Special Investigation of Pancreatic Disorder

Subject: Medical and Surgical Nursing I (Theory)

Overview

A glucose tolerance test measures how well your body is able to break down glucose, or sugar. The test can take place in your physician’s office or a local laboratory. When you arrive, they will take a small sample of blood and a urine sample. The kit for this test includes a gold topped serum blood tube, a plastic bag in which the blood tube need to be sealed, a request form and a pre-paid envelope for sending the sample to the laboratory.Before preparing insulin, verify the dose and type of product recorded in the clinical notes.Once the pen is in use there is no requirement for refrigeration, but it should not be stored above 30°C. Recommended sites are buttocks, abdomen, thigh, lateral aspect of arm.

A glucose tolerance test checks how well your body can break down glucose, which is another name for sugar. If a person has (type 1) diabetes, it's because their bodies aren't producing enough insulin to properly metabolize glucose. As well as diagnosing (type 2) diabetes and gestational diabetes, this test is also used to detect the existence of both. If a woman who does not normally have high blood sugar levels experiences this condition during pregnancy, we call this gestational diabetes.

How to get ready for a Glucose Tolerance Test ?
For the glucose tolerance test,  you should do the following things:

  • Eat normally in the days preceding the test.
  • Discuss all medications you are taking with your doctor. Antidepressants and beta-blockers, for example, can skew the results (Pagana).
  • Don't eat or drink anything (even water) eight hours before the test. It is fine to drink water, but anything besides that should be avoided in case it messes with the results.
  • You should not urinate too soon before the procedure because a sample may be required.
  • In the event thatneedll be need to wait, it is recommended that you bring something to occupy your time.
  • In the event that you will need to wait, it is recommended that you bring something to occupy your time.

Things done during the overall test 
The test can be performed in either your doctor's office or a nearby laboratory. As soon as you check in, they'll prick your finger to draw blood and collect a urine sample to analyze.

Following the collection of blood, you will be given a highly concentrated glucose solution to consume within a certain time frame (usually five minutes). Sit in the waiting room until your glucose levels are checked again after this. After an hour has passed, a blood sample will be taken for those doing the 50-gram or one-hour test. Blood samples will be taken hourly for two hours if you are taking the 75-gram test. The 100-gram test, often known as the three-hour test, entails having blood drawn once an hour for three consecutive hours.

The following are considered normal ranges for glucose levels:

  • Test for 50 grams in one hour: 140 mg/dL or less
  • #75-gram (two-hour test): less than 200 mg/dL after one hour; less than 140 mg/dL after two hours if fasting
  • For the 100-milligram test, acceptable ranges are as follows: less than 95 mg/dL in the fasting state; less than 180 mg/dL after 1 hour; fewer than 155 mg/dL after 2 hours; and less than 140 mg/dL after 3 hours.
  • Evaluation of T3, T4, and TSH in Blood
  • One can determine thyroid health using a free or total triiodothyronine (T3) blood test. The primary reason for requesting this test is to confirm the presence of hyperthyroidism, but it is also used to track the progress of treatment for people who already have a thyroid condition.
  • The thyroid gland generates two hormones, T3 and T4 (thyroxine). By regulating the body's energy expenditure, they serve as a feedback mechanism.
  • Thyroid stimulating hormone (TSH) promotes T4 (mainly) and T3 synthesis and secretion. The liver and other tissues can convert T4 to T3 as needed.
  • The majority of T4 and T3 in the bloodstream are attached to proteins, whereas only a fraction are free to circulate (not bound). Total T4 (free plus bound), total T3 (bound plus unbound), and free T3 are all possible results from a blood test.
  • While changes in total T3 can be altered by changes in protein levels and protein binding ability, changes in free T3 are not. Either test can be used to evaluate thyroid health, while some standards choose the total T3 instead. Graves disease, the most frequent cause of hyperthyroidism, is an autoimmune disorder, and thyroid antibodies are often requested alongside measurements of free T3 and total T3 to aid in making a diagnosis.
  • If the TSH is abnormal, a doctor will likely order a free or total T3 test next.

Sample of test 

Blood samples are used for this test.

Kit

This test kit comes complete with everything you need to send in your sample to the lab: a gold-topped serum blood tube, a plastic bag to seal the tube in, a request form, and a postage-paid envelope.

Instructions

When you get your blood drawn, use a tube specifically for that purpose, and label it with your full name and birth date. Verify that the information on the form is valid. To send the samples in the pre-paid envelope, place them in the plastic bag and tape the top shut. Please include the sample request form with your sample submission.

