Oman Colleges Of Health Sciences

Adult Health Nursing 11 - Practicum Course

Case Study About:

DKA
“Diabetic Ketoacidosis”

(NUR 218)

Student Name: Jahina Said Al-kalbani

Student ID: 204587

Submission Date: 22/2/2023

Clinical Instructor Ms. Fatima

YOU ARE ALERTED ON THE CONSEQUENCES OF CHEATING OR ATTEMPTING TO CHEAT IN ANY COURSE
ASSESSMENT
 CASE STUDY REQUIREMENT
The learning outcomes expected from the student upon completion of the case study are to:

1. Assess and gathers accurate and relevant data by interviewing patient and performing health
assessment skills.

2. Utilize the knowledge base related to pathophysiology, and pharmacology to incorporate

details with the selected case.

3. Practice the health history interview and physical assessment skills to perform the assessment
of the case.

4. Compare and contrast the disease etiology, clinical manifestations, and treatment modalities
of the selected case with the up-to-date reference to integrate knowledge and experience
based on scientific knowledge.

5. Establish needs priorities in collaboration with other health care providers.

6. Identify and utilize the subjective and objective data to formulate a priority care plan which
includes 2 actual and 2 potentials.

7. Implement the suggested interventions in the care plan based on the evidence-based practice

8. Formulate a health teaching plan based on the essential learning needs of the patient.

9. Evaluate the progress towards the planned outcomes.

10. Document a brief report about the patient based on standard guidelines.

11. Maintain therapeutic communication with the patient and family members.

12. Works collaboratively with other professionals in health care to enhance interprofessional
attitudes.

13. Demonstrate skills in accessing health information systems by using the electronic health
management system in the hospital and being able to utilize information.

AHNII PracticumCourseSyllabus NUR218 AY2022-2023

 Patient Initials: y. Al-hinai
Hospital Name / Ward: Ibri Regional Hospital/ FMW
Date of Hospitalization 5/2/2023

Duration of For 5 days of hospitalization

Hospitalization

1. Patient's Demographic Data: (1 mark)

Age: 20 years old Gender: Female

Address: Amla Occupation: -

Nationality: Omani Religion: Muslim
Level of Education: Secondary school
Marital Status: Single

2. Medical Data:

Diagnosis:

- Insulin-dependent diabetes mellitus with ketoacidosis (DKA)

If surgical patient please fill the following details: not surgical patient

• Pre-operative Patient: ×

• Name of the planned operation & date: ___________-_________________________ Postoperative

Patient: ×
• Name of operation: _________________________-___________________________

• Date: ___________-____________

• Postoperative duration: ________-_______

AHNII PracticumCourseSyllabus NUR218 AY2022-2023

3.Health history: (3 marks)

a. Present/chief complaints: (write a descriptive paragraph not less than 5 sentences describing the reason for seeking
health care, the most urgent health concern now, if pain is present, please provide PQRST).
Yosra Mohamed was admitted to the hospital on 5/2/2023. she is 20 years old. She came to the hospital with
a complaint of Insulin-dependent diabetes mellitus with ketoacidosis. she has nausea and vomiting,
weakness, and tiredness also, she came with severe dehydration, electrolyte loss,Anorexia, and fatigue.
Urine analysis reveals ketonuria. Her vital signs: BP=102/65 mmHg, T=35.7 C, HR=112bts/min,
RR=24breath/min. Her weight=40Kg. Her HGT level is 21 mmol/L. ABG indicate patient have metabolic
acidosis. No pain.

b. Past Medical History: (please tick what is applicable to your patient)

Childhood illnesses - The patient had Obstetric history -----------

chickenpox but she
did not remember
when.
Accidents or Immunizations - She received all immunization
injuries - She did an accident when he was a child.
in2018.
Serious or chronic - The patient had Allergies - The patient did not have any
illnesses diabetes type 1. allergies to food or medication.
Hospitalizations - She was hospitalized Operations 1. Operated on 7/2/23 for
in Ibri hospital for Incision and drainage of the
severe dehydration hematoma.
(DKA). 2. Operated on 22/5/22surgical
removal of tooth.
3. Operated on 9/6/22 for I&D of
perianal abscess.

