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Hypoglycemia Assignment Sample

   

Added on  2021-04-16

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HypoglycemiaName of StudentName of UniversityAuthor NotePage 1 of 12

IntroductionThe focus of the assignment is on the clinical care and analysis of a 67 year old woman, Ms. S.B., who experienced a hypoglycemic condition and the care, provided using “clinical reasoning cycle” method. It is important for a healthcare provider and nurse to have very good clinical reasoning and decision making skills, so that in times of clinical emergency like hypoglycemia, quick service and risk management can be arranged by healthcare providers in the facility (Sedgwick, Grigg & Dersch, 2014). The process of clinicaldecision making is a relative, progressive, and mounting process, where it is important to gather, interpret, and evaluate the clinical data for successful selection of plan of action basedon the evidence (Groves, 2014). It involves drawing conclusion based on critical thoughts and clinical interpretation (Robert, Tilley & Petersen, 2014). This assignment aims to talk about an emergency case of Hypoglycemia, when I was undergoing my clinical rotation and to practice the clinical rotation cycle. The assignment consists of the background of the condition, reflective perspective in the assessment of Hypoglycemia using Gibb’s cycle and followed by a recommendation that would help develop nursing professional conduct. Background:Individuals with diabetes face the condition of Hypoglycemia very often which has the potential to cause life-challenging difficulties (Round et al., 2014). The condition is best described as having an unusually lowered glucose levels in blood (Holt, 2011). It is observedthat people with type 2 diabetes have rare but harsh episodes of hypoglycemia in comparison to people with type 1 diabetes (Lim, Munshi & Sharon, 2015). In Al Ain, UAE, a study was conducted in 2004 which revealed that the annual diabetic treatment expense increased five folds of 1,605$ when compared to patients with hypoglycemia than without the condition (Al-Maskari, El-Sadig & Nagelkerke, 2010). Clinical reasoning cycle:The process of gathering information, processing the found data to understand the clinical condition as well as planning and implementing intervention to evaluate efficiency and reflective learning of the outcome of the concerned health issue is termed as clinical reasoning cycle (Meissner, 2010). The importance of Clinical reasoning cycle is that it can derive a positive end result of the clinical procedure based on the patient’s health condition and way of living (Levine, 2014). It also helps a nurse in prioritizing the involvement by Page 2 of 12

understanding the immediate plan of active to be devised and delayed action that can be used to manage complications (Chamberland et al., 2015). Implementation of clinical reasoning cycle is based on the skill of cognition, presence of mind and critical analysis (Rochmawati &Wiechula, 2010). Clinical reasoning errors can arise due to biased thinking, stereotypical notions and influence of social stigma, which needs to be avoided during clinical (Burbach, Barnason & Thompson, 2015). Clinical reasoning cycle includes eight stages; observation, collection, processivity, decision making, planning, action, evaluation and reflection. I havediscussed in detail about an incident that I came across during one of my clinical rotation duties.Clinical reasoning cycle:1. Consider the patient situationThe initial step of clinical logic is to familiarize with the patient’s medical history, so I got acquainted with the patient, her medical history and recognized her main issue and tried to analyze the situation. I checked with the nurse who was in her night shift when the patient was admitted. I was handed over the medical account in the morning, mentioned that Ms. S.B. was a 67-year old woman with known history diabetes, taking insulin, hadhypertension and end stage of renal disease (ESRD). The patient regularly underwentdialysis for three times in a week. Ms. S.B. was found to have a blockage in her AV fistula on the left arm the day she went to the dialysis unit to get her usual session andwas referred to the emergency unit. She was found to have high potassium in her blood, 6.1 mmol/L and underwent femoral central venous access to complete her session and avoid ventricular fibrillation (Budovich, Blum & Berger, 2014). She was referred to my ward due to this and she was assigned to Dr. R.A. to perform thrombectomy (removal of blockage in fistula) that day. She was prescribed complete bowel rest for six hours before her procedure from breakfast until lunchtime at 1200p.m. The patient’s vital symptoms were as follows: tympanic temperature- 36.6ºC, heart rate- 78, blood pressure- 121/62 mmHg, respiratory rate- 16 br/min, SpO2 levels- 99% and blood glucose levels (BGLs) at 0600 read 4.2 mmol/L. 2.Collect cues / information2.1. Review current informationI had gathered information about the patient, thorough medical and nursinghistory by noting the patient's clinical records and other accessible cues during thePage 3 of 12

second stage of the clinical reasoning cycle. It had been more than 10 years; Ms. S.B. was diagnosed with diabetes mellitus and hypertension. She had been taking dialysis for three years after she was diagnosed with ESRD. Five years ago she underwent a cholecystectomy surgery. She was prescribed a regular dose of insulin aspart and insulin glargine for diabetes and amlodipine and Prazosin for hypertension. 2.2. Gather new informationThe next step of the clinical reasoning cycle was collection fresh information and related data for an ailing patient by setting up a questionnaire with the patient, with their family members and other health practitioners or nurses assigned to the patient. In the morning at 0820 am, the patient rang a bell to which my teacher and I heeded and she complained "I feel drowsy, dizzy and very hot", for which we examined her body temperature which read normal, 36.6 ºC. We examined her BGL after this which read, 3.2mmol/L; speculating problem,we asked whether she had meal or not, to which she replied due to her fatigue and sleepiness, she had skipped breakfast and remained empty stomach since last night’s dinner. The assigned nurse from the night before failed to address that fact and informed us that the patient had breakfast. This was troublesome as the patientwas instructed to have only 6 hours of NPO before the procedure. 2.3.Recall knowledgeIt is essential to gather more knowledge apart from current record and medical history so I had searched for further information related to the condition by using newest facts based application and observing the patient's state in variousscenarios. I concluded that due to the fact that the patient was unfed for such a long time, her BGL lowered vastly and she started to perspire, palpitate, starve, confuse, nauseous, feel drowsy and could not speak (Holt, 2011). These were the obvious reasons for Ms. S.B.’s distress.3.Process information3.1.InterpretAnalysis of the found data is the next step in clinical reasoning and looking for any abnormality. It was abnormal for Ms. S.B. to have such low level of BGL, in accordance with the National Institute for Health and Care Excellence (NICE) the threshold BGL for people with type 2 diabetes is from 4 to 7 mmol/L prior to meals and post meals level is 8.5mmol/L (Oldroyd, 2011). Ms. S.B. is an Page 4 of 12

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