Aside from T4, T3 levels should be checked in patients who are receiving T3 as part of a thyroid supplement. Given that T3 is processed significantly more quickly than T4, patients should schedule blood tests for between 4 and 6 hours after taking their morning dose. Make sure the morning dose coincides with the appointment if possible. In order to communicate the results of the test and my comments and ideas for management with your primary care physician, I will need to know his or her contact information as well as any diagnoses that you may have received. Do not forget to take your regular dose of thyroid hormones on the day of testing if you are already taking them.

Insulin and blood sugar levels during fasting (pp and random)
Normal levels of glucose in the blood while fasting are below 100 mg/dL (5.6 mmol/L). If your fasting blood sugar is between 100 and 125 mg/dL (5.6 and 6.9 mmol/L), you may be at risk for developing type 2 diabetes. If it's been measured as 126 mg/dL (7 mmol/L) or above on two separate occasions, you likely have diabetes. The glucose tolerance test is performed orally.

The level of glucose in your blood can be "snapped" at any time of day. In most cases, your doctor will only need a few drops of blood from a fingerstick, though they may instead draw blood from an arm vein.

Unusually Normal Blood Glucose Levels

When you fast (don't eat for eight hours), your blood sugar level should be between 70 and 99 mg/dL.
Two hours after eating, a healthy blood sugar level is less than 140 mg/dL.
Calorie expenditure at rest
How much energy a person uses while at rest in a non-exerting, post-absorptive state, in a neutrally-temperature environment is known as their basal metabolic rate (BMR) (meaning that the digestive system is inactive, which requires about twelve hours of fasting).

Examination of the thyroid and urinalysis

  • In order to diagnose the aforementioned medical issues, a urinalysis is performed, which includes chemical, microscopic, and visual analyses to detect cells, cell fragments, and compounds like crystals or casts in the urine. It has the ability to pick any irregularities that might need further examination or testing. People may not notice they have a problem until abnormal amounts of protein or glucose start showing up in their urine.
  • Thyroid scans are a type of nuclear medicine imaging exam that looks at the thyroid gland by tracking its activity with radioactive iodine. A radioactive iodine uptake test is commonly performed in conjunction with this one.
  • Insulin injections under the skin should be done in very careful manner
  • Before manufacturing insulin, it is important to double-check the reported dose and product type in the patient's clinical notes and, if necessary, verify this information with the patient and his or her caregivers. If you're administering insulin, double-check the dose with a reliable third party every time.
  • Regular and occasional insulin (bolus) doses are administered using only commercially available insulin pen devices at GOSH. Because of the potential for infection, pen devices and cartridges are intended for usage by only one person at a time.
  • Make sure you've checked your blood sugar.
  • Use aseptic and touchless procedures to prepare and assemble the pen's needle (ANTT). Needles in pens should be used just once before being properly disposed of away.
  • Before each injection, you must first take an air shot. Taking an "air shot" entails exposing the needle to air by removing the needle's cap and turning the dose dial on the pen up to 8 units before the first use and 2 units before each consecutive shot. To reset the dial to zero, release the plunger into the air. If no insulin is expelled during the air shot, you will need to try again.
  • Adjust the dose on the pen to the number of units your doctor has ordered.
  • Independently double-check the insulin injection using the high-risk medication protocol.
  • (Before giving insulin, make sure the patient's name, DOB, and hospital number match those on the prescription and the name band. Also, double-check for allergies.)


SUGGESTIONS FOR INJECTION LOCATIONS

  • Abdomen
  • When rapid absorption is a priority.
  • Muscle activity and exercise might have less of an effect on it.
  • Thigh (front or lateral aspect) (front or lateral aspect)
  • location favored for insulins with a longer half-life.
  • Buttocks
  • Small children and people who have lost a lot of weight are candidates.
  • Arm's lateral side
  • Because an intramuscular injection is more likely and may cause bruising, it should not be used in very young children who have minimal subcutaneous fat.
  • Insulin pen storage

When first purchased, keep insulin pens in the refrigerator (2-8 degrees Celsius) rather than the freezer. After using the pen, there is no need to refrigerate it, but you shouldn't keep it at temperatures higher than 30 degrees Celsius either. The shelf life of most pen and cartridge brands is between four and six weeks.

Intravenous cortisone injections

In most cases, the doctor will decide how much cortisone to give a patient based on the severity of their condition. Two different routes of administration are used together (for instance, oral and intra-articular injection for rheumatoid arthritis) or switched back and forth in the treatment of certain diseases (e.g. orally and by inhalation for asthma).

