Recognizing and Acting on Clinical Deteriorating: A Patient with Type 1 Diabetes admitted with Ketoacidosis - Term Paper Example

Recognising and Acting on Clinical Deteriorating: A Patient with Type 1 Diabetes admitted with Ketoacidosis. Name of Student Student Number Institution Course Code Name of Lecturer Submission Date Introduction Nurses play a crucial role in critical care and detection of clinical deterioration enhancing ideal patient outcome. According to Odell, Victor, and Oliver (2009), prompt assessment and intervention measures have a positive effect within acute care settings. Extensive literature indicates that issues surrounding patient safety and risk of harm whenever physical conditions of patients deteriorates calls for immediate interventions to detect and correct the problem. This essay evaluates the strategies for recognising and acting effectively on clinical deterioration of a patient admitted with diabetes type 1 and having ketoacidosis. It is vital to note that nurses have the capability to recognise and assess the ever changing crucial signs in respect to patients with diabetes mellitus and having an attack of ketoacidosis. Having clear strategies to recognise early warnings of the occurrence of DKA allows the care nurses and physicians to come up and provide effective and appropriate interventions on the patients (Eisenbarth and Buse, 2011). In so doing, the undertakings improves the patient outcomes and helps in reducing fatalities in respect to diabetic ketoacidosis is concerned. Having effective assessment findings creates a sure way of determining what is necessary to attend to the patient in an effective way. Rationale for the Paper The management of patient with diabetes mellitus and having ketoacidosis have mainly focused on reducing the high levels of glucose in the blood with introduction of fluids and insulin (Westerberg, 2013). Further, utilisation of arterial pH and serum bicarbonate in order to assess metabolic improvement has been common. This has been based on the assumption that the interventions are critical in the reduction of ketones production in the body by reversing acidosis. Brenner (2006) indicates that there is greater need to enhance early detection of DKA even among the patients themselves. Improved patient awareness on ketoacidosis with respect to diabetes is highly crucial and contributes partially towards treating DKA prior to admission, thus reducing deterioration of patients’ condition. Nursing processes are termed as being individualised problem solving approaches undertaken by nurses to ensure effective care upon patients and enhance recovery (Johnson et al., 2011). The most crucial process consists of four distinct phases with each possessing roles that are critical. These consist of assessment, planning, intervention and evaluation (Dresser 2007). To recognise and act on diabetic ketoacidosis, it is vital to keep these four phases at hand and critically evaluate them effectively to ensure patients are attended to and get treatment before their conditions become fatal raising the mortality levels. In essence, it is vital to note that nurses ought to be readily prepared to ascertain and attend to DKA cases, as well as enlighten their patients on how to avoid excessive hyperglycaemic state (Westerberg, 2013). According to Debourgh and Prion, (2012), the nursing profession is crucial in the medical settings and their assessment and interventions are critical towards realising effective recovery of patients. In respect to diabetic complications, it is critical to note that nursing interventions create solutions that bring down levels of fatalities among patients (Eisenbarth and Buse, 2011). DKA remains among the most serious cases of acute metabolic complications that are exhibited in diabetes type 1 patient. DKA is a clear sign of type 1 diabetes in patients who have not portrayed other symptoms. Among people already diagnosed with diabetes type 1, it can be triggered by infection, injury, missing insulin doses, serious illnesses or even surgery (Brenner, 2006). It is worth noting that for a nurse, taking a critical history of a patient does not delay time to treatment but rather gives a clear leeway to establish probable cause of health deterioration. Notable symptoms that can point out DKA to a nursing profession include polysidia which is an abrupt occurrence of elevated thirst, worsening polyuria, first presentation of weight loss, nausea and vomiting, body lethargy and fatigue, generic abdominal pains (Westerberg, 2013). On the same note, breathlessness is common among DKA patients due to increased respiratory rate coming about due to the fact that the body is trying to compensate by blowing off carbon dioxide. Case Scenario This case study is based on Pedro (pseudonym for study purposes) who suffers from diabetic ketoacidosis (DKA). Although he had been diagnosed with diabetes type 1 a few years before, the changes in toxic levels of ketones in the urine was observed after his conditions worsened while seeking medical help once he fell seriously ill. The patient was also evaluated and engaged to ascertain probable causes of his complications. It was evident that Pedro had missed to continuously take his insulin medication which resulted to experiencing decreased alertness, muscle stiffness, headaches, nausea and vomiting. On visiting his physician, tests revealed imbalance levels of electrolytes due ketone poisoning and imbalance of essential mineral salts. The main tests carried out were the body hydration levels, insulin levels and electrolytes balance constituting of potassium, phosphate and sodium. The patient was detected to be dehydrated and was treated by giving intravenous fluids, and progressed to oral fluids once his health improved. The nurses were keen to monitor the patient’s vital signs in order to evaluate fluid replacement effectiveness. Further, the insulin level for Mr Pedro was assessed and rapid-acting insulin administered with the insertion of an insulin drip. The insulin was continued until a level of close to 250mg/ml was achieved. From the laboratory results, it was prudent to effect the introduction of potassium as