Care Provided to a Patient with Metabolic Ketoacidosis

Introduction

The use of the reflective practice in nursing helps the nurses to identify, analyse and evaluate their experiences in practice to develop a sense regarding their strength and weakness along with the improvement to be made to deliver quality care (Naicker and Van Rensburg, 2018). The current purpose of the assignment is to reflect care provided to Mary as a nurse who is suffering from metabolic ketoacidosis and has type-1 diabetes. For this purpose, the Rolfe model of reflection is to be used. This is because the model is simple allows developing clarification regarding pros and cons in care practice in meaningful manner with clarity (Swift and Twycross, 2020). In the initial stage, explanation of main scenario of care practice is to be discussed. Thereafter, the care performance executed is to be analysed to determine its impact on the patient and support provided. Further, the actions to be further taken for improving care practice based on the performance analysis is to be discussed.

What?

The key issue to be focussed in care is that the patient named Jones who has type-1 diabetes and suffers from depression has attended the hospital to access care because she is been vomiting for the past 48 hours. As asserted by Danne et al. (2019), lack of presence of enough insulin in the body in type-1 diabetes patients leads them incapable to breakdown glucose in producing energy. In this condition, the body initiates to breakdown fat and produce ketones to use as energy. However, increased ketone presence in the body leads to cause acidosis that makes patient to vomit (Duca et al., 2017). The fact is known to me as a nurse and therefore, I supported urine analysis of Mary to be made which led to report that she has ketones and insulin in the urine. It led me to analyse that she is suffering from metabolic ketoacidosis as they are caused by presence of ketones in the body that is found in her urine test.

As a nurse, I asked Mary to mention if she is suffering from consciousness issue so that she can be referred to disability section for managing that situation. In acidosis, people may develop respiratory issue such as Kussmaul breathing where their breathing is shallow and rapid (Farsani et al., 2017). Since Mary was suffering from acidosis, I performed her respiratory state and found her breathing is 26 breaths/per minute (bpm). The normal breathing level in adults is between 12-20 bpm and breathing above 25 bpm is considered abnormal (Demet et al., 2017). This led me to analyse that Mary is experiencing respiratory issue due to acidosis which is to be managed by making her develop breathing exercise as her oxygen level in the blood was normal (SpO2= 95%).

The ketoacidosis may affect cardiovascular functioning by lowering blood pressure due to dehydration and extreme acid level in the body (Kao et al., 2020). Thus, the blood pressure in case of Mary is checked that revealed her blood pressure is 90/60. The normal blood pressure level is 120/80 and it indicates that Mary is suffering from low blood pressure. For this purpose, I as a nurse provided her initially isotonic saline at 15-20 mL/kg/h followed by 0.45% hypotonic saline for 4–14 mL/kg/h (Gosmanov et al., 2014). This is because it would normalise her blood pressure and the water lost due to vomiting from the body would be restored resolving dehydration along ketones are released with intake of increased water through urine assisting to resolve ketoacidosis (Akturk et al., 2019). The body temperature is ketoacidosis is mentioned to be affected and temperature above 38℃ creates risk of sepsis development (Kim et al., 2018). Thus, the body temperature of Mary is measured which indicates her body temperature is 36℃ that ensures she does not have risk of sepsis development.

So What?

The thing that went well while caring for Mary is that I as a nurse appropriately followed the NMC Code of practise that mentions that care to be arranged for the patient are to be made in their best interest (NMC, 2018). This is because such care leads to meet the specific needs and demands of the patient and offer them satisfaction from care. However, failure to provide care in the best interest of the patient makes the patient become non-cooperative with the nurses to access care. This is because their needs and demand for better health as per their perception and attitude is not fulfilled, in turn, making them feel ignored and unsatisfied with care by the nurses (Peters et al., 2020). I acted in best interest of the patient (Mary) which is evident as I immediately supported her urine analysis which was required to determine the reason for her continuous vomiting. The is because patients with type-1 diabetes may develop vomiting and nausea due to hindered level of insulin or ketones in the body that can be detected through urine test (Inayat Gill and Cappell, 2020). The other thing that went well is I was able to deliver urgent care to Mary to resolve her condition of ketoacidosis by providing her fluids and arranging respiration exercise in improving her breathing.