AHNII PracticumCourseSyllabus NUR218 AY2022-2023

 c. Past family history: (identify any medical, surgical, serious illness and mental illness (this should
be shown in the genogram if any members are not healthy)

Father - Uncle -
Mother - Auntie 3 aunts havediabetes
Brother diabetes Grandparents diabetes
Sister -

5. Health Assessment: (Head to Toe examination details should provide both the subjective and objective
data of abnormal findings and will be documented using the sample table shown below.)

Head-to-Toe Physical Examination (8 marks)

General Survey:
Gender: Female Age:20years old Weight:40kg Height:162cm
General - A female patient was 20 years old, came to the ward, was
Appearance: oriented, and wore clean and professional clothes. She has
Hint: Grooming normal bodybuilding and posture with normal behaviors
/ facial and a good manner.
expression - She looks tired due to the disease and because of not
eating (nausea and loss of appetite).She has good eye
contact with me and others.

AHNII PracticumCourseSyllabus NUR218 AY2022-2023

Vital Signs:
Temp: 35.7C Pulse:112 beats/minRR: 24breaths/min BP: 102/65mmHg SpO2: 85%

Neurological Assessment:
Assessment Patient’s Findings
Level of The patient was awake and aware of the location, time,
Consciousness (LOC): and event. She responded to all of my queries and
(alertness & statements with the appropriate answers.
Orientation)
Eyes: Good vision, inner conjunctiva looks normal in color, no
(inspection external & swelling, no exudates, foreign body or lesion, normal
Internal, visual fields, sclera and Iris, no dryness or paleness.
inner eye &
extraocular
muscles)
Pupils: The normal size of the pupil, deep black pupil, good
(size, reaction to light reaction to light and accommodation.
& accommodation)
Ears: No discharge, equal, pain, and good reaction when doing
(inspection of external the hearing test.
& internal, hearing
test)
Extremities: Normal no weakness in extremities.
(hand grip & foot
push)
Cranial nerves: I (Olfactory nerve): good smell.
(CN: I – XII) II (Optic nerve): she has good vision, and no retinal
detachment, or problems.
III (Oculomotor nerve): good muscle function and pupil
response.
IV (Trochlear nerve): the muscle responsible for
downward, outward, and inward eye movement.
V (Trigeminal nerve): good ophthalmic reaction, no
Maxillary, and mandibular problems.
VI (Abduces nerve): good outward eye movement.
VII (Facial nerve): good sensory and motor function of

AHNII PracticumCourseSyllabus NUR218 AY2022-2023

 facial muscles.
VIII (Vestibulocochlear nerve): good hearing and body
balance.
IX (Glossopharyngeal nerve): good throat and neck
condition.
X (Vagus nerve): good chest movement, normal gag
reflex, and normal speech.
XI (Accessory nerve): good rotation, flex, and extend the
neck and shoulder.
XII (Hypoglossal nerve): good movement of most of the
muscles in the tongue.
Pain: COLDSPA
(character, onset, No pain.
location, duration,
severity, pattern &
associated factors)

Cardiovascular Assessment:
Skin & Mucous Skin is dry, the mucous membrane is pink.
membranes:
(color)
Pulses: Her pulse is 99 beats/minute taken from the jugular vein,
(location, sounds, with a regular rhythm, and in lub dub sound.
rhythm, abnormal
sounds)
Jugular vein: The jugular vein was present in the patient and present
well by palpation way.
Capillary refill: Return within 3 seconds.
Edema: No edema in lower extremities.
(location / character)
Risk factors: --

AHNII PracticumCourseSyllabus NUR218 AY2022-2023

Respiratory Assessment:
Nose: she has conjunction in his nose, good patency on both
(inspection, patency, sides, no nasal discharge and drainage, no bleeding, no
drainage) pain, and no swelling.
Respirations: Her respiration was20 breaths/minute, the pattern is
(inspection, palpation, regular and even the rhythm, its depth is not exaggerated,
percussion & and effort.
auscultation)
Cough: No cough presents.
Character of cough
Risk factors: -

