Hypoglycemia is low blood glucose. Patients who have diabetes may have episodes of hypoglycemia or hyperglycemia due to the body’s inability to produce or regulate insulin. Hypoglycemia is most likely to occur in diabetic patients due to the misadministration of insulin.
Hypoglycemia can also occur in patients who are not diabetic due to causes such as excessive alcohol use, malnutrition, and chronic conditions that affect the liver.
The symptoms of hypoglycemia include:
- Shakiness
- Hunger
- Headaches
- Pale color (Pallor)
- Sweating
- Palpitations
- Impaired vision
- Weakness
The brain requires glucose to function. If blood glucose levels fall, the brain stops working. This will result in loss of consciousness and changes in cognition. Untreated, symptoms can worsen and lead to seizures, coma, and death.
Despite a low blood sugar level, some patients may be asymptomatic. The severity of hypoglycemia and symptoms will drive treatment. It’s important to teach patients how to recognize and when to self-treat hypoglycemia. In a clinical setting, a 50% glucose intravenous (IV) solution is given to a patient who has seizures, is unable to eat, or has very low blood glucose levels. In the absence of an IV access, 1 mg of glucagon intramuscular (IM) is administered.
Nursing Process
The nursing assessment focuses on the patient’s physical and mental symptoms. A thorough history of dietary habits, comorbidities, and medications is also necessary.
Nursing interventions include health teaching about the following:
- Causes of hypoglycemia
- Need for diagnostic tests
- Recording and evaluation of symptoms
- Administration of antidiabetic medications
- Causes and prevention of hypoglycemia
- Reinforcing dietary advice and limitations
Nurses are essential in providing ongoing health education. Successful monitoring and patient education can reduce the incidents of hypoglycemia and its complications.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for hypoglycemia, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for hypoglycemia.
Acute Confusion
Acute confusion can result from hypoglycemia. Low blood glucose may cause a reversible loss of consciousness and confusion.
Nursing Diagnosis: Acute Confusion
Related to:
- Inadequate glucose for cellular brain function
- Malfunction of the vasomotor of the brain
As evidenced by:
- Changes in mentation
- Agitation
- Restlessness
- Alteration in the level of consciousness
- Alteration in psychomotor functioning
- Misperception
- Delirium
- Failure to initiate purposeful or goal-directed behavior
- Failure to follow commands
Expected outcomes:
- Patient will be alert and oriented x4, or at their baseline level of cognition.
- Patient will verbalize 3 symptoms of confusion and change in cognition to monitor for.
- Patient will not display a decrease in consciousness, restlessness, or agitation.
Assessment:
1. Determine additional risk factors for confusion.
Review the patient’s risk factors to determine if confusion is related to hypoglycemia or other conditions such as:
- Low levels of oxygen (hypoxia)
- Metabolic, endocrine, or neurological diseases
- Toxins, electrolyte imbalances
- Systemic or central nervous system infections
- Nutritional deficiencies
- Acute psychiatric disorders
2. Assess the patient’s mental status.
Changes in mental status can occur abruptly and progress over hours or days. The nurse should closely monitor for subtle changes.
3. Monitor the patient’s blood glucose level.
A change in mental status should always alert the nurse to obtain a glucose level. This is an easy and quick way to identify or rule out hypoglycemia.
Interventions:
1. Manage the underlying condition.
Confusion is a symptom of hypoglycemia. It is necessary to manage the underlying issue to resolve the confusion.
2. Review current medications and usage.
A review of current medications and usage is important, particularly for diabetic patients. The common cause of hypoglycemia is excessive insulin administration. Ensure the patient understands how and when to administer insulin.
3. Provide safety.
Worsening or unrecognized hypoglycemia can cause seizures or inappropriate behavior. It is the nurse’s responsibility to keep the patient safe in the event of a seizure and prevent the risk of injury through fall precautions.
4. Instruct on recognizing symptoms.
Educate the patient and family on changes that signal hypoglycemia. These can be individualized for each patient and take time to recognize. A change in personality such as irritability, forgetfulness, slurred speech, drowsiness can be symptoms.
5. Teach how to administer glucose.
In the hospital, the nurse can administer D50 IV to quickly treat hypoglycemia when the patient is not alert or oriented. Glucagon may be given IM and the family can be educated on its administration. If the patient is capable of swallowing safely, juice, milk, or glucose gel can be given.
Decreased Cardiac Output
Low blood glucose levels can lead to cardiac arrhythmias and reduced myocardial perfusion.
