Diabetic type I Ketoacidosis

Diabetic type I Ketoacidosis

Diabetic type I Ketoacidosis (DKA) is a type 1 diabetic emergency with 10-30% mortality characterized by extreme hyperglycemia, severe acidosis, electrolyte imbalance, hyperketonemia, altered state of consciousness, and severe dehydration (hypovolemic shock). The role of nursing in DKA is to improve the patient’s outcome and to reduce the chances of mortality. This includes the resuscitative measures, rapid fluid replacement with normal saline, stabilization of blood glucose with soluble insulin, stabilization of blood electrolytes and pH, prophylaxis medication, nursing care, and Monitoring and evaluation of the patient’s condition (Dhatariya et al., 2020). Mary (16 years, a female who is a Christian) is suffering from this condition and is admitted to the intensive care unit. This patient was diagnosed with diabetes type 1 when she was 4years of age and had been receiving treatment since then, and it is the third time to be admitted because of DKA. The patient has been admitted because of extreme hyperglycemia and severe acidosis with an altered state of consciousness. The patient will be admitted until her glucose levels are of normal levels and maintained below 10mmol/L because a failure to maintain the patient’s blood sugar levels below 10mol/L may cause hypoglycemia also a life-threatening complication. The aim of DKA stabilization of blood sugar is between 8-11mmol/L, but on the day of the patient’s discharge, the patient’s blood sugar should be maintained less than or equal to 10mmol/L.

Patient Care

DKA is an emergency condition where the patient should receive care immediately; the patient is receiving care according to the specific protocols of DKA management (Holt et al., 2017), that include: firstly, the nurse should do resuscitative measures that are the ABC management (opening of the airway, assessing respiration and assessing of circulation. Secondly, rapid fluid replacement occurs when the nurse infuses the patient with fluids to increase the circulatory volume. Here the nurse uses normal saline and dextrose. Twelve bottles of 500ml normal saline are handled within 24 hours together with one bottle of 50% dextrose and three bottles of 5% dextrose each of 500 ml. The patient has infused 20 drops per minute and injected enough insulin. Thirdly the nurse stabilizes the patient’s blood sugars by use of soluble insulin. The patient is given 10 I.U intravenously stat(bolus), then 10 I.U intramuscularly stat then 6 I.U soluble insulin hourly until the blood sugar is between 15-13 mmol/L. After 24 hours, stop the insulin given hourly, give a day thrice subcutaneously, and monitor and evaluate the progress. Fourthly the nurse stabilizes the patient’s blood electrolytes and pH, and lastly, the nurse administers antibiotics and anticoagulants for prophylaxis treatment. The nursing staff’s concerns are to reduce or stop the occurrence of complications from Mary’s condition like fluid overload, electrolyte imbalance, and acute renal failure due to hypovolemic shock. The staff is addressing to curd the extreme hyperglycemia and severe acidosis to save the patient and to reduce the chances of developing the complications. The nursing interventions to the patient to help her reach her goal of a stable, healthy life is first to resuscitate the patient, replace the patients fluid to increase the circulatory volume, to stabilize the patient’s blood sugars, stabilization of blood electrolytes and pH, prophylaxis treatment, nursing care and Monitoring and evaluation (Dhatariya, Glaser, et al., 2020). These interventions will bring back the patient to her normal state being that is for resuscitation the patient will be able to breathe freely without any obstacle, a rapid fluid replacement will increase the body’s circulatory volume that will reduce dehydration, stabilization of blood sugars will curb the extreme hyperglycemia, stabilization of blood electrolytes and pH will facilitate a healthy balance of hemostasis in the system, and prophylaxis treatment will manage any septicemia in the process management. These interventions aim to improve the patient’s state, including blood pressure measurements, input and output, body weight, fluid intake, temperature, and fluid intake, that should be taken around the clock to facilitate the improvement of the patient’s health.

Analysis

Evidence-based practice involves three components. They include external evidence (the best), clinical skill, and patient liking preference. Evidence-based practice contrasts with this case scenario because EBP uses current best evidence while making decisions for the patient((Hoffman, & Sullivan, 2019). The textbook uses research findings conducted on other patients. Thus the care the patient is receiving contradicts evidence-based practice. It corresponds well because the nurse used external evidence to diagnose the patient correctly. The nurse used the patient’s features and the patient’s relatives’ explanation about the condition. Since the patient was brought in an altered state of consciousness, this well corresponds to the textbook because it also focuses on the learning of the clinical presentations of diabetic ketoacidosis as well as external evidence (presenting features) in EBP. The patient did not have to say her preferences in her management; therefore, the care also contradicts evidence-based practice. In this case, the nurse had to differ with the method because the patient was semi-conscious. Since there was limited information on the patient’s care, the nurse had to deviate the training and focus on saving the patient’s life.

Summary

DKA is a type 1 diabetic emergency with 10-30% mortality, therefore, apart from stabilizing the patient the nurse should not only be significant in the emergency management on a short-term basis but also ensuring the patient has a wide range of knowledge in diabetes and its complications to ensure self-care and prevention of the complications (Hoffman, & Sullivan, 2019). The nurse should play an active role in equipping the patient with the knowledge, ensuring she is well informed about her condition, and discussing the associability of diabetic clinics to address complications like diabetic ketoacidosis prevent its reoccurrence.

Reflection

In this case study, I learned the step by step management of DKA and the dangers of management. For example, fluid overload can occur as a result of over infusion. This knowledge has impacted my experience since I had only learned in theory now, I can practically do all the procedures required for the management. I feel more confident in my practice and have gained more skills. In my future practice, I’ll be so conversant with any DKA case. All the guidelines and procedures I learned in my theory allowed me to use the knowledge into practice because they are similar.