Case Study Of Clinical Integration Specialty Practice

Clinical integration – Specialty practice
Introduction
The nursing profession is enclosed with numerous responsibilities. The nurses are expected to
provide safe and quality nursing care by abiding by the code of conduct for nurses. The
clinical reasoning cycle is the structured outline for the nurses to plan for nursing care. It
improves patient care and promotes the knowledge and skill of the nurses. The aim of the
assessment is to Plan and implement the nursing care for the case scenario using clinical
reasoning cycle. The nursing care plan is designed based on the stages of the clinical
reasoning cycle. Three nursing problems were identified and nursing care is planned for the
fast recovery of the patient. Impaired fluid balance, insufficient insulin, and diabetic
ketoacidosis are the nursing problems identified for the case scenario and discussed according
to clinical reasoning cycle. Ethical, legal, evidence-based, holistic person-centered care can
be ensured for the patient with the support of clinical reasoning cycle.
Consider the person’s situation
Consideration of the patient situation provides present condition which aids in the planning
the nursing care for the patient. Mr. Brad Taylor is presented with the elevated vital signs and
signs and symptoms of hyperglycemia in the Emergency department. Diabetic ketoacidosis is
the complication of hyperglycemia (De Vries et al. 2013). He is admitted to the High
dependency unit. Presently his vital signs are elevated and Saturation is slightly decreased.
Collect, process and present related health information

Collection of data is the second stage of the clinical reasoning cycle which helps the nurse to
gather the data to diagnose the actual condition of the patient and to prevent potential
complications. On admission, Taylor was feeling unwell, and complaints of vomiting,
polydipsia, and malaise. He has a history of Diabetic ketoacidosis five years ago. On
assessment his vital signs are elevated (HR 125bpm, RR 35/mt). His saturation is decreased
slightly (Spo2 98%). His blood pressure is decreased (100/60 mmHg).The physical
assessment shows that the patient is restless, has complaints of increased thirst, nausea, and
vomiting. His urine output is 25ml/hr.
Investigation results show that his blood glucose level is increased (26.1 mmol/l). Ketone
levels are high on finger prick. His urine analysis shows that his Ketone is 3+ and glucose is
2+, with microhematuria. WCC is slightly elevated and the magnesium and Phosphorus are
mildly low in level. Arterial Blood Gas shows that patient has metabolic acidosis. He is on
insulin therapy (Bergenstal et al. 2010). On admission he was administered with four hourly
Dextrose (5%) alternated with Hartmanns Solution in 1L bag in SITU with the potassium
chloride supplement. Insulin infusion is started with 50u/s Actrapid in the 50mls of the
normal saline (Umpierrez, 2016).
Identification of the problem
Mr. Taylor is presented with signs and symptoms of diabetic ketoacidosis, one of the
complications of hyperglycemia. The nursing problems identified in the case of Mr. Brad
Taylor are impaired fluid balance, insufficient insulin and the metabolic acidosis in which the
nurse needs to prioritize the nursing care to prevent further complications.
 Impaired fluid balance

Mr. Taylor is presented with nausea, vomiting, and increased thirst. His vital signs are
slightly elevated (HR 125bpm, RR 35/mt) and the blood pressure (100/60 mmHg) is
decreased which are the indications of the fluid imbalance. The nurse has to be aware of the
Pathophysiology of the impaired fluid balance that is related to the disease condition. It helps
the nurse to establish the goals and plan the nursing interventions. Hyperglycemia caused by
the lack of insulin secretion in the body leads to a condition called osmotic diuresis, which
causes fluid and electrolyte loss through polyuria (Razavi, 2010). Excretion of Ketone
through urine leads to loss of sodium and potassium which may cause deficiency of both
electrolytes. The loss of water and electrolyte continues until the insulin imbalance is
corrected (Palmer & Clegg, 2015).The nurse has to relate the cause and the complication to
prioritize the nursing care and implement the appropriate nursing interventions to promote the
condition of the patient.
 Insufficient insulin
Mr. Taylor is presented with an increased blood glucose level (26.1 mmol/l). Urinalysis
shows that the Ketone is 3+ and glucose is 2+, with microhematuria. The patient’s present
condition is severe hyper glycaemia. The major cause of severe hyperglycaemia in patients
with type 1 diabetes is insufficient insulin (Umpierrez & Korytkowski, 2016). Lack of insulin
secretion may induce the body to metabolize the triglycerides and amino acids in the place of
glucose. Insulin deficiency may cause increase the glucagon which conversion of the fatty
acids into the Ketone. Insulin is the hormone that generally prevents the formation of
Keaton’s. So, absence of insulin induces the production of acids like acetoacetic and beta
hydroxybutyric acid. These acids cause metabolic acidosis which is termed as diabetic keto
acidosis in Type 1 diabetic patients (Wilson, 2010). The major cause for diabetic keto
acidosis is insulin deficiency. The nurse has to rule out the cause for the fatal condition in