Managing Cerebral Oedema in Children with Paediatric Diabetic Ketoacidosis: A Policy Review and Recommendations

NUR5926 Assessment 2
Contemporary

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................3
Outlining the policy and context -...................................................................................................3
Recommendations –.........................................................................................................................5
CONCLUSION................................................................................................................................9
REFERENCES..............................................................................................................................11

INTRODUCTION
Paediatric diabetic ketoacidosis (DKA) has been determined as the common presentation of
type 1 diabetes mellitus and type 2 diabetes mellitus among children and adolescents.
Mechanism of DKA is associated with the lack of insulin in the body. The decreased rate of
insulin along with the corresponding elevation of the glucose leads to increase in the release of
glucose in liver. The treatment of paediatric diabetic ketoacidosis is concerned with the
administration of the intravenous fluids along with insulin (Abbas & et.al. (2018). However, in
this context during treatment close clinical monitoring for the signs of Cerebral Oedema is
required. Furthermore, effective interventions are often required. There has been clear link
established in the paediatric diabetic ketoacidosis and cerebral Oedema. It has been stated as
potential complication in the paediatric diabetic ketoacidosis. Cerebral Oedema which often
stated as swelling in the brain is one of the most serious complication of paediatric diabetic
ketoacidosis. Studies have found that, lack of blood flaw in brain during DKA cause the
complication. (Cerebral Oedema). In addition to this, keen monitoring and interventions are
required.
In this assignment, discussion in regards to policy from a major hospital in Australia which
have adopted the framework in context of managing Cerebral Oedema in children due to
paediatric diabetic ketoacidosis will be done. In addition, the appropriate reference will be made
only to the intra emergency monitoring and intervention of Cerebral Oedema. The discussion in
regards of the policy has been taken in consideration as effective monitoring is required in
relation of solving the complexities that may be created due to Cerebral Oedema. Furthermore,
intervention needs to be stated in well-defined manner that can be used at the time of emergency.
Within considering this, critical situation can be managed. Moreover, recommendation in context
of future policy will be proposed in the assignment.
Outlining the policy and context -
As per the views of Eisenhut, (2018) in order to manage the complex situation (Cerebral
Oedema) proper medication and therapy has to be given to the children. In case, the patient is on
a surgical unit then the immediate actions need to be taken are associated with the reducing the
fluid rate by 1/3, giving mannitol 0.5-1g/kg IV over the 20 minutes. Glackin & et.al. (2020)
Elucidates that, risk of cerebral oedema is higher. Additional risk of the diagnosis during the

treatment includes higher acidosis and very elevated BUN at the presentation. Using bicarbonate
for the treatment of the acidosis, the greater volume of the fluid has to be given under the first 4
hours of the treatment. Also, administration of the short acting insulin under the 1 hour of fluid
treatment is performed. Considering this information, there is lack of consistency in the hospital
services. This clearly presents the mandatory need in context of quality improvement and the
policy revision practice. The framework that has been adopted in the Hospital have stated that,
close monitoring and interventions are required. However, appropriate information in this
regards have not been mentioned. In addition to this Araya & Menon, (2020) said that Diagnostic
criteria involves the abnormal motor or the verbal response to the pain, cranial nerve palsy,
decorticate or decerebrate posture and abnormal neurogenic respiratory pattern.
As stated by Nehring, Tadi & Tenny, (2019) the major criteria aligned with the altered
mental status, sustained heart rate deceleration, fluctuation level in the consciousness and the
minor criteria entitled with the vomiting, lethargy, headache, diastolic BP >90 mm Hg in the age
<5 years of children. The data that has been collected depicting the wide difference in the
framework adopted by hospital in context of managing cerebral oedema. The information that
has been reviewed in the policy of hospital was just limited to the minor criteria of the diagnosis.
Thus, there is a strong need in terms of revising policy.
As per the views of Agarwal, (2019) Cerebral Oedema is associated with the range of
different cause that involves Brain Tumor, Infection, Traumatic brain injury and so on. Often, the
diagnosis of the cerebral oedema is highly challenging as service provider must perform the
physical exam of the head and neck, CT scan and MRI of the head, blood test need to be
performed and a neurological exam as well. However, the collected data is clearly depicting the
mandatory task that has to be performed in order to monitor the risk of Cerebral oedema in
patient so the timely actions can be taken. The policy framework of the hospital needs to be
revised in this context as the emergency diagnosis criteria for cerebral oedema has not been
mentioned. In accordance with the major treatment or therapy that needs to be follow for treating
the cerebral oedema are medication, surgery, Hypothermia and Osmotherapy.
In context of medication studies have shown that, medical professionals used drugs in
order to reduce the swelling and blood clots. The major example of the drug is warfarin that
helps in thinning the blood and decreases the chance of blood clot. In some cases, service
provider often recommends Aspirin. However, current guidelines do not provide this advice for