a flow meter, oxygen mask, blood pressure cuff, stethoscope, glucometer, lancets, tongue blade or bite stick, timing device, clipboard, PCR forms, pen, goggles, masks, gown, gloves, sharps container.SCENARIO: _________________________________________________________________________________________262890019685PASS00PASS354330019685FAIL00FAILEXAMINER(S):______________________Attempt:1st2nd3rd (final) PREPARATIONPerformance CriteriaYESNOCommentsEstablishes appropriate BSI precautions PROCEDUREPerformance CriteriaYESNOCommentsCompletes primary assessment:Completes a secondary survey ANDObtains VSPrepares to obtain a blood glucose levelVerbalizes the indications for finger stick blood glucose testingALOC with suspected hypoglycemiaUnconscious with suspected history of diabetesVerbalizes the signs and symptoms of hypoglycemiaRapid onsetCool, moist skinsTachycardiaALOCPallorSeizuresWeakness/paralysis on one (1) sideVerbalizes the signs and symptoms of hyperglycemiaKussmaul respirationsFruity odor to breathTachycardiaPolydipsiaPolyphagiaPolyuriaVerbalize the normal and abnormal low blood glucose levels:Normal - 70-120mg/dLLow - <60mg/dLHigh – 120mg/dLPerformance CriteriaYESNOCommentsCalls for an Advanced Life Support UnitPrepares the equipment required for blood glucose determination by following the manufacturer’s directionsPROCEDUREPerformance CriteriaYESNOCommentsTurns on the glucometerEnsures the device has been calibratedPlaces hand in dependent position for 10-15 secondsGrasps the patient’s finger Cleanses site using aseptic technique from inner to outerPunctures the lateral aspect of the fingertip with a single use lancet deviceSqueezes the fingertip gently to form a drop of bloodWipes away the first drop of blood using a 2 X 2 dressing or cotton ball Gently re-squeezes the fingertip to form a drop of blood – if necessaryScenario dependentPlace the blood into the glucometer using the device-specific receptacle at the appropriate time. Interprets the results of the blood sugar testing from thedeviceAdministers oral glucose – if indicatedScenario dependentApplies a sterile adhesive bandage on the finger stick siteDispose the lancet and test strip into a sharps containerADDITIONAL CRITERIAPerformance CriteriaYESNOCommentsMade appropriate decisions based upon reassessment findings and response to interventionsGave appropriate report to equal or higher level of care personnelPerformed procedure in a safe and appropriate mannerDeveloped: 1//2018 Rev 3/2018 ................
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