Gastrointestinal Assessment:
Oral: Lips are pale and dry, the color of mucous membranes
(Mucous membrane, and gums is pink. The tongue is smooth and not tender.
Teeth, gums, tongue, she has good oral hygiene. she is able to provide dental
palate & uvula) hygiene two times a day.
Abdomen: (inspection, During the inspection, no wounds no drainage, no
auscultation, percussion signs of infection, and scars. In auscultation, normal
& palpation) powel sound.
Bowel sounds: Normal active.
Bowel movement: Normal bowel movement, defecate 2 times a day in
(frequency, color, normal frequency and color.
consistency)
Nutrition: She avoids food with high sugar and fat .
(lifestyle & type of diet)

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Musculoskeletal Assessment:
Mobility: She has a normal gait, doesn’t use any assistive devices
(gait, assistance can perform ADLs by herself but she feels tired when
devices, moving or working for a long time.
ADLs, RoM&
positioning)
Circulation, Sensation Good circulation in upper and lower extremities, good
& movement (CSM): sensation.
Risk for fall: Risk for fall 9/10. When fainting occurs only.
Score / precautions
Integumentary Assessment:
Appearance: (color, dry, normal skin temperature, good skin turgor.
temperature, turgor,
texture, integrity)
Wound dressing: No wound.
(site & wound
character, drainage)
Pressure ulcers: No presence of an ulcer.
(location, size, stage)

Genitourinary Assessment:
Urine: Frequent urination, light yellow in color, with no
(Frequency, color & bleeding on it.
clarity)
Genitalia: She is a female; she has normal discharges,LMP (before
(gender, discharge, 2 weeks)
LMP
– if female)
Intake & output: -13 liters per a day approximately (output).
(route & total I&O
amount)

AHNII PracticumCourseSyllabus NUR218 AY2022-2023

Focused Assessment: (8 marks)

Health assessment Subjective data Objective data Suggested Health problems

system
GI system - Feeling nausea She refused to eat any
and anorexia. things. Diabetic ketoacidosis.
- She said “I
feel want to
vomiting when I
smell or see
food”.

- She feels tired Look tired and Fatigue (the cell doesn’t get
Skeletal muscle - Unable to listlessness. enough glucose).
system move or work
for a long time.

Genitourinary She said “I need - High level of serum Impaired kidney function.
System to urinate many creatinine.
times in a short
periods and
during sleep”
Integumentary -------- Has dry skin. Dehydration.
system

6. Definition of the disease: (write in-text reference) (1 mark)

DKA: 1.

- It is primarily associated with type 1 diabetes mellitus. Diabetic ketoacidosis (DKA) is a state of
uncontrolled hyperglycemia due to insulin insufficiency(Anon, 2019).

7. Alteration/s in the affected system (Pathophysiology): (5marks)

(Should be written in diagram form which is summarized by the student)

AHNII PracticumCourseSyllabus NUR218 AY2022-2023

 lack of insulin

-Decrease utilization of glucose Increased breakdown of fat

by muscle, fat, and liver.
- Increased production of
glucose by liver

Increased fatty acid

Hyperglycaemia
Increased ketone bodies

Blurred polyuria
vision
Acidosis
 Acetone breath
Dehydration  poor appetite
 Nausea

Nausea
Increasingly
rapid Vomiting
respiration
Abdominal
 Weakness  Increased pain
thirst
 Headache (polydipsia)

(White,B.(2015)) DKA

AHNII PracticumCourseSyllabus NUR218 AY2022-2023

8. Etiology of the Disease: (3 marks)

S.. According to Literature In your patient

● Autoimmune reaction  Strong family
history of T1DM (3
● Genetic reaction
aunties and one
● Hormonal disease brother)
● Some medication

● Curry certain genes that are linked to the  She has been
disease (family history) suffering from the
disease since she
 Age (more likely to develop when you’re a
was 10 years old.
child, teen, or young adult)

(Taylor & Francis, 2019)

9. Clinical Manifestations of the disease: (3 marks)

S.#. According to Literature In your patient (Description)

