NUR251 Diabetic Ketoacidosis and Hyperosmolar Crisis in Adults Assignment Sample

Subject Code : NUR251
University : Charles Darwin University My Assignment Services is not sponsored or endorsed by this college or university.
Subject Name : Nursing

Medical Surgical Nursing - Task 1

Three 3 priority nursing assessments would be conducted at the commencement of the shift are as follows:

Monitoring blood pressure levels
Monitoring blood sugar levels
Monitoring diet

The blood pressure in the case study or Lily Orange is very low 95/65 mmHg. Low blood pressure can impact the health of the patient negatively. Therefore, it is required to consider this point for the patient’s care. According to Parket al. (2018), the normal blood pressure values in a healthy adult is 120/80 mmHg. The patient is already suffering from dizziness, fatigue, and feeling of unwell. These are the symptoms of low blood pressure. Too low blood pressure in patient can lead to serious complications; therefore if this assessment is not completed accurately then it might lead to consequences such as falls and fall-related injuries, poor oxygen supply, and damage to the heart, brain, and major organs of the body. This can lead to a few other health problems such as blurred vision, dehydration, nausea, and lack of concentration. Therefore, it is necessary for the patient’s condition and the nursing care to consider this point to prevent potential harm to health. The assessment can be recorded in medical records/reports or documented in form of ISBAR.

The blood sugar levels of the patient are12 mmol/L. It is a very high level that can impact the health of the patient. According to Haak et al. (2017), the normal blood sugar levels of an adult are 4.0 – 5.4 mmol/L. Too high blood sugar levels impact the patient’s condition and nursing care; therefore if this assessment is not completed accurately then it might lead to consequences as it will lead to damage to the blood vessels which supply blood to major organs and can lead to heart attack, stroke, nerve problems, kidney disease, and vision problems. It will also lead to a condition call hyperglycemia. Therefore, it is important to control and manage this factor to stabilize the patient to prevent unexpected outcomes such as blurred vision, headaches, problems with thinking, and frequent urination. The assessment can be recorded in medical records/reports or documented in form of ISBAR.

The diet of the patient should be monitored effectively; this is so because the patient is diabetic and might suffer from frequent hunger and any high sugar or salt content in the diet can affect the patient’s condition and nursing care. As high blood pressure and blood, glucose level the patient is refusing to eat, so it is required to encourage her to eat a healthy and nutritious diet to prevent unnecessary weight loss or weakness. If diet assessment is not completed accurately then it might lead to consequences, these are as follows: According to Lewis et al. (2016), poor diet impacts the health of patients with heart disease, hypertension, diabetes, or other illness.The assessment can be recorded in medical records/reports or documented in form of ISBAR.

Medical Surgical Nursing - Task 2

Nursing Care Plan: Mrs. Lily Orange

Nursing problem:Risk of fluid volume deficit
Related to: Dehydration
Goal of care	Nursing interventions	Rationale
The goal of the care is to prevent dehydration problems in the patient.	Ask the patient to drink the prescribed amount of fluids. The patient should be provided with IV fluids.	According to Parker et al. (2016),older patients have a decreased sense of thirst and they often do not remember to drink. Therefore they need continuous or frequent reminders for marinating their fluid intake levels so that dehydration issues are resolved. Moreover, drinking of adequate amount of fluids will help in maintaining fluid-electrolyte balance of the body. IV fluids are used in such dehydrated patient who cannot drink normally to maintain the hydration levels of the patient.
Nursing problem:Nutritional Imbalance
Related to: Poor diet that results in serious health issues
Goal of care	Nursing interventions	Rationale
The goal of the care is to prevent unwanted weight loss and weakness.	The nursing interventions include providing a nutritionally balanced diet as prescribed by the nutritionist and ask the patient to measure her diet regularly. The use of nasogastric tube can also be administered as an intervention.	According to Bush et al. (2020), a nutritionist suggests a balanced diet with patient-centered approaches. For example, a low blood pressure patient will be provided with a diet of slightly high salt content. The self-management is important for the patient to stay adhered to the progress toward desired goals and self-determined performance criteria. Moreover, NG tubes are administered to give extra calories to the patient.
Nursing problem:Risk ofunstable blood glucose level
Related to: Diabetes that can cause cardiovascular issues
Goal of care	Nursing interventions	Rationale
The goal of care is to prevent the condition of hyperglycemia.	The nursing interventions include administration of insulin as prescribed by the doctors and providing food or other glucose forms to maintain the blood glucose levels. Educate and ask the patient for daily exercises for blood glucose level and energy maintenance.	According to Yaping et al. (2020), insulin is required to be administered in patients who suffer from type 1 diabetes. If the patient cannot take diet or other edible components orally then intravenous glucose is administered. Moreover, physical inactivity is also found as a reason in diabetic patients for abnormal blood glucose levels so, diabetic should exercise daily. However, if the patient cannot perform high-level physical activity then the physiotherapists suggest special exercises that should be performed by the patient. This maintains body glucose levels and energy as well.