insulin was being administered. This is because potassium becomes highly crucial with administration of insulin. Insulin is vital in causing the movement of potassium into the intracellular compartment at the time acidosis is corrected. Sodium and phosphate were also administered to Pedro to ensure normal electrolytic levels. Nursing Actions for Assessing, Monitoring and Interventions Ketoacidosis in diabetic patients occurs with consistently high blood sugar levels (Westerberg, 2013). This causes the body to outsource for alternative sources of energy due to lack of insulin resulting to ketones as the by-products. Ketones are fatal products in the body and if left unchecked results to the body becoming acidic, thus the condition acidosis (Eisenbarth and Buse, 2011). In context, any diabetic patient that is dependent on insulin could develop diabetic ketoacidosis. Diabetic ketoacidosis (DKA) is a medical problem that is fatal and has considerable morbidity and mortality. There is need to diagnose it on time and manage the symptoms to a large extent and thus, ensure it fatalities are lessened (Henneman, Gawlinski and Giuliano, 2012). The main characteristic of this medical condition are hyperglycaemia, ketonaemia and acidosis. Critical analysis of DKA means reducing fatalities and thus, the nursing professionals have a duty to ensure appropriate monitoring strategies during diabetes check-ups (Brenner, 2006). For patients with glucose levels beyond 15mmols/L, there is a greater need to test for ketones in the blood or urine. This ensures that later occurrences of DKA attack are mitigated. Further, there are cues that show early signs of high glucose levels in diabetic patients and nurses ought to establish early signals on diabetic patients that could reveal possibilities of ketoacidosis occurrence (Westerberg, 2013). There is need for care nurses to possess effective skills to make early observations and detect of complications to help in the minimization of negative outcomes of the patient. DKA is avoidable by ensuring that diabetes type 1 patient always takes their insulin in the right proportions of diets and activity patterns. Further, ensuring a good check on the blood sugar levels and consulting the physician effectively for check-ups ensures that episodes of danger that threaten or disrupt life are mitigated. According to Brenner (2006), many patients are unaware of their health condition and particularly with respect to diabetes mellitus; considerable people have no idea whether they have the medical condition. Thus, it is vital for nurses to have effective strategies to detect deteriorating health conditions and grasp probable clinical problems (Elliott and Conventry, 2012). This is vital as it helps to initiate treatment measures help ease further health deterioration and improve recovery. DKA interventions are critical and involve ensuring that increased serum osmolality is corrected through hydration. One observation to make in case of polydipsia (extreme dehydration) is that it is triggered by increased serum osmolality (Eisenbarth and Buse, 2011). Further, hyperosmolar state brings about osmotic dieresis leading to frequent urination (polyuria). The urine voided contains high levels of potassium, sodium, magnesium and phosphate. There is need to follow to the latter the guidelines put in place within most acute hospitals to effectively ensure proper management of DKA. However, there is also need for nurses and other medical professionals to ensure that the guidelines are updated to look into arising issues and consequently address them effectively (Henneman, Gawlinski and Giuliano, 2011). This is in respect to coming up with strategies that look into measures to arrest critical cases of ketoacidosis at the early stages or else alleviate the occurrence. Monitoring cases of DKA are paramount and also creating awareness among patients to establish early signs of DKA is crucial. Conclusion It is critical to note that diabetic ketoacidosis is a fatal conditions and has symptoms that if detected and recognised on time, effective medical and nursing care would mean mitigating the effects and improving patient recovery. One point to note among the nursing profession is that early warning scoring strategies are crucial in mitigating patient deterioration by detecting the problem prior to progressing to advanced stages. In essence, the rationale for early detection is that, it creates a way of evaluating and establishing vital signs of a patient to bring up extra effective interventions. On top of prevention of DKA, there is need for nurses to help patients detect early signs of it which constitute abdominal pains, fruity breadth, nauseating and vomiting, high levels of ketones, dehydration among others as discussed. References Brenner, Z. R. (2006). Management of hyperglycaemic emergencies. AACN Advanced Critical Care, 17(1): 56-65. Debourgh, G. and prion, S. (2012). Patient safety manifesto: A professional imperative for pre-licensure nursing education. Journal of Professional Nursing, 28(2): 110-118. Dresser, S. (2007). The role of nursing surveillance in keeping patient safe, The Journal of Nursing Administration. 42(7/8): 361-368. Eisenbarth, G. S. and Buse, J. B. (2011). Type 1 diabetes mellitus. In, Melmed, S. Polonsky, K. S. and Kronenberg, H. M. Williams textbook of endocrinology. 12th ed. Philadelphia, Pa.: Elsevier Saunders. Elliott, M. and Conventry, A. (2012). Critical care: the eight vital signs of patient monitoring. British Journal of Nursing, 21(10). Henneman, E., Gawlinski, A. and Giuliano, K. (2012). Surveillance: A strategy for improving patient safety in acute and critical care units. Critical Care Nurse. 3292): 9-17. Johnson, T., Jonsdttier, H., Moller, A. and Baldursdottier, A. (2011). Nursing documentation prior to emergency admissions to the intensive care unit, Nursing in Critical Care, 16(4). Odell, M., Victor, C. and Oliver, D. (2009). Nurse’s role in detecting deterioration in ward patients: systematic literature review . Journal of Advanced Nursing. 65(10):1992- 2006. Westerberg, D. P. (20130. Diabetic ketoacidosis: evaluation and treatment. Am Fam Physician, 87:337-346. Read More