 Increased thirst The patient has:

 Increased thirst
 Frequent urination

 Extreme hunger  Frequent urination

 Unintended weight loss  Fatigue and weakness

 Fatigue and weakness  Dry skin

 Dry skin

 Sudden vision changes

 Drowsiness or lethargy

(Taylor & Francis, 2019)

10. Investigation conducted for your patient: Lab & Diagnostic tests (4 marks)

AHNII PracticumCourseSyllabus NUR218 AY2022-2023

 Name of Results Normal range Significance of results
investigation
PH ^7.20 (7.35-7.45) Abnormal because the
PO2 ^29.10 mm(Hg) (83-101) mm(Hg) patient has diabetic
Venous blood SO2 59.3% 95-99% Ketoacidosis
gas (PH only) HCO3 ^11.60 mmol/L (21-28) mmol/L
PCO2 41.60 mm(Hg) (32-45) mm(Hg) Normal
Electrolytes Sodium ^135.52 mmol/L (137-148) mmol/L Low sodium level
(excessive urination)

Potassium 4.34 mmol/L (3.5-5) mmol/L Normal

Urea ^7.27 mmol/L (2.5-6.7) mmol/L Abnormal

RFT (Impaired kidney function)
Serum ^95.23. umol/L (45-100) umol/L Because of reduce creatinine
creatinine clearance.
LFT Total protein 75.05 g/L (60-80) g/L Normal

Albumin 41.72 g/L (35-50) g/L Normal

Globulin 33.33 g/L Normal

AHNII PracticumCourseSyllabus NUR218 AY2022-2023

 (3 marks)

S.#. Name of Diagnostic Patient’s Result Significance of

Investigation Results

 ECG Normal ----

 Chest X-ray Normal ----

11. Treatments carried out for your patient: (3 Marks)

A.Medical: (The student has to list all the type of treatment according to his case which should be taken from reference
and then compare whether it is applied or not)

AHNII PracticumCourseSyllabus NUR218 AY2022-2023

Types of Name of Purpose Applied to your If it is not
Treatment treatment patient applied give
the reason
Insulin regular Control the blood sugar and Applied
Medical injection prevent complications of ___
(human) diabetes

Surgical The patient

didn’t do any
surgery before
for this disease.

Non- - Diabetes diet

pharmacological:
- Physical activity moderate-intensity aerobic physical activity)

- Snakes (prevent hypoglycemia)

- Blood glucose monitoring

AHNII PracticumCourseSyllabus NUR218 AY2022-2023

 12. Medical treatment: (Write FIVE specific drugs as per disease) (10marks)

No Name of Classificatio Dose Route Frequenc Action Side effects Nursing responsibilities
medication n y
Is recombinant form  Hypoglycemia  Check the patient medical record
1 Insulin regular Antidiabetics, 30 IU SC Split dose of human insulin  Headache for any allergic to insulin
injection short –acting used to control  Hunger.  Monitor signs of hypoglycemia
insulin hyperglycemia in  Sweating especially during and after
diabetes mellitus  Dizziness exercise
during meals and
snacks.  Assess blood pressure
periodically.
(KarchA, 2013)
2 Heparin Anticoagulan 4000 IU SQ OD Inhibits reactions  Fever  Don’t give by IM injection
t that leads to the  Irregular  Assess the signs of bleeding
clotting of blood breathing gums, and nosebleeds.
and the formation  Chest pain  Assess the site of injection for
of fibrin clots.  Chills pain, swelling, and irritation.
(Karch A, 2013)  Osteoporosis
(Karch A,2013)

AHN IIPracticumCourseSyllabus NUR218 AY2022-2023

N Name of Classification Dose Route Frequenc Action Side effects Nursing responsibilities
o. medication y

Normal Saline 1000ML IV OD Replaces deficiencies of  Anorexia  Monitor electrolyte levels and
3 Sodium chloride sodium and chloride and  Nausea & blood chemistry results.
0.9 IV maintains these Vomiting  Watch for signs and symptoms of
electrolytes at adequate  Dizziness pulmonary edema or worsening
levels .  increase heart failure.
thirst  Carefully monitor vital signs, fluid
(Karch A, 2013) balance, weight, and cardiovascular
status.

