Professional Nursing Continuum Generic Narrative

Running head: NURSING PRACTICE
NURSING PRACTICE
Name of Student:
Name of the University:
Author Note:

Employee #: __________________ Professional Nursing Continuum Generic Narrative
It was like any other day in the step down ICU unit where I have been working as a
nurse. It was almost the end of the patient rounds when a patient was shifted from the ER to
the SDICU who has been suffering from Diabetic ketoacidosis (DKA). She was brought into
the SICU ward and it was evident that she was suffering from distress due to difficulty in
breathing. That day the staff count was less in the emergency unit since this was the end of
the shift for most of the staffs therefore on seeing the patient I at once took charge. I was
informed that the doctor had asked for the conduction of the Arterial Blood Gas test on her.
The test had been conducted at approximately 9.30 pm. The reports had shown that the health
was deteriorating of the patient. The results had been reported to the doctor in charge. The lab
work results were as follows: FIo2 arterial was 21, pH arterial- 7.16(LL), pCO2- 18 (LL),
pO2- 137 (H), Bicarbonate – 6.9 (L), Total CO2- 6.9 (L), base deficit was – 20.3 (H), O2
saturation – 99.4, Haemoglobin was 12.1, chloride – 123 (H), hematocrit – 37, potassium-
4.3, sodium- 148 (H), glucose- 205(H) and Wh blood lactate was 0.8. Again at 2.30 am,
another set of Arterial Blood Gas test had been conducted on the patient which showed no
evident improvement in the patient. After the results of the 2.30 am results had come on in,
that the patient was shifted to our ward. The results were as follows: FIo2 arterial was 21, pH
arterial- 6.99 (LL), pCO2- 9 (LL), pO2- 133 (H), Bicarbonate – 2.1 (L), Total CO2- 2.3 (L),
base deficit was – 27.5(H), O2 saturation – 98.8, Haemoglobin was12.9, chloride – 122 (H),
hematocrit – 40, potassium- 4.7, sodium- 148 (H), glucose- 306(H) and Wh blood lactate was
1.0. As a night charge I went to attend the patient as she seemed to be in lot of pain. It was
also my duty to properly assign the patient to a particular nursing team. I felt that it would be
appropriate to assign her to a novice RN. On arriving near the patient, she looked at me with
sad eyes, and asked me to be by her side until her family arrives in the morning. She has been
feeling lonely and helpless since her illness has worsened few hours ago before she was
brought in into the ICU. I was informed by the nurses of her previous medical ward that she

Employee #: __________________ Professional Nursing Continuum Generic Narrative
has been on an insulin drip even since she was brought in into the hospital. The insulin drip
had been titrating bases on the patient’s hourly glucose level l. Apart from this, there was
replacement of Potassium level according to the protocol so levels less than 3.8. There was a
repetition of BMP lab work being done at every 4 hours interval in order to monitor the anion
gap which is base off the sodium +potassium divided by Chloride +bicarbonate.
In the morning after the patient was awake I found that the patient looked quite
relieved. I asked for updates from the primary RN. Immediately I took to monitoring her
glucose and ketone levels, since this is a must for which should be conducted at an interval of
every 4 hours. I noticed that the blood glucose level was still higher than the normal range so
I immediately informed the doctor about the situation. In the morning when the patient was
served breakfast, she had difficulty in consuming the food and even vomited after having it.
Therefore the doctor prescribed that she should be given only fluids and drinks in order to
maintain proper nutrition. Later several other tests were also conducted which included
checking the presence of ketone in her urine. Later in the day she showed symptoms like
excessive thirst, frequent urination, abdominal pain, nausea and vomiting, acetone breath. I
immediately noted all these down so that I could report these when the doctor gain came for
his rounds in the ICU.
For taking care of patients suffering from diabetic ketoacidosis, several interventions
are required which included correction of fluid loss, insulin therapy, electrolyte correction,
correction of acid-base balance and treatment of concurrent infection. An important aspect of
taking care of such patients included long-term monitoring therefore I tried to keep an eye on
the blood glucose monitor as long as I was on my duty.
In patients with diabetic ketoacidosis, hypoglycemia may result from inadequate
monitoring of glucose levels during insulin therapy. Insulin sensitivity improves after