The development of increased level of ketones in the body during ketoacidosis makes the blood acidic that interferes with the respiration ability and lower blood pressure (Mohammad et al., 2017). Thus, the thorough enquiry of Mary’s vital health status such as respiratory rate, blood pressure, pulse rate, temperature and SpO2 level by me as a nurse was another aspect in care that went well. This is because it ensured I tried to effectively assess the impact of ketoacidosis on Mary to determine and deliver her appropriate care. The vomiting leads people to develop lower consciousness about their health and hygiene because they are incapable to physically manage the altered health situation (Mohammad et al., 2017). However, I failed to assess her cognitive and consciousness level in the current health condition and depended on her to express which was one of the things that did not went well. This is because Mary is already depressed with her condition and may avoid sharing her hindered health details thinking they may be ignored to be fulfilled by the nurse.

The NMC Code of Conduct mentions that nurses are to thoroughly communicate with the patient to determine their needs and demands of care (NMC, 2018). This is because it helps the nurse to develop bonding and trust with the patient along identify their specific personal needs to be fulfilled. However, in the current care, this aspect did not go well as no effective communication was made with Mary to determine her needs and the care was mainly provided based on her health analysis. This may have made her feel ignored to mentioned her needs and deliver hindered quality care (Peters et al., 2020). The NMC also mention that patient is to be included in making decision regarding their care and care is to be provided through informed consent (NMC, 2018). This is because it would help to create patient-centred care and makes patient feel valued out of their decision been approved in delivering care. However, in caring for Mary, limited consent regarding her care is asked from her and this aspect did not go well as it may have made her feel less valued. Moreover, later she may show non-acceptance to care out of feeling of lack of personal ability to make own care decisions.

Now What?

The initial area of improvement to be focused by me is developing skills to make holistic health assessment of patient. This is because in Mary’s care I focussed to identify her physical health issues but ignored to determine her social and psychological health issues that may have been due to her hindered health condition and needs to be resolved. For this purpose, I need to learn regarding the way Roper-Logan-Tierney Model is to be used as it leads to execute holistic health assessment of the patient (Ong, 2017).

The other aspect to be improved is my ability to develop communication with the patient. This is because it was found that due to hindered ability to develop meaningful interaction with Mary in care, I failed to abide by many NMC rules and deliver person-centred care. In order to improving communication skills, I need to engage in communication training in the workplace to learn the skills to be used in making effective interaction with patients. Moreover, I need to develop effective observation of the way other experienced nurses are making successful communication with patients to develop practical knolwdege regarding the way to effectively interact with patient in understanding their need and develop informed consent of care.

The other skill to be improved is focus on resolving co-morbidities that are identified during health assessment of the patient. This is because I ignored to focus on maintaining hygiene and resolving overweight issues in case of Mary though they are co-morbid situation identified by me. For this purpose, better therapeutic actions with the help of multi-disciplinary team is to be taken by me in future. This is because multi-disciplinary team provide wider expert knolwdege regarding the way different com-morbidities in patient are to be cared while supporting them health to resolve key health issue (Thewjitcharoen et al., 2019).

Conclusion

The above discussion mentions that Mary has type-1 diabetes and depression who is current receiving care for complain of ketoacidosis. As a nurse, Mary’s physical health vitals are thoroughly checked, and effective care is arranged on urgent basis to help her overcome the health issue. However, care towrads improving her psychological health that is been hindered by current health condition is ignored. As a nurse, I was able to express effective ability to check and monitor patient's health, deliver urgent care and show stamina in delivering care support. However, the weakness faced as a nurse in delivering care to Mary is that I failed to communicate effectively with the patient, show hindered ability to determine her comorbidities and execute inappropriate holistic health assessment that led to deliver her less quality care.

