Management Of Diabetic Ketoacidosis Nursing Essay

Management Of Diabetic diabetic acidosis Nursing EssayDiabetes UK (2008) explains that Diabetic Ketoacidosis (DKA) occurs when dec air glucose levels ar systematically high. When in that respect is lack of glucose in the blood, the personifys cells use fat stores to acquire energy, this surgical procedure cooks an acid called ketones. As ketones be potentially harmful to the body, it tries to get free of them by excreting them in the urine. If the level of ketones in the bloodstream slip by to rise, ketoacidosis occurs whereby the blood turns acidic. as a consequence, uncomplainings whitethorn feel nauseous, ante up off blurred vision and go very rapid breathing. Because people vomit, the body becomes dehydrated and it is harder for the body to flush divulge the ketones, if this happens and is left untreated, the patient give fall into a coma which female genital organ be fatal.As Daniel was scathe from a chest infection, he was at high venture of growth DKA as h is body was releasing more glucose into the bloodstream and stop insulin from puzzle outings 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 turn over been call for alongside hypoglycaemia (high blood glucose levels). His urine would select been tested for ketones as standard regime. Arteirial blood gas measurement whitethorn withal pitch been per imprinted to demonstrate the level of acidity. A series of blood tests would have been overhearn to measure Daniels urea and creatinine levels (measures of kidney function), markers of infection would excessively have been measured much(prenominal) 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 habituation unit.What coul d have influenced Daniels locomote BMs?It should be taken into consideration that Daniels rising blood moolah levels could be influenced by a number of factors and Jo should take these into account. Jo should fall in the equipment supplying Daniels insulin as it whitethorn be faulty or the nerve whitethorn not be functioning correctly. She should also crack that the line is properly connected to the cannula and that it is not leaking or that there is no plosive along the line, or that the cannula has not tissued. Daniels cannula site should be inspected on all shift to check for Phlebitis using the Visual Infusion Phelbitis score (VIP) in line with local insurance policy.Nursing decisionsM all factors could have contri onlyed to both Jo and the ripened Nurses decisions and the decision do either way could impact on Daniels condition. If Jo had refractory not to increase the insulin and the old hold up had not increased it either, Daniel may have slipped back into a co ma as his blood glucose levels had been rising over epoch. This would have led to more complications and could have been fatal. However, increasing the insulin may also have had a negative result for Daniel. As it was not prescribed, it may have been increased too 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 fosters decision to transmute the prescription(prenominal) without it be prescribed was wrong.AccountabilityAccording to the NMCs code of maestro conduct (2008), as a professed(prenominal), you are personally accountable for actions and omissions in your practice and moldinessiness always be able to justify your decisions. As the senior controls made a decision to bowdlerize 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 a lso accountable for her omissions so it could be seen that both of the fellates are responsible for what they do or dont do in this view. The senior nurse may have thought she was acting in the best interests of the patient, following(a) the NMC code of conduct standard .Accountability is the fundamental aspect to pro practice (NMC 2008) and nurses need to be able to justify why they made any decision in practice. Nurses do make judgments establish on a number of influences which implicate their professional person fellowship/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 doctor. She may also have had background knowledge of Daniels condition and thought the best decision to make was to shift the insulin venereal disease so that the patient would not have deteriorated further.The senior nurse should be working(a) indoors her acquired job description which would have overwhelmd expectations and limitations to what she was undeniable to do as get out 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 levelheaded wrongs for which the law exits 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 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 impudently commensurate, it can be assumed that s he may need uphold from her peers. She would have had a supernumerary period, where she was allocated patients but support was there when she needed it. Also known as preceptorship, newly qualified nurses are accompanied by an experienced nurse who acts as a role model and resource (Ashurst 2008). If the senior nurse was Jos preceptor, she would not have been setting a grave 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 all the way 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 screen very quickly and in addition, adapt to a whole array of situations that they have never experienced before. Jo may have been feeling unsubstantiated by her senior and her pledge may have been knocked due to the military stren gth and response of the senior nurse.DocumentationAs the senior nurse did change the prescription, it needs to be put down 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 nebs it should be written. practice of medicine 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 aware of the legal responsibility of accuracy of doc umentation. So in this situation, the senior nurse should frame 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 sentry goJo could look about writing an incident form in this situation to articulatio her concerns. The scenario could be seen as a near 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 Dangerous Occurances Regulations (RIDDOR 1995) places a legal responsibility to employers, self diligent 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 surmount herself. By completing an incident report, Jo is following local and national policy and it could also bring to light other prob lems such as step on it transfers, doctor shortage and lack of support. RIDDOR coordinates its work with the NPSA.The National Patient Safety Agency (NPSA) was formed in 2001 following two publications of patient safe 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 lessons and implementing solutions to prevent harm. Dimond (2002) explains how the NPSA aims to ensure that adverse 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 an d also make others aware of it and improve the patient safety of not only Daniel but every patient on the ward.Inter-professional WorkingThere are some(prenominal) benefits of inter-professional working, the senior nurse and Jo should be aware of these in order to work together and provide effective care. Benefits of inter-professional working which were identified in a report by Cook et al (2001) showed that the team parts 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 downing with similar situations in the prox if the senior nurse had spoke to her and answered her questions.There is a great deal of literature which discusses the barriers and difficulties associated with inter-professional coa ction. 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 go that delay the developments of close collaborative working relationships. Hudson (2002) outlines some barriers to effective inter-professional working in barriers 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 dual-lane 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 pr escription, 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 struggle between a more senior nurse and a very junior member of staff. Although inter-professional working has much potential to enhance 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 unify 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 social 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 notes that when budgets and resources are limited, the issue of who will pay for the intervention can also relieve oneself tension within teams. flat if practitioners wish to work collaboratively, their managers may be less able to help 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. various professions or grades will see patients needs as being at different levels of imp ortance 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 ignored 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 sticking 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 it of the occupations membership gender report card 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.