AHN IIPracticumCourseSyllabus NUR218 AY2022-2023

No Name of Classification Dose Route Freque Action Side effects Nursing responsibilities
. medication ncy

Binds to mu-opioid -CNS: sedation,  Control environment (temperature,

4 Tramadol Analgesic 50mg IV SOS receptors and dizziness or vertigo, light) if sweating or CNS effects occur.
(centrally inhibits the headache,  Ensure that the patient does not cut,
acting) reuptake of confusion, sweating, crush or chew ER tablets.
Opioid norepinephrine and seizure  Be aware there is an increased risk for
analgesic serotonin, causes -CV: hypertension, seizures in patients with a history of
many effects tachycardia, seizures or who are taking other drugs
similar to the bradycardia, that lower the seizure threshold.
opioid-dizziness, vasodilation (Karch A, 2013)
somnolence, -Dermatologic:
nausea, and sweating, rash,
constipation- but pallor, urticarial
does not have the -GI: nausea,
respirator vomiting, dry
depressant effects. mouth, constipation

AHN IIPracticumCourseSyllabus NUR218 AY2022-2023

N Name of Classification Dose Route Frequency Action Side effects Nursing responsibilities
o. medication

Decreased the amount Headache,  Assess the dizziness that might

5 Omeprazole Anti- 30 mg IV OD of acid produced in the abdominal pain, affect gait, balance, and other
injection secretory stomach and treat fever, rash. functional activities.
-Proton pump symptoms of (Karch A,  Monitor any chest pain and attempt
inhibitor gastroesophageal 2013) to determine if the pain is drug-
reflux disease and induced or caused by cardiovascular
other condition caused dysfunction.
by excess stomach acid

AHN IIPracticumCourseSyllabus NUR218 AY2022-2023

13. Nursing Care Plan: (List all possible nursing diagnoses related to your patient)

S.No. Nursing Diagnoses

1 Ineffective breathing pattern related to metabolic acidosis as manifested by ABG results ( HCO3 = 11.60mmol\l, PH=7.20

2 Unstable blood glucose level related to non-adherence to the therapeutic regimen and adequate blood glucose monitoring secondary
to diabetic ketoacidosis as manifested by HGT=21 mmol/L, and breath fruity odor.
3 Electrolyte imbalance related to the compensatory mechanism for ketoacidosis manifested by ketonuria and metabolic acidosis

4 Deficient fluid volume related to electrolyte imbalance manifested by dehydration and fruity breath.

5 Imbalanced nutrient: less than body requirement related to insulin deficiency and decreased oral intake manifested by the patient’s
refusal to eat any type of food, weight loss (from 50kg to 40kg), weakness, and fatigue.
6 Fatigue related to insufficient insulin manifested by: the patient’s inability to perform ADLs for a long time, feeling generalized
weakness, she feeling listlessness.
7 Risk for impaired skin integrity related to dehydration and decreased mobility