Nursing Diagnosis: Decreased Cardiac Output
Related to:
- Altered heart rate/rhythm secondary to increased sympathetic activity
- Decreased myocardial oxygenation
- Increased cardiac inflammation secondary to increased oxidative stress
- Increased afterload
- Increased/decreased preload
- Altered myocardial contractility
As evidenced by:
- Tachycardia
- Tachypnea
- Dyspnea
- Orthopnea
- Chest pain
- Reduced oxygen saturation
- Decreased central venous pressure
- Dysrhythmia
- Fatigue
- Anxiety/Restlessness
- Decreased activity tolerance
- Decreased peripheral pulses
- Decreased urine output
- Alterations in EKG results
Expected outcomes:
- Patient will manifest adequate cardiac output as evidenced by the following:
- Systolic BP within 20 mmHg of baseline
- Heart rate: 60 to 100 beats/min with a regular rhythm
- Respiratory rate: 12 to 20 breaths/min
- Strong peripheral pulses
- Patient will not demonstrate arrhythmia or dysthymias on EKG.
Assessment:
1. Monitor vital signs noting changes in vital signs.
With hypoglycemia, the workload of the heart temporarily increases, resulting in tachycardia, increased systolic BP, and a widening pulse pressure.
2. Monitor dysrhythmias.
EKG results associated with hypoglycemia show changes in ST waves and QT interval lengthening.
3. Evaluate weight trends.
Severe hypoglycemia is associated with a 68% increased risk of developing heart failure. Monitoring body weight provides sensitive information on fluid retention associated with heart failure.
Interventions:
1. Administer medications as ordered.
Severe hypoglycemia is associated with high mortality when combined with acute coronary syndrome (ACS). Patients with a history of stroke, heart failure, myocardial infarction (MI), or hypertension must adhere closely to their medication regimens. Treatment includes angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, anticoagulants, calcium channel blockers, and diuretics.
2. Assist in the conduct of diagnostic modalities.
- 12 lead ECG: a first-line diagnostic tool for diagnosing ACS or MI
- Imaging tests, i.e., echocardiography and MRI, provide a practical assessment of myocardial structural and functional abnormalities.
3 .Educate the patient about recognizing and managing hypoglycemia.
Ensure the patient understands the signs of hypoglycemia:
- Racing heart
- Shaking
- Sweating
- Anxiety
- Dizziness
- Hunger
And how to treat it:
- Suck on hard candies or glucose tablets
- Consume 4 oz of juice or regular soda
- Eat one tablespoon of honey or sugar
The patient should check their blood sugar 15 minutes after and continue to treat until glucose levels are within normal range.
4. Review the patient’s insulin administration.
Hypoglycemia is the most common side effect of insulin therapy. Ensure patients understand their insulin regimen, including proper dosage and when and how to administer insulin.
Deficient Knowledge
Deficient knowledge associated with hypoglycemia can be caused by misinformation or interpretations, or failure to recall correct information about hypoglycemia and its management.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Inadequate knowledge about hypoglycemia
- Lack of knowledge about the management of hypoglycemia
- Insufficient knowledge of self-care management
- Wrong information or interpretations
- Failure to recall correct information about hypoglycemia
As evidenced by:
- Development of hypoglycemia and complications
- Verbalization of concerns
- Inquiries about hypoglycemia and its management
- Misconceptions about hypoglycemia and its management
- Inaccurate or insufficient instructions in self-care
- Progress of preventable complications
- Nonadherence with treatment
- Incorrect demonstration of medication administration or glucometer use
Expected outcomes:
- Patient will be able to verbalize causes and symptoms of hypoglycemia and self-care management.
- Patient will be able to demonstrate 2 behavior and lifestyle modifications to prevent hypoglycemia.
Assessment:
1. Assess the patient’s knowledge level of hypoglycemia.
Patients’ awareness of hypoglycemia and self-care management affects outcomes. Have the patient teach back the causes of hypoglycemia and how it can be prevented and treated.
2. Establish the patient’s capacity, readiness, and learning obstacles.
Ensure the patient is willing, motivated, and capable of learning. Provide information in several forms at their level of education.
3. Recognize avoidance cues.
Avoidance may occur as a result of a diagnosis of a lifelong condition. It can be difficult for patients to accept information if they are in denial.
Interventions:
1. Identify the patient’s motivating elements.
Recognize the patient’s motivating elements, which can be either positive or negative. Identify specific goals to motivate the patient to seek information and succeed.
2. Provide facts about hypoglycemia and its management.
Listen to the patient’s concerns and personal barriers causing poor glycemic control. Patients may need information explained in a different way or reiterated in small chunks.
3. Encourage using positive reinforcement.
Reinforcement can promote new skills or behavior modification. Positive feedback inspires continued attempts to control blood glucose levels. Avoid using punishment (e.g., criticism, threats) as this will further discourage the patient.
