الفهرس 
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Abstract
Hypoglycemia is often defined by a plasma glucose concentration below 70 mg/dL; however, signs and symptoms may not occur until plasma glucose concentrations DROP below 55 mg/dL. Nursing staff are at the forefront of health service delivery, forming the largest group of healthcare professionals, and they play a pivotal role in the prevention, early detection and treatment of hypoglycemia in the hospital setting. Aim of study: - This study aimed to evaluate the effect of nursing-directed protocol on the occurrence of hypoglycemic episodes among patients at medical intensive care unit. Research hypothesis: Study subjects who exposed to nursing-directed protocol on hypoglycemic episodes’ occurrence will exhibit early detection of hypoglycemia, decreasing its episodes and complications compared to control group who does not exposed. Research design: A quasi- experimental research design was utilized to perform the study. Research settings: - This study was conducted at Medical Intensive Care Unit at Tanta Main University Hospital. Subjects and sample: - A purposive sample of 60 patients divided into two groups 30 in each in the above previously mentioned settings was selected. The subjects were divided into two groups: group I (Control group): Consisted of (30) patients had been received routine ICU care. group II (Study group): Consisted of (30) patients had been received a protocol of care as designed and implemented by the researcher. Subjects were selected according to the following criteria: Inclusion Criteria. •Adult patients aged 21 to 60 years. • Both sexes. • Newly admitted patients within 24 hours. •diabetes mellitus Tools of data collection: - Data were collected using the following tools: Tool (I): Patients Structured Assessment Tool. This tool was developed by the researcher, after reviewing of the related literatures. It consisted of two parts: Part (1): Socio-demographic Data of the Patients: It included; patient`s code, age, sex, marital status, level of education, occupation, duration of stay in intensive care unit, diagnosis, consciousness level, past medical and surgical history. Part (2): Patient`s Clinical Data: It included; duration of diabetes, risk factors associated with hypoglycemia, previous history of diabetes, prior episodes of severe hypoglycemia, delay in the timing of meals, glaciated hemoglobin A1c, hypoglycemia episodes, vital signs and drug history. Tool (II): Blood Glucose Measurements Flow Sheet Tool: It was composed of two parts: - Part (1): Capillary Blood Glucose Measurements: A blood sugar meter or device was being used for measuring capillary blood glucose level. Part (2): Glycemic Penalty Index (GPI) Tool: It was used to asses and compare different blood glucose control algorithms and evaluation of blood glucose control in the intensive care unit (ICU). Tool (III): Monitoring of Hypoglycemic Manifestations and its Complications among Critically Ill Patients: It comprised of two parts: Part (1): Hypoglycemic manifestation Assessment. It was used for monitoring sign’s and symptoms and complications of hypoglycemia such as sweating, facial pallor, shakiness/tremors, increased appetite, nausea, dizziness or lightheadedness, sleepiness, weakness, rapid heart rate, headache, tingling around mouth and tongue, difficulty seeing clearly, and bizarre behavior or personality changes. Part (2) : Complications Assessment Tool for Hypoglycemic Patients: It was used for monitoring complications of hypoglycemia such as seizure, loss of consciousness, dizziness, weakness, falls, injuries, greater risk of dementia in older adults, increase length of ICU stay, and death. The main findings of this study revealed that: The study revealed that, about two third (60 %) of the control group and near half (46.67%) of the study groups had age ranged from (50-60) years old with mean SD(52.577.380) in control group and (48.6310.447 ) in the study group. The study presented that, the mean period for diabetes duration of the control group was 8.806.088 year, and the study group was 10.405.170 year and two third (66.67%) of the control group and less than three quarter (70.00%) of the study group had episodes of sever hypoglycemia before. Regarding mean scored of vital signs of the studied patients, the study reveald that, there was no significant difference among patients of the control group and the study groups regarding heart rate and blood pressure on admission, post a week, post 2 weeks.Concerning level of consciousness of the studied patients, the study revealed that, there was a statistically significant difference between patients in the study group regarding level of consciousness on admission, post a week, post 2 weeks. In relation to blood glucose measurements, the study illustrated that, there was a statistically significant difference between patients in the control and study groups regarding blood glucose measurements on admission, post a week and post 2 weeks. Regarding hypoglycemic manifestations assessment, the study revealed that, there was a statistically significant difference between patients in the control and study group regarding hypoglycemic manifestations assessment on admission, post a week and post 2 weeks. Concerning complications assessment, the study showed that, there was a statistically significant difference between patients in the control and study groups on admission, post a week and post 2 weeks, and there was a statistically significant difference between patients in the study group on admission, post a week and post 2 weeks. Concerning correlation between monitoring of hypoglycemic manifestations and complications, the study reported that, that there was a high positive correlation was observed among the control group regarding the total monitoring of hypoglycemic manifestations and total monitoring of hypoglycemic complications on admission. Conclusion: Based on findings of the study, it can be concluded that: The study showed that, there was no significant difference among patients of the control group and the study group regarding heart rate and blood pressure on admission, post a week, post 2 weeks. While, there was a statistically significant difference between patients in the study group regarding level of consciousness, blood glucose measurements on admission, post a week, post 2 weeks. Also, there was a statistically significant difference between patients in the control and study group regarding hypoglycemic manifestations and complications assessment on admission, post a week and post 2 weeks. Additionally, there was positive correlation between hypoglycemic manifestations and complications on admission. Finally, concluded that, the nursing-directed protocol had positive effect on decreasing hypoglycemic episode by improving blood glucose level, reducing hypoglycemic manifestations and complications. The important recommendations inferred from the study results were: Studying hypoglycemic episodes more broadly in the nursing specialty. Replication of the same study on larger probability sample at different geographical locations for results generalizability. Future studies should target diverse populations in order to test whether similar factors are similarly important for occurrence of hypoglycemic episodes.