Question

HbA1c is a blood test used in the management of diabetes. Describe what this test identifies.     

Describe how HbA1c levels might help a registered nurse or diabetes educator manage a patient’s diabetes.

List 4 signs and symptoms of acute respiratory distress.

Describe four (4) nursing interventions in the direct post-angiogram period for a patient who had an angiogram via the right radial artery.   

  

Answer 1

HbA₁C : The redcells of normal human adults and children above the age of 6 months contain three genetically determined heamoglobin species HbA,HbA2 and HbF, these three species represent the total heamoglobin content of redcells,

- Besides these heamoglobins, redcells contain other heamoglobin variants, these represented as HbA1a, HbA1b and HbA1C of the total HB of red cells,

The role of HbA1C indicate that , it reflects the average blood sugar concentration for an extended time period (6 to 8 weeks) and that it remains unaffected by the short term fluctuations in blood sugar level.

- The determination of HbA1 helps in evaluating the adequacy of diabetic control in the prevention of various diabetic complications,

- HbA1C levels may better reflect carbohydrate imbalance than fasting glucose concentration or GTT,

- Reference range of HbA1C is 5 - 8 %

How it helps for Health care professionals:

1. This can assist in differentiating perioperative stress hyperglycaemia from Undiagnosed diabetes,

2.helpful in determining what therapy is required,

3. Evaluating renal function is also recommended given the increased prevalence of renal disease in diabetes,

4. Cardiovascular risk stratification may require other evaluations,

5. Useful in uncontrolled diabetes that change of medication.

6. Easily identified that low levels indicate in patients with haemolytic disease or other conditions with shortened RBC,

7. High levels reported in Iron deficiency anemia, probably because of old erythrocytes.

Signs and Symptoms of ARDS: Essential of diagnosis is : Acute onset respiratory Failure ,

- Bilateral radiographic pulmonary opacities,

- respiratory failure not fully explained by heart failure or volume overload,

- ratio of partial pressure of oxygen in arterial blood to fractional conc of inspired oxygen with PEEP.

Signs and symptoms:

1. Dyspnea,

2. Labored breathing,

3. Tachypnea,

4. Intercoastal retractions,

5. Pleural effusion,

6. Marked hypoxemia,

7. Many patients with ARDS demonstrate multiple organ failure particularly involving the kidney, liver,gut,CNS and CVS.

Nursing interventions Post angiogram: 1)Post procedural cannulation of any artery vessel but particularly those at risk for retro peritoneal bleed due to cannulation of femoral vessel,

2) Monitor the cardiac status note the vitals and enter into patient IP sheet,

3. Monitor for signs and symptoms of shock,

4. Access site complications ( bleeding, heamatoma, AV fistula, pseudoaneurysm and occlusion),

5. Proper wound care,

6. Periodic ECG considerations for any ventricular tachycardia or arrhythmia,

7. Counsel the patient about his condition and act according their subjective discussion.