Effects of Hyperglycemia on Neurologic Outcome in Stroke Patients

Alison S. Paolino; Krista M. Garner

Disclosures

J Neurosci Nurs. 2005;37(3):130-135. 

In This Article

Nursing Considerations

Strict glycemic control in the ICU requires a collaborative effort from the entire medical team. Nurses play an important role in this process by identifying patients at risk for prolonged hyperglycemia. They must evaluate admission serum glucose levels and closely monitor elevated bedside glycemic levels when caring for critically ill patients, especially neurological patients. Prompt reporting of worrisome observations to the medical team can significantly improve outcomes.

Nursing responsibilities for patients receiving insulin include proper administration, assessment of patient response to insulin therapy, and education of patients and their families about insulin's administration, adjustment, and side effects (Lewis, Heitkemper, & Dirksen, 2000). ICU nurses also must report deviations from accepted parameters or the proactive approach to intravenous insulin therapy.

Nurses must educate themselves and their peers about hyperglycemia and its profound negative influence on outcomes. Resistance to improved therapies and new protocols or techniques usually stems from a fear of change or a lack of understanding. Newly developed plans of care often are viewed as laborious "busy work," with no clear recognition of the evidence-based approach. Educational speakers and in-services that address the importance of hyperglycemic management can help nurses improve the continuity and quality of care.

If glycemic levels remain elevated throughout the acute illness phase, patients should be transitioned to an oral or long-acting subcutaneous antihyperglycemic regimen. Patient education at this point is extremely valuable, especially when combined with outpatient resources and endocrinology referrals. Stroke patients requiring rehabilitation benefit from early nursing discharge planning and maintained glycemic management planning.

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