References

www.sandiegowaltz.org/176181/lilly-diabetes-webcast/
pregnancylane.com/glucose-tolerance-test-pregnancy-100-gram/
https://es.scribd.com/doc/208497493/Preparing-for-a-Glucose-Tolerance-Test
http://www.blogarama.com/health-fitness-blogs/376664-signs-diabetes-blog/5600981-glucose-tolerance-test
lbltrip.wikispaces.com/file/view/Bell+ringer.docx/567244249/Bell+ringer.docx
www.alcalalabs.com/blood freetotal t3.html
www.planetayurveda.com/glucose-tolerance-test.htm
https://newcenturylabs.com/product/t3-total/
Author: Mandal, G. As of this writing (August 2013). Towards a Conceptual Framework for Adult Health Nursing Education (2nd ed.). Dilllibazar, Kathmandu: Makalu Publishing House. Obtainable as of August, 2013
imgac.com/tag/somanytests

 
Things to remember
  • A glucose tolerance test measures how well your body is able to break down glucose, or sugar. 
  • A normal fasting (no food for eight hours) blood sugar level is between 70 and 99 mg/dL
  • A normal blood sugar level two hours after eating is less than 140 mg/dL
  • Different brands of pens/cartridges have an in-use expiry of between 4–6 weeks.
  • Insulin pens should be refrigerated initially (2–8°C) away from the freezer section. 

  • The free or total T3 test is usually ordered following an abnormal TSH.

     

Questions and Answers

How well your body can digest glucose, sometimes known as sugar, is determined through a glucose tolerance test. Diabetes (type 1) patients struggle to digest glucose because their bodies are unable to produce enough insulin. Additionally, type 2 diabetes and gestational diabetes are both detected using this test. When a pregnant woman who is not diabetic develops high blood sugar levels as a result of the pregnancy, this is known as gestational diabetes.

 

Glucose tolerance test (GTT):

How well your body can digest glucose, sometimes known as sugar, is determined through a glucose tolerance test. Diabetes (type 1) patients struggle to digest glucose because their bodies are unable to produce enough insulin. Additionally, type 2 diabetes and gestational diabetes are both detected using this test. When a pregnant woman who is not diabetic develops high blood sugar levels as a result of the pregnancy, this is known as gestational diabetes.

There are some things you need to do to prepare for the glucose tolerance test:

  • In the days preceding the test, keep eating normally.
  • If you are currently taking any medications, discuss them with your doctor. Some drugs, including beta-blockers and antidepressants, can affect the outcomes (Pagana).
  • Eat nothing for at least eight hours before the exam time. Water is okay, but stay away from other drinks because they might affect the outcome.
  • Avoid using the restroom right before the procedure in case a urine sample is required.
  • Bring a book or something to do to pass the time while you wait.

During the Test

The test can be performed in a nearby laboratory or in your doctor's office. When you come, they will take a urine sample and a little sample of blood. You will be required to consume a highly sweet and concentrated glucose solution within a predetermined time frame following the drawing of a blood sample (usually five minutes). You will then be requested to wait until another glucose test is conducted in the waiting area. They will take a blood sample from you if you are taking the 50-gram or one-hour test after an hour. They will take a blood sample every hour for two hours if you are taking the 75-gram or two-hour test. They will take a blood sample every hour for three hours if you are taking the 100-gram or three-hour test.

Normal glucose levels are:

  • #50-gram (one-hour test): 140 mg/dL or below.
  • #75-gram (two-hour test): levels during fasting range from 60 to 100 mg/dL; at one and two hours, they are both below 140 mg/dL.
  • Fasting levels should be less than 95 mg/dL; one-hour levels should be less than 180 mg/dL; two hours should be less than 155 mg/dL; and three hours should be less than 140 mg/dL.
  • Blood analysis T3, T4, TSH

To evaluate thyroid function, a free or total triiodothyronine (free T3 or total T3) test is employed. It may also be requested to help monitor the therapy of a person with a known thyroid problem. It is primarily ordered to help detect hyperthyroidism. The thyroid gland produces the hormones T3 and T4 (thyroxine). They are governed by a feedback system and aid in regulating the body's rate of energy use. Thyroid-stimulating hormone (TSH) promotes the release of T3 and T4—primarily—and the synthesis of T4. The liver and other tissues turn T4 into T3 as needed. The majority of T4 and T3 circulate in the blood attached to proteins, with only a small amount free. Blood tests can detect free T3, total T4 (bound plus unbound), total T3 (bound plus unbound), and total T4 (unbound plus bound).

Since the majority of T3 is protein-bound, factors like protein concentration and protein-binding capacity can have an impact on total T3, but not on free T3. Nevertheless, total T3 is advised by some professional standards, therefore either test can be used to evaluate thyroid function. To diagnose Graves disease, an autoimmune disorder that is the most common cause of hyperthyroidism, free T3 or occasionally total T3 may be ordered in addition to thyroid antibodies. Typically, a free or total T3 test is requested after a TSH that is abnormal.

Sample:

An examination of a blood sample is conducted.

Kit:

A gold-topped serum blood tube, a plastic bag in which the blood tube must be sealed, a request form, and a pre-paid envelope for sending the sample to the lab are all included in the kit for this test.