8 Risk for hospital-acquired infection related to hospitalization.

AHN IIPracticumCourseSyllabus NUR218 AY2022-2023

 Assessment Nursing Goals(2 marks) Nursing Rationale (2.5 marks) Evaluation
diagnoses orders/interventions (5 (2.5 marks)
(Actual) (3 Marks)
marks)
Subjective: Ineffective The patient will maintain an 1. Assess ABG levels 1. To monitor the oxygen and ventilation The goal is met as
breathing effective breathing pattern according to facility policy status evidenced by:
 She came with severe
pattern with oxygen saturation and
dehydration. 2. Observe for the 2. Most people panic when they cannot 1. ABG results
related to blood gases within the
perception of respiratory breathe or have difficulty breathing. This returned to the normal
 Tiredness metabolic normal range.
distress and anxiety. anxious state may worsen the ability of level and remained
acidosis as
Objectives: Outcome Criteria breathing. within established
manifested by
1. Patient’s ABG levels limits.
 Weakness ABG results 3. It is important to act when there is an
return to and remain within 3. Assess and record
HCO3 = alteration in breathing patterns to detect 2. The patient
 Vital signs: established limits. respiratory rate and depth
11.60mmol\l, early signs of compromise in the behaviorally
BP=102/65 mmHg, every 4 hours.
PH=7.20 2. Patient indicates, either respiratory system. (diaphragm
T=35.7 C, SPO2:
verbally or through 4. Monitor for movement) indicated a
85% 4.Paradoxical movement of the abdomen
behavior, feeling diaphragmatic muscle sense of relief when
HR=112bts/min, (an inward versus outward movement
comfortable when fatigue or weakness he was breathing.
RR=24breath/min. during inspiration) is indicative of
breathing. (paradoxical motion).
Wt.=40Kg. respiratory muscle fatigue and weakness. 3. Patient's respiratory
HGT=19.6 mmol/L. 3. Patient's respiratory rate 5. Put the patient on a rate remained within
5. To return ABG results and SPO2 to
ABG = (HCO3:11.60 remains within established ventilator as doctor’s established limits.
normal.
mmol /L, PH:7.20) limits. orders

AHN IIPracticumCourseSyllabus NUR218 AY2022-2023

Assessment Nursing Goals(2 marks) Nursing orders/interventions (5 Rationale (2.5 Evaluation (2.5
diagnoses Marks) marks) marks)
(Potential)
(3 marks)
Subjective: Unstable blood The patient will report no 1. Assess for signs of 1. Hyperglycemia results The goal is met as
 She came glucose level related signs and symptoms of hyperglycemia when there is an evidenced by:
with severe to non-adherence to hyperglycemia. inadequate amount of 1. The patient maintains
dehydration. the therapeutic insulin to glucose. Excess a blood glucose level of
Outcome Criteria
regimen and glucose in the blood less than 12 mmol/L
 Tiredness 1. Patient will maintain a
adequate blood creates an osmotic effect . 2. The patient showed a
blood glucose level of less
glucose monitoring 2. Assess eating patterns. 2. No adherence to dietary willingness to
Objectives: than 12 mmol/L
secondary to change: dangling legs, ambulation guidelines can result in participate in the
 HGT=21 2. Patient will be able to show
diabetic ketoacidosis hyperglycemia. therapeutic management
mmol/L a willingness to participate in
as manifested by plan.
 Breath fruity the therapeutic management
HGT=21 mmol/L, 3. Teach the patient how to perform 3. To maintain blood 3. Increased knowledge
odor. plan.
and breath fruity home glucose monitoring glucose of the importance of
3. Patient will increase
odor. maintaining normal
knowledge of the importance
4. Encourage the patient to do 4. Physical activity helps blood glucose levels.
of maintaining normal blood
physical activity. lower blood glucose.
glucose levels.

5. Administer insulin medication as 5. To lower blood glucose

directed. level

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SNo. Nursing diagnoses Goals(2 marks) Nursing orders/interventions (5 Rationale (2.5 marks) Evaluation (2.5
(Potential) (3 marks) Marks) marks)

Subjective: Risk for impaired skin The patient will be free 1. Assess the overall condition of 1. To feel warm and dry to The goal is met as
integrity related to from any signs of the skin. the touch, be free from evidenced by:
dehydration and impaired skin and impairment.
1. Patient took adequate
decreased mobility normal integrity within 2. Evaluate the patient’s strength
2. To identify a greater risk factor fluid intake.
1 wk. to move (e.g., shift weight while
in skin breakdown is immobility.
sitting, turn over in bed, move 2. Patient had normal
Outcome Criteria
--------- from bed to chair). 3. To the pressure needed to vital signs. T: 36.8 c,
1. Patient will take
close capillaries are around 32 HR: 88/min., RR:
adequate fluid intake. 3. Encourage the patient to mm Hg; any pressure above 32 20/min., BP: 120/75
2. Patient will have change position every 15 minutes mm Hg leads to ischemia. mmHg, SPO2: 99%.
normal vital signs. and change chair-bound positions
4. To reduce pressure on the skin 3. Patient was free from
every hour.
3. Patient will be free from immobility thus lessening any signs of impaired
from any signs of 4. Encourage ambulation if the the factors that may result in skin integrity.
Objectives: impaired skin integrity. patient is able. impaired skin integrity.
4. Patient used correct
4. Patient will use 5. To provide hydration and methods for skin care.
5. Encourage adequate nutrition
correct methods for nutrition to help maintain
and hydration.
skin care. skinturgor, moisture, and
suppleness.