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References

Akturk, H.K., Taylor, D.D., Camsari, U.M., Rewers, A., Kinney, G.L. and Shah, V.N., 2019. Association between cannabis use and risk for diabetic ketoacidosis in adults with type 1 diabetes. JAMA internal medicine, 179(1), pp.115-118.

Danne, T., Garg, S., Peters, A.L., Buse, J.B., Mathieu, C., Pettus, J.H., Alexander, C.M., Battelino, T., Ampudia-Blasco, F.J., Bode, B.W. and Cariou, B., 2019. International consensus on risk management of diabetic ketoacidosis in patients with type 1 diabetes treated with sodium–glucose cotransporter (SGLT) inhibitors. Diabetes care, 42(6), pp.1147-1154.

Demet, D., Aksoy, N. and Kiraz, N., 2017. Nursing care after kidney transplant: Case report. Kidney.pp.89-123.

Duca, L.M., Wang, B., Rewers, M. and Rewers, A., 2017. Diabetic ketoacidosis at diagnosis of type 1 diabetes predicts poor long-term glycemic control. Diabetes Care, 40(9), pp.1249-1255.

Farsani, S.F., Brodovicz, K., Soleymanlou, N., Marquard, J., Wissinger, E. and Maiese, B.A., 2017. Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): a systematic literature review. BMJ open, 7(7).pp.56-90.

Gosmanov, A.R., Gosmanova, E.O. and Dillard-Cannon, E., 2014. Management of adult diabetic ketoacidosis. Diabetes, metabolic syndrome and obesity: targets and therapy, 7, p.255.

Inayat Gill, A.I.E. and Cappell, M.S., 2020. Proposed characterization of the syndrome of epidural pneumatosis (pneumorrhachis) in patients with forceful vomiting from diabetic ketoacidosis as a clinico-radiologic pentad based on systematic literature review & an illustrative case report. Medicine, 99(35).pp.89-99.

Kao, K.T., Islam, N., Fox, D.A. and Amed, S., 2020. Incidence trends of diabetic ketoacidosis in children and adolescents with type 1 diabetes in British Columbia, Canada. The Journal of Pediatrics, 221, pp.165-173.

Kim, D.H., Yu, T.Y. and Cho, C.G., 2018. Pneumomediastinum after Forceful Vomiting in a Patient with Diabetic Ketoacidosis. Chonnam medical journal, 54(3), p.199.

Mohammad, J.I., Chigurupati, S., Mallik, K.A. and Noor, H.M., 2017. A case study on anion gap metabolic acidosis secondary to Diabetes ketoacidosis. Journal of Innovation in Pharmaceutical Sciences, 1(1), pp.58-59.

Naicker, K. and Van Rensburg, G.H., 2018. Facilitation of reflective learning in nursing: reflective teaching practices of educators. Africa Journal of Nursing and Midwifery, 20(2), pp.1-15.

NMC 2018, The Code, Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on: 31 March 2021]

Ong, S.P.D., 2017. Application of the Neuman's System Model to the Management of Paediatric Case with Gastroenteritis and Type I Diabetes Mellitus. Singapore Nursing Journal, 44(2).pp.23-78.

Peters, A.L., McGuire, D.K., Danne, T., Kushner, J.A., Rodbard, H.W., Dhatariya, K., Sawhney, S., Banks, P., Jiang, W., Davies, M.J. and Lapuerta, P., 2020. Diabetic ketoacidosis and related events with sotagliflozin added to insulin in adults with type 1 diabetes: a pooled analysis of the inTandem 1 and 2 studies. Diabetes care, 43(11), pp.2713-2720.

Swift, A. and Twycross, A., 2020. Using ways of knowing in nursing to develop educational strategies that support knowledge mobilization. Paediatric and Neonatal Pain, 2(4), pp.139-147.

Thewjitcharoen, Y., Plianpan, P., Chotjirat, A., Nakasatien, S., Chotwanvirat, P., Wanothayaroj, E., Krittiyawong, S. and Himathongkam, T., 2019. Clinical characteristics and outcomes of care in adult patients with diabetic ketoacidosis: a retrospective study from a tertiary diabetes center in Thailand. Journal of clinical & translational endocrinology, 16, p.100188.