A female patient comes in OPD routine checkup. Her random blood sugar (RBS) level on 2 different occasion are 110 mg/dl and 113 mg/dl. On the basis of the RBS result the nurse would write what diagnosis in the patient record?

1. A

   HbA1c

2. B

   Diabetic

3. C

   OGTT

4. D

   Normal

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-2)

Explanation

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• The patient's random blood sugar (RBS) readings of 110 mg/dL and 113 mg/dL are within the normal range for a non-diabetic individual.
• A normal random blood glucose level is considered to be less than 140 mg/dL.
• Since the values do not meet the criteria for pre-diabetes or diabetes, the correct documentation is 'Normal'.
• The other options are either incorrect diagnoses or are names of other diagnostic tests.

Why Other Options Were Wrong

• Option A: HbA1c (Glycated Hemoglobin) is a specific blood test used to measure average blood glucose over the past 2-3 months. It is a diagnostic tool, not a diagnosis or a finding.
• Option B: A diagnosis of 'Diabetic' is incorrect. The diagnostic criterion for diabetes using a random blood sugar test is a level of 200 mg/dL or higher, typically with accompanying symptoms. The patient's values are far below this threshold.
• Option C: OGTT (Oral Glucose Tolerance Test) is a diagnostic procedure to test for diabetes or pre-diabetes. It is a test, not a diagnosis to be written in the patient's record based on RBS results.

Related Visual

• Visual 1: Chart 1: Diagnostic Criteria for Diabetes. A table comparing the blood glucose values for Normal, Pre-diabetes, and Diabetes categories across different tests (Fasting, Random, OGTT, and HbA1c). This helps visualize why the patient's values are considered normal.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Interpretation of Random Blood Sugar (RBS) results in the context of diabetes screening to guide bedside assessment, documentation, and the next nursing action.
• Nurses play a crucial role in screening for chronic diseases like diabetes. Correctly interpreting initial lab results is a fundamental skill.
• Accurate documentation is essential for continuity of care. Incorrectly labeling a patient as 'diabetic' can cause undue anxiety and lead to unnecessary tests and treatments.
• Patient education is key. The nurse should inform the patient that their results are normal but also provide general advice on maintaining a healthy lifestyle to prevent future health issues.

How to Approach the Question

• First, identify the key clinical data provided in the question: the type of test (Random Blood Sugar) and the results (110 mg/dL and 113 mg/dL).
• Recall the standard diagnostic criteria for diabetes mellitus, specifically the threshold for a random blood sugar test.
• Compare the patient's values to the established normal and diabetic ranges. The diagnostic threshold for diabetes via RBS is ≥200 mg/dL with symptoms. A normal RBS is <140 mg/dL.
• Evaluate the given options. Recognize that 'HbA1c' and 'OGTT' are names of tests, not diagnoses.
• Eliminate 'Diabetic' as the patient's values are well below the diagnostic threshold.
• Conclude that 'Normal' is the only option that accurately describes the patient's status based on the provided lab results.

Concept Tested & Keywords

• Concept Tested: Interpretation of Random Blood Sugar (RBS) results in the context of diabetes screening.
• Stem keywords: random blood sugar (RBS), 110 mg/dl, 113 mg/dl, routine checkup
• Lead-in keywords: what diagnosis
• Clinical cues: Patient is in for a routine checkup, suggesting they are likely asymptomatic.
• Clinical cues: Two separate occasions for the RBS test strengthen the reliability of the findings.

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Q-U5SCDwBP53TClF_ueftR

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