Management Of Diabetic Ketoacidosis Nursing Essay

Management Of Diabetic Ketoacidosis Nursing EssayDiabetes UK (2008) explains that Diabetic Ketoacidosis (DKA) occurs when blood glucose levels ar consistently high. When there is lack of glucose in the blood, the bodys electric cells consumption fat stores to acquire energy, this process produces an acid cal move back ketones. As ketones ar potentially harmful to the body, it tries to get rid of them by excreting them in the urine. If the level of ketones in the bloodstream continue to rise, ketoacidosis occurs whereby the blood turns acidic. as a consequence, patients may feel nauseous, apply blurred vision and charter very rapid breathing. Because mickle vomit, the body becomes dehydrated and it is harder for the body to flush out the ketones, if this happens and is left untreated, the patient will fall into a coma which can be fatal.As Daniel was scurvy from a chest infection, he was at high run a risk of developing DKA as his body was releasing more glucose into the blo odstream and stop insulin from working efficiently, this is a triggered response to the infection (Moore, 2004).How is DKA managed?Kisiel and Marsons (2009) explore the regime which is usually carried out in hospitals faced with patients like Daniel. Firstly, a diagnosis of DKA would have been made alongside hypoglycaemia (high blood glucose levels). His urine would have been tested for ketones as standard regime. Arteirial blood gas measurement may as well have been performed to demonstrate the level of acidity. A series of blood tests would have been taken to measure Daniels urea and creatinine levels (measures of kidney function), markers of infection would likewise have been measured such as white blood cell count. Fluid replacement would have been commenced, insulin administered and his potassium level would have also been monitored in the high dependency unit.What could have influenced Daniels rising BMs?It should be taken into dateation that Daniels rising blood sugar le vels could be influenced by a number of factors and Jo should take these into account. Jo should check the equipment supplying Daniels insulin as it may be faulty or the pump may not be functioning correctly. She should also ensure that the account is properly connected to the cannula and that it is not leaking or that there is no cube along the line, or that the cannula has not tissued. Daniels cannula site should be inspected on every shift to check for Phlebitis using the Visual Infusion Phelbitis score (VIP) in line with local policy.Nursing decisionsMany factors could have contributed to both Jo and the Senior Nurses decisions and the decision made either way could impact on Daniels condition. If Jo had decided not to annex the insulin and the cured suck had not increased it either, Daniel may have slipped back into a coma as his blood glucose levels had been rising over time. This would have led to more complications and could have been fatal. However, increasing the insu lin may also have had a negative result for Daniel. As it was not prescribed, it may have been increased withal much and the blood sugar level could be reduced to an unsafe level and he may suffer a hypoglycaemic episode. Although this is unlikely, it should be mentioned that the senior draws decision to alter the prescription without it being prescribed was wrong.AccountabilityAccording to the NMCs code of professional point (2008), as a professional, you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions. As the senior nurses made a decision to alter the insulin infusion without it being prescribed, she is personally accountable to what happens to that patient as a consequence of doing so. On the other hand, Jo is also accountable for her omissions so it could be seen that both of the nurses are liable for what they do or dont do in this situation. The senior nurse may have thought she was acting in the sco op interests of the patient, pursuit the NMC code of conduct standard .Accountability is the fundamental aspect to professional practice (NMC 2008) and nurses need to be able to justify why they made any decision in practice. Nurses do make judgments based on a number of influences which take their professional knowledge/skills, evidence based practice and acting on the patients best interests. In this situation, the senior nurse may have been a nurse prescriber who had the authority to prescribe drugs from a limited group in the nurse prescribers formulary (McHale 2003). This would have allowed her to alter Daniels prescription without a concern. She may also have had background knowledge of Daniels condition and thought the best decision to make was to tilt the insulin dose so that the patient would not have deteriorated further.The senior nurse should be working within her acquired job description which would have included expectations and limitations to what she was essent ial to do as part of her job. Vicarious liability comes into mind in this instance Richardson (2002) explains that as the employer is responsible for any torts which are committed by an employee during their employment. Torts are described as any legal wrongs for which the law provides a remedy. In this case, the senior nurse has preformed a tort and the person employing her is liable.As Jo was the nurse who was looking for after Daniel that day, she also has responsibility to what happens to the patient whilst in her care. This raises the question of who actually is accountable for what happens to Daniel the nurse looking after him or the nurse who performed the alteration.As it states that Jo is saucily qualified, it can be assumed that she may need support from her peers. She would have had a supernumerary period, where she was allocated patients but support was there when she needed it. Also cognize as preceptorship, newly qualified nurses are accompanied by an experienced nur se who acts as a role model and resource (Ashurst 2008). If the senior nurse was Jos preceptor, she would not have been setting a good example to her. The NMC code of conduct states that you must work cooperatively within teams and respect the skills, expertise and contributions of your colleagues, the senor nurse was clearly not being cooperative with Jo and did not allow her to share her concerns. Castledine (1999) explains how newly qualified nurses are sometimes expected to fit into the system of the guard very quickly and in addition, adapt to a whole range of situations that they have never experienced before. Jo may have been feeling unsupported by her senior and her confidence may have been knocked due to the attitude and response of the senior nurse.DocumentationAs the senior nurse did change the prescription, it needs to be documented somewhere in line with the NMC code. In this situation it could be questioned who documents the alteration of the insulin and where in the nursing notes it should be written. Medication administration arguably carries the biggest risk for nurses (Elliot Liu 2010). This particular scenario could be described as a medication error as the change in prescription was not verified by a doctor. Elliot and Liu (2010) confirm the fact that nurses must only administer the dose prescribed by the medical officer, and that the nurse who administers the medication must sign the medication chart. It should also be documented in the nursing