Instruction:

Make sure your name and birthdate are legibly written on the blood tubes before having your blood drawn and placed in them. Verify your information is accurate on the request form. Before mailing the samples in the pre-paid addressed envelope, place the samples in the plastic bag and seal the top. Please be sure to include the request form with the samples when sending them.

T3 levels should be checked in addition to T4 in any patients who are taking T3 as part of their thyroid supplement. Since T3 is metabolized considerably more quickly than T4, blood tests should be performed 4-6 hours after the morning dose. Make adjustments to the dose time if the appointment does not coincide with the morning dose. Please provide me with your GP's contact information as well as any diagnoses you have received so I can write to your GP with the test results, my observations, and management recommendations. Please let me know the dosage if you are already taking thyroid hormones; you must take your regular dose on the day of the test.

Blood sugar fasting blood sugar (pand random): It is normal to have fasting blood sugar less than 100 mg/dL (5.6 mmol/L). Prediabetes is defined as having a fasting blood sugar level between 100 and 125 mg/dL (5.6 to 6.9 mmol/L). You have diabetes if it is 126 mg/dL (7 mmol/L) or above on two different tests. test for oral glucose tolerance. To obtain a "snapshot" of the blood glucose level, a random test is performed at any moment. In most cases, this can be determined from a few drops of blood drawn with a simple fingerstick; nevertheless, your doctor may choose to draw blood from an arm vein.

Normal Blood Sugars:

  • A typical fast (no food for eight hours) The range of blood sugar is 70 to 99 mg/dL.
  • Less than 140 mg/dL is the normal blood sugar level two hours after eating.
  • Metabolic rate at rest

Basal metabolic rate(BMR): It is the quantity of energy used up while at rest and in the post-absorptive state in a neutrally temperate atmosphere (meaning that the digestive system is inactive, which requires about twelve hours of fasting).

Urinalysis / Thyroid scan: Urinalysis is a process that involves a number of chemical, microscopic, and visual tests to identify cells, cell fragments, and other materials like crystals or casts in the urine that are linked to the numerous illnesses mentioned above. It can spot irregularities that can call for more research and testing. It's common for substances like protein or glucose to start showing up in urine before people realize they might have a problem. A thyroid scan is a nuclear medicine procedure that looks at the structure and operation of the thyroid gland using a radioactive iodine tracer. A radioactive iodine uptake test is frequently performed in conjunction with this test.

Administration of subcutaneous insulin:

  • Before preparing insulin, double-check the dosage and product type listed in the clinical notes, and if necessary, confirm the information with the patient and his or her caregivers. Before administering insulin, always make sure to double-check the dosage independently.
  • Only commercial insulin pen devices are used at GOSH for both routine and one-time (bolus) doses of insulin. Due to the possibility of cross contamination, pen devices and cartridges are only intended for single user use.
  • Verify a blood glucose test has been performed. Consult the GOSH Blood Glucose Monitoring guideline, please.
  • Utilizing the principles of the Aseptic and NonTouch Technique, prepare and assemble the needle on the end of the pen. Pencil needles ought to be used just once and discarded properly.
  • Each and every injection must be preceded with an air shot (Rationale 2). An "air shot" is administered by removing the needle's cap and exposing it to air, then increasing the dose dial on the pen by eight units the first time you use it and by two units each time after that. Until the dial reaches zero once more, thrust the plunger into the air. Repeat this process if no insulin emerges from the needle after the air shot.
  • Adjust the pen's dosage setting to the recommended number of units.
  • Utilizing a high-risk medication, independent double check process, examine the insulin for administration.
  • Check for allergies and make sure the name, date of birth, and hospital number on the medication prescription match the information on the patient's identification name band before administering insulin.

Recommended Injection Sites:

  • Abdomen:
    • Favored location when a quicker absorption is needed.
    • The effects of exercise or muscular movement might be less pronounced.
  • Thigh (front or lateral aspect):
    • The preferred site for longer-acting insulin types' slower absorption.
  • Buttocks:
    • To be taken into account in patients who have lost a lot of weight, especially young children.
  • Lateral aspect of arm:
    • ​​​​​​​Small children with little subcutaneous fat shouldn't receive the injection because an intramuscular injection is more likely and could result in bruising.

Storage of insulin pens:

Initial storage of insulin pens should be in the refrigerator (2-8°C) away from the freezer section. The pen doesn't need to be refrigerated once it's in use, but it shouldn't be kept over 30 degrees. The shelf life of various brands of pens and cartridges ranges from 4-6 weeks while in use.

Administration of cortisone therapy:

The decision by the doctor to administer cortisone is largely based on the patient's illness and that decision. For certain diseases, two modes of administration are combined (e.g. orally and intra-articular injection for rheumatoid arthritis) or alternated (e.g. orally and by inhalation for asthma).

 

 

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