-------

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Assessment Nursing Goals(2 marks) Nursing Rationale (2.5 Evaluation (2.5 marks)
diagnoses orders/interventions (5 marks)
(Potential) Marks)
(3 marks)
Subjective: risk for infection The patient will remain free from 1-Assess the patient for 1- Identify the risk factor for The goal is met as evidenced by:
related to impaired infection during hospitalization signs and symptoms of infection
1-the patient was able to perform
immune system and and after discharge infection 2- Help in the reorganization
hand washing in an appropriate
leukocytes and 2- Educate the patient of infection early.
way before and after meals, and
inadequate glycemic about the sign and 3- To prevent any possibility
--------- Outcome Criteria after using the bathroom
control symptoms of infection of transmission of the
1-demonstrate understanding the
3- Encourage the patient disease . 2-the patient was able to follow
steps of hand washing techniques
to wash hands 4- Early diagnosis of precautionary measures against
continuously infection (Gil. Wane, infection like wearing a facial
2- verbalize ability to follow
Objectives: 4- Monitor WBC 2020) mask, using disinfected, and
precaution measure against
5- Provide food that 5- To build a strong immune wearing gloves during
infection
continues the amount of system hospitalization
3- Patient remains free of
------- protein and calories.
infection, as evidenced by normal 3- Patient can state signs and
vital signs and absence of signs symptoms of infection with normal
and symptoms of infection vital signs. T: 36.8 c, HR: 88/min.,
RR: 20/min., BP: 120/75 mmHg,
SPO2: 99%.

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14. Evidence: (10 marks)
(Provide two best evidence from the literature to support one area of nursing care
plan. The evidence should be analyzed by answering the questions below.)Each
question is worth 2 marks.

1. How it is related to your patient

2. Summary of literature finding
3. Compare literature finding with real practice
4. Implication in practice
5. Your own learning experience

Title:(Clinical Effects of Balanced Crystalloids vs Salinein Adults with Diabetic

Ketoacidosis)

1. How it is related to your patient:

The study speaks about the clinical effects of balanced crystalloids and saline in the
treatment of adults with diabetic ketoacidosis, and the first management for my patient was
IV fluid therapy. So, the study compares the clinical effects of both balanced crystalloids and
saline in the treatment of adults with diabetic ketoacidosis.

2. Summary of the literature finding:

This study was a subgroup analysis of adults with DKA in 2 previously reported companion
trials: Saline Against Lactated Ringer's or Plasma-Lyte in the Emergency Department and
the Isotonic Solutions and Major Adverse Renal Events Trial. These trials were conducted in
an academic medical center in the US. This study included adults who presented to the ED
with DKA, defined as a clinical diagnosis of DKA plasma glucose greater than 250 mg/dL,
plasm Summar bicarbonate less than or equal to 18 mmol/L, an anion gap greater than 10
mmol/L.94 balanced crystalloids and 78 salines were given to the 172 adults who were a part
of this secondary analysis of cluster trials. The volume of isotonic fluid supplied in the ED
and ICU was 4478 (3000-6372) mL, which was the median (IQR) value. A cumulative
incidence analysis showed that the balanced crystalloids group experienced DKA resolution
more quickly than the saline group (median time to resolution: 13.0 hours. Additionally,
cumulative incidence analysis showed that the balanced crystalloids group had a shorter time

AHN IIPracticumCourseSyllabus NUR218 AY2022-2023

to insulin infusion termination (median: 9.8 hours) than the saline group (median: 13.4
hours).

3. Compare the literature finding with real practice.

If we compare this study’s findings and real practice, we would find the same result as in Ibri
regional hospital they used balanced crystalloids solutions for acute management of adults
with diabetic ketoacidosis than saline.