4. Consult with a diabetes educator.
Diabetes educators are a wealth of knowledge, especially for newly diagnosed patients. They can assist the patient with bridging education gaps and teaching new ways to understand their complex disease.
Ineffective Tissue Perfusion
Consistently low blood glucose levels cause poor blood flow to the brain and other organs.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Impaired oxygen transport
- Decreased nutrients to the tissues
- Insufficient knowledge of hypoglycemia and its management
As evidenced by:
- Changes in the level of consciousness
- Anxiety
- Paresthesia
- Tremors
- Palpitations
- Hunger
- Nausea
- Diaphoresis
- Headache
- Blurred vision
- Agitation
- Seizures
Expected outcomes:
- Patient will maintain optimal perfusion as evidenced by the following:
- Absence of changes in the level of consciousness
- No alterations in sensation
- Palpable peripheral pulses
- Absence of palpitations
- Patient will maintain a glucose level above 70 mg/dL.
Assessment:
1. Monitor the level of consciousness.
The brain is highly dependent on glucose. Decreased blood glucose levels below 50 mg/dl trigger a cascade of abnormal cellular metabolism in the CNS leading to changes in consciousness and orientation.
2. Assess causative and contributing factors.
Identifying the underlying condition causing hypoglycemia can prevent further deterioration in perfusion.
Hypoglycemia may also be caused by:
- Malnutrition or starvation
- Cirrhosis
- Sepsis
- End-stage renal disease
- Advanced heart failure
- Adrenal insufficiency
- Inappropriate insulin use
- Dumping syndrome
- Medications (some antibiotics, sulfonylureas, beta-blockers, indomethacin, etc.)
Interventions:
1. Draw blood for a plasma glucose level.
If hypoglycemia is suspected, yet the patient is not diabetic or taking antidiabetic medications, a plasma glucose level should be assessed. A result of < 55 mg/dL with symptoms that respond to dextrose or another glucose source diagnoses hypoglycemia.
2. Administer SQ glucagon or IV dextrose.
If oral methods of glucose are ineffective, glucagon or IV dextrose is beneficial for both diabetic and non-diabetic patients.
3. Administer medications for non-diabetics.
Patients with hypoglycemia not related to diabetes may need medications such as acarbose or diazoxide. Acarbose prevents reactive hypoglycemia, while diazoxide inhibits insulin release.
4. Teach methods to prevent hypoglycemia.
Depending on the underlying cause, the patient may benefit from the following strategies:
- Eat smaller, more frequent meals
- Eat a carbohydrate-rich snack at bedtime
- Do not fast
- Avoid or take caution with alcohol
- Choose complex carbs with fiber and protein
Risk for Unstable Blood Glucose Level
Risk for unstable blood glucose levels can be applied to patients who have difficulty maintaining normal glucose levels, resulting in hypoglycemia and other health conditions.
Nursing Diagnosis: Risk for Unstable Blood Glucose
Related to:
- Denial of the diagnosis
- Inadequate knowledge of diabetes management
- Excessive stress
- Nonadherence to diabetes treatment plan
- Insufficient blood glucose monitoring
- Inappropriate insulin administration
- Deficient dietary intake
- Excessive weight gain or loss
- Pregnancy
- Excessive exercise
Expected outcomes:
- Patient will be able to maintain glucose levels within normal limits.
- Patient will be able to verbalize knowledge of energy requirements.
- Patient will be able to modify behavior and lifestyle to maintain blood glucose levels within normal limits.
Assessment:
1. Identify risk factors.
Causes of glucose fluctuations include the following:
- Chronic conditions causing poor glucose control
- Eating disorders (such as morbid obesity)
- Exercise habits
- Adolescent growth spurts
- Pregnancy
- Side effect of anti-diabetic medication
- Stress
2. Assess perceptions and cultural impacts.
The patient’s dietary habits, medication adherence, and perception of their illness may be influenced by cultural or religious beliefs.
3. Assess the patient or caregiver’s ability to use their glucose monitoring device.
Proper supplies, technique, and equipment can impact the accuracy of the results. Have the patient or family member demonstrate how they use their glucometer.
Interventions:
1. Educate on diet and exercise requirements.
Help the patient recognize the need for increased food for energy when partaking in exercise or physical activities to prevent a drop in glucose.
2. Help the patient recognize occasions that contribute to hypoglycemia.
Missed meals, illness/infection, overdoses of insulin, weight changes, stress, and more can contribute to low glucose levels.
3. Provide health teaching about the patient’s antidiabetic medications.
Provide education to help the patient understand how their medications work. Ensure they are administering the medication correctly, in the correct dose, and at the correct time.
4. Inform of complications and consequences.
Unstable glucose levels damage blood vessels and harm organ systems. Long-term complications can include kidney disease, eye problems, and heart conditions.
References
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