Medical Surgical Nursing - Task 3

The discharge planning is performed to ensure safe transitions and delivery of long-term care services to the patient even at his/her home. It reduces stay at hospitals and includes information about the type of care needed by the patient (Rodakowski et al., 2017).

The 2 important topics are – 1. Educating the patient for maintenance of the vital signs on a normal range and 2. Encourage the patient for daily physical activity.

As the patient had abnormal vital signs such as low blood pressure and high blood glucose levels. Therefore, she needs to be educated about the importance of frequent monitoring and evaluation of her vital signs. The strategy includesa frequent visit to the nurse or doctors to get the vital signs checked and ensure that the values are in the normal range. The patient should be taught about the signs and symptoms of high blood pressure, hypoglycemia, and hyperglycemia. So, that the self-management of the patient is encouraged and she can immediately inform her doctors whenever she notices any unexpected sign or symptom in her health. The patient should be educated about her loose clothing to ensure effective blood circulation, low glucose containing diet, and slightly high salt containing diet so that the vital is maintained in normal ranges (Wales et al., 2018). The patient and her family members should be asked to ensure that there is no skipping of meals or medicines. It should be ensured that medicines are taken at the scheduled time and fluid intake and output levels are maintained by drinking 8 glasses of water daily. Moreover, the patient and family members should be informed about health issues and management plans.

The patient should be asked for daily physical activity so maintenance of her energy levels and blood glucose levels. Thestrategy is – sessions with a physiotherapist. It is very important for a diabetic patient to exercise daily. A physically active body becomes more sensitive to insulin and it also helps in lowering the risk of cardiovascular disease that the patient might have due to her low blood pressure and high blood sugar levels. The patient should daily perform yoga, aerobics, dancing, or walking. These factors will help her get a better lifestyle and sound sleep, which will ultimately help in her controlled and healthy weight, happy life, controlled vitals, physical fitness for the body, and prevention of risk factors that can impact her health negatively (Durocher et al., 2017). A physically fit body will ensure limited co-morbidities, stable emotional, and physiological state of the patient to prevent the illness.

Medical Surgical Nursing - Task 4

Intravenous compound sodium lactate

Volume is 500 mls

Time is 2 hours

Hourly rate = volume in ml / time in hours

= 500 ml / 2 hours

= 250 ml per hour (for intravenous compound sodium lactate (CSL))

Intravenous sodium chloride

Volume is 1000 mls

Time is 8 hours

Hourly rate = volume in ml / time in hours

= 1000 ml / 8 hours

= 125 ml per hour (for intravenous sodium chloride)

Intravenous sodium chloride

According to Dhatariya et al. (2019), pharmacokinetics include the administration of the fluid intravenously and excretion of the excess sodium through urine and small amounts is lost in sweat and feces. It maintained the fluid-electrolyte balance, acid-base balance, and electrodynamic properties of the cells in the body.

In this case study, the patient is not eating much and has diabetes, this might impact her healthy with metabolic acidosis. Metabolic acidosis is a serious disorder of electrolyte imbalance that is caused due to reduced ability of the kidney to excrete acids, loss of bicarbonates, and increased acid production (Shuster et al., 2020). In uncontrolled diabetes, there is increased production and presence of ketone bodies (which are acidic in nature) (Shuster et al., 2020).So, prevent such complications the patient is used for intravenous sodium chloride.The side effects include swelling of feet or ankles, drowsiness, confusion, fluid build-up in the lungs, and few others (Dhatariya et al., 2019).

Insulin Glargine

According to Tuttle et al. (2018), the pharmacokinetics of insulin glargine involves the regulation of insulin production. After its administration in the body, it is neutralized from its acidic nature and is converted into microprecipitates from which the insulin is released at a slow rate. It enters the body the lowers the blood glucose levels by stimulating the muscles and fat to take up blood glucose and it stimulates the inhibition of hepatic glucose.

The patient in this case study has very high levels of blood glucose levels, so in order to control her glucose levels, it is important to administer her with this medication.