notes as well as signing the chart, and should include the reason for administration and the desired effect (Elliot Liu 2010). Woodrow (2007) stipulates that nurses should be cognizant of the legal responsibility of accuracy of documentation. So in this situation, the senior nurse should write in the nursing notes why she gave the unprescribed dose to Daniel, and Jo should comment why she did not, as well as outlining what happened.Incident Reporting Patient SafetyJo could think about writing an incident form in this situation to voice her concerns. The scenario could be seen as a penny-pinching miss as the patient may well have suffered dire consequences from either of the decisions made by the nurses. The Reporting of Injuries, Diseases and stern Occurances Regulations (RIDDOR 1995) places a legal responsibility to employers, self employed people and people in control on premises, to report any dangerous occurrence/near miss (Ashurst 2007). Jo could include on the form that she was not happy with the senior nurses decision to alter the insulin pump, and therefore cover herself. By completing an incident report, Jo is following local and national policy and it could also bring to light other problems such as rushed transfers, doctor shortage and lack of support. RIDDOR coordinates its work with the NPSA.The theme Patient Safety Agency (NPSA) was formed in 2001 following two publications of patient safety in the NHS. These incorporated research conducted by Vincent et al (2001) which showed that 10% of patients admitted to hospital suffered some kind of patient safety incident. The NPSA has produced a guide to good practice called Seven Steps to Patient Safety (NPSA, 2003) Steps include building a safer culture, leading and supporting your practice team, integrating your risk management activity, promoting reporting, involving and communicating with patients and the public, learning and sharing safety less(prenominal)ons and implementing solutions to prevent harm. Dimond (2002) explains how the NPSA aims to ensure that contrary events will be identified, reported, analyzed and recorded to make a change to local and national policies and procedures. Jo could refer to this guide and also make others aware of it and mend the patient safety of not only Daniel but every patient on the ward.Inter-professional WorkingThere are several benefits of inter-professional working, the senior nurse and Jo should be aware of these in order to work unitedly and provide effective care. Benefits of inter-professional working which were identified in a report by Cook et al (2001) showed that the team members had more confidence in their decision making as they had encouragement and support from their colleagues. This allowed team members to make better contributions to the overall service in which they were a part of, consequently providing a more effective service to the patients in their care. Jo would have increased her confidence in dealing with similar situations in the future if the senior nurse had spoke to her and answered her questions.There is a great deal of literature which discusses the obstructions and difficulties associated with inter-professional collaboration. It should not be assumed that simply instructing professionals to work together will be sufficient to result in effective teams which provide improved services to their patients. A variety of barriers to interdisciplinary working exist that defy the developments of c lose collaborative working relationships. Hudson (2002) outlines some barriers to effective inter-professional working in terms of relationships between members of different professions such as nurse and doctors. One barrier that he notes is that the character of professional identity is such that where members of a certain profession have similar or shared values, perceptions and experiences, there will be more agreement between members of a profession than between members of different professions. This disagreement shapes inter-professional relationships, and is likely to cause problems within multi-disciplinary team working.In Jos case, she could have bleeped the doctor herself and asked him about the prescription, but as mentioned if he was busy he may have been reluctant to take the call. The senior nurses reaction to Jo demonstrated the hierarchical vie between a more senior nurse and a very junior member of staff. Although inter-professional working has much potential to enh ance care, it can also produce tensions and concerns within the health care team (Peate 2006). It is also important to note that some barriers are organisational or structural such as concourse or Trusts, relocation and withdrawal of services. In this scenario, the main barrier is that there are two different skill mixes with conflicting ideas.Irvine et al (2002) also consider some organisational difficulties and barriers to the effectiveness of inter-professional practice. They identify that differences in working hours may hinder the development of close working relationships between professionals. Also the time different professionals take to carry out particular work may cause difficulties. For example doctors may be making decisions regarding clients on a day-to-day basis whereas fond workers need to undertake longer term casework to meet their clients needs. Also, financial constraints can influence the ability of a team to practice effective collaborative working. McCray no tes that when budgets and resources are limited, the issue of who will pay for the intervention can also make out tension within teams. Even if practitioners wish to work collaboratively, their managers may be less able to facilitate this due to budgeting constraints, and may therefore place restrictions on the amount of collaboration that can take place.Irvine et al (2002) considers that differing value systems between professions may also contribute to problems with the determining of priority of certain cases. The senior nurse may have decided that she would prioritise Daniels well-being over the values of Jo. diverse professions or grades will see patients needs as being at different levels of importance as their aims and goals for the patient will be dissimilar. This can create problems and sources of conflict between different grades of nurses and some, such as the senior nurse may feel as though their patients needs are being handle or devalued mainly in this situation by Jo or the doctor who is looking after Daniel.Hudson (2002) also explains that issues relating to professional status also have implications for inter-professional relationships. Health and social care professions in particular have very different levels of training, education and legal restriction. In this case, it seems that the senior nurse is devaluing Jos opinions and knowledge and adhesive to her own.All the barriers discussed can create stress and tension between team members. Irvine et al (2002) state that professional structures are differentiated by demographics the size of the occupations rank gender composition the class of origin of its members educational attainment status and the relative size and source of primary income. These differences are all quoted as barriers to inter-professional working.What have I learnt?By analysing this scenario I have learnt many attributes which contribute to effective patient care and working in a team.