diabetes ketoacidosis: To evaluate a patient from a pathophysiologic, environmental, and nursing perspective.

Clinical Paper Purpose:

1. …

2. To critically analyze the contributing factors of multiple disease processes for a patient.

3. To compose a professional nursing paper.

Instructions:

1. At the end of this directive is your patient’s case scenario, follow the template provided to present this patient’s past medical history and reason for hospitalization, complex needs etc. (see below)

Criteria: 1. No more than 7 to 9 pages (excluding Title, Abstract, and Reference pages).

2. Paper must be done according to APA format. No other format will be accepted.

3. At least five nursing references must be used for this paper.

4. References should be nursing journal articles less than five (5) years old, and One Textbook (ONLY) is allowed for one reference.

Clinical Paper Header(s) Template: Clinical Situation (APA first level header) Introduce your patient’s clinical situation, and medical history (For APA it is required to have at least 3-5 sentences for a paragraph) Complex Needs (APA, Second level header) Pathophysiology of the disease Contributing factors Subjective Clinical Data (APA Third level header) Clinical data obtained from therapeutic communication between you and your patient) If your patient is unable to speak then explain why Objective Clinical Data (APA Third level header) Clinical data obtained through your assessment and any diagnostics implemented Management of Care (APA first level header) Safe and effective care (one to two paragraph) Basic Care and Comfort (one to two paragraph) Pharmacological and Parenteral Therapies (one to two paragraph) Make sure you explain why the drug is being used Are there any Risk Potentials? (One or Two paragraphs) Examples of APA levels of headers Example of First Level Header (First level) Example of a Second Level Header (Second Level) Example of a third level header. You start typing your sentence here (Third level) Use this case scenario for your paper! Clinical Case Scenario: CASE HISTORY: KJ is a 20-year-old Caucasian male who was brought by EMT to the ED due to a fainting spell while playing piano at a college rehearsal. Besides being an athlete (football) and an A student, he is also a member of the debate team, an editor for the school’s weekly paper, and the pianist for the college choir. His daily schedule is very hectic, most of the time Kevin grabs whatever he can eat from the vending machine whenever his schedule allows. He is so busy he sometimes does not get enough sleep, forgets to eat and gets stressed over school, although he is very excited to be away from his parents for the first time and wants to experience life being independent. Vitals signs: BP – 94/65, HR – 102, RR – 24, T – 97. NKDA. PAST HEALTH HISTORY: Bilateral tonsillectomy & Adenoidectomy at age 8 MEDICATIONS: Insulin – two injections per day of 4 units NPH (before breakfast and at supper time). FAMILY HISTORY: Grandmother (maternal) HTN, father diagnosed with hypothyroidism Grandmother (paternal) type 2 diabetes SOCIAL HISTORY: KT is a freshman in college – school started three weeks ago Only child – first time away from parents High achiever Does not like to drink alcohol Your Initial Assessment Initial Assessment: Objective information: BP – 70/40 HR – 140 RR- 30 shallow Temp – 96.5 Pulse Ox= 97% Blood Gases…Blood work: pH – 7.23 PCO2 – 30 mmHg PO2 – 70 mmHg HCO3- – 20 mEq/L Blood Ketones= 1.5 mmol/l Urine Ketones Large amounAssessment: tachypnea, dry mucous membrane, Drowsy Fruity breath with acetone smell Subjective Information: Patient reported, very thirsty drinking a lot, and urinating a lot, has upset stomach Your patient’s condition worsens: Second Assessment He shows clinical signs of Labored, irregular breathing (Kussmaul) ↓ LOC (coma) ↓ Pulses ↑ BP (150/100) His Blood gases are: pH – 7.1 PCO2 – 26 mmHg PO2 – 60 mmHg HCO3- – 14 mEq/L Here are the patient’s medical orders: ü Change D5LR to an isotonic solution ü Give 1 L IV bolus within an hour then decrease IV to 125cc/hr ü Insert second IV with 14g needle – IVF – 0.45% NS 1 L ü Strict I & O ü Insert Foley Cath ü Accu-check, ABG, VBG, blood and urine ketone strip & electrolytes q h ü Monitor serum K+ level – delay insulin therapy until K+ is > 3.3 mEq/L ü If K+ >/= 5 mEq/L No KCL ü If K+ < 5 mEq/L add 20 meq KCL/L ü If K+ < 4 mEq/L add 40 meq KCL/L ü If K+ < 3 Call Physician ü Add K+ to isotonic solution and infuse at 10 meq/hr ü Give 10 units regular insulin as IV bolus now if BS > 300 mg/dl ü Give 5 units regular insulin as IV bolus if < 150 – 300 mg/dl ü Start insulin infusion drip, mix 100 units regular insulin in 100cc NS, run at the rate of 5 units/hr for 2 hours then adjust rate according to hospital insulin infusion rate protocol ü D/C insulin infusion when 2 consecutive readings of glucose is < 150 mg/dl ü Change 0.45% NS bag to D5 0.45% NS ü SQ insulin as needed – refer to hospital SQ insulin protocol NaHCO3- management as follows: ü pH > 7 = No NaHCO3- ü pH 6.9 – 7 = Give 1 amp NaHCO3- IV push and call MD ü pH < 6.9 = Give 2 amps NaHCO3- IV push and call MD ü Report any change in mental status and abnormal lab results STAT ü Transfer to ICU ASAP This patient is in a Diabetic Ketoacidosis Crisis Grading Rubric for Clinical Paper Topic Points First Submission Points Earned Final Points Awarded Clinical Situation · Patient intro. · Medical history 5 Points Complex Needs · Pathophysiology · Contributing Factors · Subjective clinical data · Objective clinical data 40 Points Management of Care · Safe and effective care · Basic Care and Comfort · Pharmacological and Parenteral Therapies · Risk Potentials 45 Points Format · APA style · Grammar, Spelling · 5 Nursing Journals 10 Points

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