It has side effects as well like weight gain, reactions, fluid retention at extremities, cough, backache, and running and stuffy nose. There are some severe complications as well like trouble in breathing, low blood sugar levels, low blood pressure, low amount of potassium in the body, and few others. The less severe expressions are throat irritation, headache, itching, diarrhea, skin rash, and common cold (Pozzilli et al., 2017).

References for Medical Surgical Nursing

Bush, C. L., Blumberg, J. B., El-Sohemy, A., Minich, D. M., Ordovás, J. M., Reed, D. G., &Behm, V. A. Y. (2020).Toward the definition of personalized nutrition. Journal of the College of Nutrition, 39(1), 5-15.https://doi.org/10.1080/07315724.2019.1685332

Dhatariya, K. (2019). Diabetic ketoacidosis and hyperosmolar crisis in adults. Medicine, 47(1), 46-51.https://doi.org/10.1016/j.mpmed.2018.10.001

Durocher, E., Gibson, B. E., &Rappolt, S. (2017). Rehabilitation as “destination triage”: A critical examination of discharge planning. Disability and Rehabilitation, 39(13), 1271-1278.https://doi.org/10.1080/09638288.2016.1193232

Haak, T., Hanaire, H., Ajjan, R., Hermanns, N., Riveline, J. P., &Rayman, G. (2017). Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: A multicenter, open-label randomized controlled trial. Diabetes Therapy, 8(1), 55-73.https://doi.org/10.1007/s13300-016-0223-6

Lewis, M., & Lee, A. (2016).Costing ‘healthy’food baskets in Australia–A systematic review of food price and affordability monitoring tools, protocols and methods. Public Health Nutrition, 19(16), 2872-2886.https://doi.org/10.1017/S1368980016002160

Park, S., Buranakitjaroen, P., Chen, C. H., Chia, Y. C., Divinagracia, R., Hoshide, S., &Sogunuru, G. P. (2018). Expert panel consensus recommendations for home blood pressure monitoring in Asia: The Hope Asia Network. Journal of Human Hypertension, 32(4), 249-258.https://doi.org/10.1038/s41371-017-0025-y

Parker, B. (2016). Feminist forays in the city: Imbalance and intervention in urban research methods. Antipode, 48(5), 1337-1358.https://doi.org/10.1111/anti.12241

Pozzilli, P., Norwood, P., Jódar, E., Davies, M. J., Ivanyi, T., Jiang, H., &Milicevic, Z. (2017).Placebo‐controlled, randomized trial of the addition of once‐weekly glucagon‐like peptide‐1 receptor agonist dulaglutide to titrated daily insulin glargine in patients with type 2 diabetes (AWARD‐9). Diabetes, Obesity and Metabolism, 19(7), 1024-1031.https://doi.org/10.1111/dom.12937

Rodakowski, J., Rocco, P. B., Ortiz, M., Folb, B., Schulz, R., Morton, S. C., & James III, A. E. (2017). Caregiver integration during discharge planning for older adults to reduce resource use: A metaanalysis. Journal of the Geriatrics Society, 65(8), 1748-1755.https://doi.org/10.1111/jgs.14873

Shuster, S., Borici-Mazi, R., Awad, S., &Houlden, R. L. (2020).Rapid desensitization with intravenous insulin in patient with diabetic ketoacidosis and insulin allergy. AACE Clinical Case Reports.https://doi.org/10.4158/ACCR-2019-0562

Tuttle, K. R., Lakshmanan, M. C., Rayner, B., Busch, R. S., Zimmermann, A. G., Woodward, D. B., &Botros, F. T. (2018). Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate-to-severe chronic kidney disease (AWARD-7): A multicentre, open-label, randomised trial. The lancet Diabetes & endocrinology, 6(8), 605-617.https://doi.org/10.1016/S2213-8587(18)30104-9

Wales, K., Salkeld, G., Clemson, L., Lannin, N. A., Gitlin, L., Rubenstein, L., & Cameron, I. D. (2018). A trial based economic evaluation of occupational therapy discharge planning for older adults: The HOME randomized trial. Clinical Rehabilitation, 32(7), 919-929.https://doi.org/10.1177%2F0269215518764249

Yaping, X., Huifen, Z., Chunhong, L., Fengfeng, H., Huibin, H., &Meijing, Z. (2020).A meta-analysis of the effects of resistance training on blood sugar. Midwifery, 102839.https://doi.org/10.1016/j.midw.2020.102839

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