Reflective account of clinical incident - Essay Example

Reflective Practice of a Clinical Incident Reflective practice is an excellent tool to learn and acquire clinical skills. It provides a retrospective review of the clinical incident and experience and questions the reason for the actions done. The clinician gets an opportunity to assess, assimilate, understand, analyze, evaluate and learn from the clinical experience. There are many models which can be used for reflective practice. Common ones are Gibb's cycle of reflection and Driscoll's 'What' model for reflection. The following clinical incident has been reflected using Driscoll's model in this assignment. According to the Driscoll model (Driscoll, 2000), the reflective phases are in the form of a cycle and the questions in each phase aid the practitioner with the process of reflection. The phases in Driscoll's 'What' Model' are: 1. What': A description of the event 2. So what': An analysis of the event 3. NOW WHAT': Proposed actions following the event What': Description of the event 29 year old Marina (name changed for the purpose of confidentiality and anonymity) was bought to the Accident and Emergency department with complaints of intermittent abdominal pain since 3 days and recurrent vomiting since one day. She was pale with dry cracked lips and very weak. Due to the busy A&E Department, the patient waited for 45 minutes before being assessed by me. Temperature was 37.5 degree Celsius, blood pressure 108/70 mmHg, pulse rate was 100 per minute and respiratory rate was 36 per minute. Blood sugar level was 22.9 mmol/l and urine dip stick revealed plus 3 ketones, plus 3 of Glucose and traces of protein. Blood ketone levels as determined by ketone strip were 5.8 mmol/l. Based on these basic investigations, I made a diagnosis of diabetic ketoacidosis (DKA) and then shifted her into the resuscitation room without wasting much time. Further treatment was instituted in that room. In the resuscitation, immediate treatment was instituted according to the protocol used for managing DKA patients. Soon after admission, blood samples were sent for serum blood glucose level, arterial blood gas analysis, serum sodium, potassium, phosphate, calcium and magnesium, blood urea and serum creatinine, glycosylated hemoglobin, full blood count, serum amylase, serum osmolarity and serum triglycerides. Urine samples were sent for urine glucose and ketone bodies. Pregnancy was ruled out. The first therapy initiated after sending the blood samples was fluid and electrolyte therapy and insulin replacement. Two large bore venous lines, one in each arm, were placed; one was to facilitate fluid therapy, and the other to draw blood samples as and when required. The dehydration status of the patient was corrected over 24 hours after calculating the fluid deficit by clinical assessment. For initial resuscitation, 10 ml/kg of isotonic sodium chloride solution (0.9%) was administered over 30 minutes. This was repeated after 10 minutes. Thereafter, maintenance fluid therapy with isotonic sodium chloride solution was continued until blood glucose levels fell to 250-300 mg/dL (ie, 12-15 mmol/L). Once dehydration was corrected and there was normal urine output, potassium chloride was added to all the fluids. Maintenance therapy was started with glucose containing solution, 5% glucose with normal saline. After, the patient stabilized, she was shifted to the critical care unit for further management. No bicarbonate therapy was given. So what': An analysis of the event DKA may be defined as a state of absolute or relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration, and acidosis-induced derangements in intermediary metabolism (Rucker, 2006). It is a life threatening event that occurs commonly in Type-1 diabetes mellitus. In most of the cases it is managed in a hospital, in an ICU setting. It is the most common cause of diabetes-related death in children (Della Manna et al, 2005). It is characterized by hyperglycemia over 300mg/dl, low bicarbonate (15mEq/L) and acidosis (pH Read More