4. Implication in practice.
This study has a significant effect on both medical and nursing practice as it helped the
doctors to decide which type of fluids to prescribe for patients with diabetic ketoacidosis and
explained to them and nurses the importance of doing different tests in a wide range of
people to decide which type of fluids has a rapid effect on the resolution of diabetic
ketoacidosis. Moreover, doctors and nurses will keep on doing different research on first-line
management and the way of delivering the best treatment to their patients.

5. Your own learning experience.

The study improved my knowledge level and explained to me the importance of doing
different lab tests before administering any medication or fluid infusion to patients. It also
taught me to do my own research and not rely on other people’s research and statistics before
examining them in my own country and applying them in our own settings. Furthermore, it
added to my knowledge of the more effective treatment and management that help us to
provide optimal care to our patients(self,Evans,Collins, 2020)

AHN IIPracticumCourseSyllabus NUR218 AY2022-2023

15. Health Education:(The student can use the METHOD approach.) (8 marks)

Medication:

 Encourage the patient to report any side effects of the drugs immediately to healthcare
providers

 Instruct the patient to take her insulin and other diabetes medication on time and in the
right dose.

 Explain to the patient never to remove the label from the bottle and always keep the
medicine container tightly closed.

Environment:

 Provide a comfortable, quiet, clean environment, free from sharp things for the patient to
feel comfortable.

 encourage the patient to avoid dirty environments to avoid infection due to

hospitalization.

 Provide a cool, quiet, and dark environment for the patient to promote sleeping.

Treatment:

 Encourage the client to continue treatment when he discharges to the home.

 teach the client the worsening of sickle cell anemia if doesn’t treat.
 Advise the patient to follow the instruction that is given by the doctor.
Health:

 Tell the patient about DKA and what mean.

 Taught patient about relaxation techniques like taking deep breathing and make a gentle
pressure for the body to improve blood circulation.

 Discussion the basic information of drug to patient.

AHN IIPracticumCourseSyllabus NUR218 AY2022-2023

Outpatient referral:

 Teach patient to contact doctor of any complications occurs

 Observe any complication occur to the patient after giving the medication

 encourage the client to take his medication for described period

Discussion the basic information of drug to patient

Diet:

 Provide information about diet and explain for the client about the importance of
nutrition foods in maintaining the general health.

 Encourage patient to eat regular meals that spread her calories and carbohydrate
throughout the day this will help keep her blood sugar steady.

 Taught to maintain body hydration by increase fluid intake 2 L/day

 Try to eat as you normally do, with a focus on healthy food choices.

AHN IIPracticumCourseSyllabus NUR218 AY2022-2023

16. References: (The student should use APA method of referencing) (2 marks)

1. Anna, B. (2022, May 16). Diabetic ketoacidosis DKA nursing diagnosis and nursing
care plan. Retrieved December 5,2022,fromhttps://nursestudv.net/diabetic-
ketoacidosis-dka-nursing-diagnosis/

2. Karch, A., 2013. Lippincott's nursing drug guide. Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins

3. Mayo (2021) diabetes diet: create your healthy –eating plan [online] Available at
https://www.mayoclinic.org/diseases-conditions/ diabetes/in-depth/diabetes-diet/art-
/syc-20044295

4. R. M., Casey, J. D., Collins, S. P., ... & Pragmatic Critical Care Research Group.
(2020). Clinical effects of balanced crystalloids vs saline in adults with diabetic
ketoacidosis: a subgroup analysis of cluster randomized clinical trials. JAMA-
network open, 3(11), e2024596-2024596. Available
at:https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772993
5. Taylor & Francis. (2019).:diabetes type1. [online] Available at:
https://www.cdc.gov/diabetes/basics/what-is-type-1-diabetes.htm

6. Wayne, G. (2022, March 19). Ineffective breathing pattern - nursing diagnosis

& care plan. Nurseslabs. Retrieved December 5. 2022.
From https://nurseslabs.com/ineffective-breathing-pattern/

~ End of the Case Study ~

AHN IIPracticumCourseSyllabus NUR218 AY2022-2023