Effective clinical reasoning skills are essential in nursing; an estimated half of all clinical adverse events are attributed to errors in clinical decision-making (Levett-Jones et al., 2013). Tanner (2006) defined clinical reasoning as the process via which nurses arrive at clinical decisions by weighing evidence, pattern recognition, using intuition, selecting from alternatives and patient safety. This clinical reasoning cycle (CRC) consists of 8 cyclical steps namely, consideration of the patient’s situation; collecting of cues and information; processing of information; identification of problems and issues; establishing objectives; taking action; evaluation of outcomes; and reflecting on processes and new learning (Levett-Jones, et al.,
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John vital signs were not in normal ranges. John’s temperature and tachycardia may be due to an infection (Noble et al., 2014). The condition of his oral mucosa is related to his fluid status (dehydration due to osmotic diuresis in DKA) (Umpierrez et al., 2002). John’s sweet-smelling breath could be related to ketone production in the liver Noble-Bell G, Cox A 2014). The presence of Kussmaul respirations indicates the possible presence of metabolic acidosis as these represent the body’s attempt to maintain a normal pH in the presence of metabolic acidosis (Foster & Provost, 2012). If inappropriate action was not taken at this time, John would have developed cerebral edema or gone into a diabetic coma and died (Craig et al., …show more content…
The diagnosis of DKA is usually clear-cut in patients who has diabetes type I. Umpierrez et al. (2002), however, cites evidence that seems to indicate that DKA is usually the first manifestation of type I diabetes mellitus in an estimated 30-40% of children and 20% of adults. Hyperglycemia and DKA factors that could have led to John’s deterioration are infection or illness, omitted or inadequate insulin; poor understanding of carbohydrate intake; failure of insulin administration device (Lemone et al., 2011).
The fifth step of the CRC is establishment of goals. DKA is a medical emergency that requires immediate care and which can have fatal consequences if misdiagnosed (Hardern & Quinn, 2003). The goal of care in John’s case was to confirm the diagnosis and its severity through appropriate diagnostic tests and to commence treatment with the aim of establishing rehydration within 24 hours; stabilising serum glucose within 6 hours; stabilizing electrolytes within 6 hours; and resolution of ketosis and acidosis within 12 hours (lelena, & Andrew,
John vital signs were not in normal ranges. John’s temperature and tachycardia may be due to an infection (Noble et al., 2014). The condition of his oral mucosa is related to his fluid status (dehydration due to osmotic diuresis in DKA) (Umpierrez et al., 2002). John’s sweet-smelling breath could be related to ketone production in the liver Noble-Bell G, Cox A 2014). The presence of Kussmaul respirations indicates the possible presence of metabolic acidosis as these represent the body’s attempt to maintain a normal pH in the presence of metabolic acidosis (Foster & Provost, 2012). If inappropriate action was not taken at this time, John would have developed cerebral edema or gone into a diabetic coma and died (Craig et al., …show more content…
The diagnosis of DKA is usually clear-cut in patients who has diabetes type I. Umpierrez et al. (2002), however, cites evidence that seems to indicate that DKA is usually the first manifestation of type I diabetes mellitus in an estimated 30-40% of children and 20% of adults. Hyperglycemia and DKA factors that could have led to John’s deterioration are infection or illness, omitted or inadequate insulin; poor understanding of carbohydrate intake; failure of insulin administration device (Lemone et al., 2011).
The fifth step of the CRC is establishment of goals. DKA is a medical emergency that requires immediate care and which can have fatal consequences if misdiagnosed (Hardern & Quinn, 2003). The goal of care in John’s case was to confirm the diagnosis and its severity through appropriate diagnostic tests and to commence treatment with the aim of establishing rehydration within 24 hours; stabilising serum glucose within 6 hours; stabilizing electrolytes within 6 hours; and resolution of ketosis and acidosis within 12 hours (lelena, & Andrew,