Holistic Care Nurse Essay

The name and other identifying information about the affected role of included within this piece of work have been changed to protect confidentiality, as conveyd by The Code of Professional Conduct (Nursing and Midwifery Council, 2008). For this reason, the patient included in this case study forget be presumptuousness the pseudonym of surface-to-air missile Jones.The purpose of this assignment is to identify one leaf node problem and provide an evidence-based program of apprehension for the individual. The purpose of commission supply is to show a logical and systematic flow of ideas through from the initial assessment to the final evaluation (Mooney and OBrien, 2006).The nursing model that go forth be incorpo telld in this complaint plan impart be the Roper, Logan and Tierneys model (2000). This model was chosen beca wasting disease is it extremely prevalent in the United Kingdom and is the or so widely used model massive-familiar to nurses. The model of nursing spe cifies 12 activities of daily living which are relate to basic human needs and incorpo plaza five dimensions of holistic rush, physiological, psychological, sociocultural, politicoeconomical and environmental (Roper, Logan and Tierneys model, 2000).Care plans are based on evidence-based practice, allowing the nurse to determine the best realistic care and rationale for the chosen nursing hindrances (Roper, Logan and Tierney, 2000). They counter into account the psychological, biologic and sociological needs of the soul and therefore provide a holistic border on to care (Roper, Logan and Tierney, 2000). The signifi open firet practise of living that will be affected within this care plan will be maintaining a safe environment as Mr. Jones may have a prob equal problem of d tuckerh, due to hypovolemic and/or metabolous wallop caused by ketoacidosis.Diabetic ketoacidosis (DKA) usually occurs in people with vitrine 1 diabetes mellitus, nevertheless diabetic ketoacidosis back give away in both person with diabetes (Diabetes UK, 2013). DKA results from vaporisation during a area of relative insulin inadequateness, associated with high downslope levels of edulco treasure level and ketones (Diabetes UK, 2013). This happens because there is not liberal insulin to allow glucose to enter the cells where it can be used as energy so the carcass begins to use stores of fat as an alternative source of energy, and this in turn let ons an acidulent by-product known as ketones (Diabetes UK, 2013). It is evident that DKA is associated with significant disturbances of the bodys chemistry, which should resolve with permittherapy (Diabetes UK, 2013).Severe metabolic acidosis can lead to break or death (Dugdale, 2011). The particularised problem was chosen because there are measures that can significantly clip the risk of metabolic and hypovolemic shock which can be caused by severe metabolic acidosis (Dugdale, 2011). Within the care plan relevant care interventions will be identify to prevent the possible instruction of shock for Mr. Jones. In practice the interventions would happen contemporaneously.The interventions involve identifying the potential risk factors for the development of shock by using specific assessments. This will be through with(p) by go withing an assessment which includes planning, assessing, implementing and evaluating the care that will be provided to Mr Jones and to treasure its effectiveness (Mooney & OBrien, 2006).Once the diagnosis was made, specific, achiev qualified, measur adequate to(p), realistic and sequence limited goals of care for Mr. Jones were made. The NHS rear practice specific guidelines for adult diabetic ketoacidosis imply a series of immediate actions and assessments for suspected DKA which will allow for get interventions to be made and will provide a baseline which will provide a measure of the effectiveness of the treatment (The reciprocal British Diabetes Societies In patient Care Group, JBDS, 2012).Mr Jones will need quiet and electrolyte management to draw in ketones and compensate electrolyte imbalance (Nazario, 2011). He will to a fault require pharmacological involvement which will include administrating medication that is inevitable to reverse the acidosis, brocaded contrast glucose and pH levels (Nazario, 2011).Psychological intervention is also necessary to lose weight his fretfulness and therefore veer potential shock (Nazario, 2011). The goal of treatment for Mr Jones is to refuse his high short letter slit level with insulin an minute after the insulin selection is administ stepd with the expected outcome of maintaining a kind glucose level in the scarper of 8.3mmol/l 10.0mmol/l within 72 arcminutes (JBDS, 2012). Due to this it is vital that Mr Joness personal line of credit sugar is monitored and regulated frequently (JBDS, 2012).Another goal is to replace his muddled body tranquils endovenous unsounds will be ac customed to treat dehydration and dehydration status will be assessed every hour by monitoring intake and out lay, skin turgor and vital signs (JBDS, 2012). Mr. Jones will be able to understand the care that is beingness given and why it is being given within 30 minutes of diagnosis and he will also be able to express his fears and cover his needs with nursing staff, whichunite with improvements in his blood sugar levels will reduce his fretfulness.Intervention one changeable and Electrolyte Management gibe to The junction British Diabetes Society (2012) the usual cause of shock in DKA is severe fluid depletion secondary to osmotic diuresis leading to intravascular volume depletion. Diabetes occasional (2013) justify this by stating that dehydration can become severe enough to cause shock. So once a diagnosis of DKA has been established, fluid permutation should be commenced immediately (Park, 2006).According to Oaks and Cole (2007) the development of total body dehydration a nd sodium depletion is the result of increase urinary output and electrolyte losses. They state that insulin deficiency can also contribute to renal losses of water and electrolytes (Oaks and Cole, 2007). The Joint British Diabetes Society (2012) suggests that the most important initial therapeutic intervention when treating a patient with DKA is fluid replacement followed by insulin initiation. They also state an adult weighing 70kg or above presenting with DKA may be up to 7 litres in fluid deficit with associated electrolyte disturbances (JBDS, 2012).Rhoda, Porter and Quintini (2011) propose that a fluid and electrolyte management plan developed by a multidisciplinary group is advantageous in promoting continuity of care and producing safe outcomes. The development of a plan for managing fluid and electrolyte abnormalities should start with veraciousing the underlying condition (Rhoda, Porter and Quintini, 2011).In most cases, this is followed by an assessment of fluid balance with the goal of achieving euvolemia (state of normal body fluid volume) (Rhoda, Porter and Quintini, 2011). The Joint British Diabetes Society (2012) propose the main aims for the first few litres of fluid replacement are to clear ketones and correct electrolyte imbalance.The Joint British Diabetes Society (2012) has issued guidelines on the management of adults with DKA to each NHS foundation trust. The guidelines state that intravenous fluids should be commenced via an intravenous cannula (JBDS, 2012). It is recommended that 9% Sodium chloride 1000mls should be infused initially everyplace one hour (JBDS, 2012).Park (2006) clarifies this by stating that slower rates have been associated with a more fast correction of plasma hydrogen carbonate and it is recommended that 1000mls is to be infused in the first hour. Rhoda, Porter and Quintini (2011) propose that after fluid status is corrected,electrolyte imbalances are simplified.To correct dehydration and achieve the goal of rehy drating Mr Jones, some(prenominal) assessments will need to be completed. Rhoda, Porter and Quintini (2011) suggest that after a plan is developed, frequent monitoring is vital to regain homeostasis. Mr Joness pee output, heart rate, blood pressure, respiratory rate and pulse oximetry will be monitored periodical to ensure the treatment being given is working efficaciously (JBDS, 2012).Also, to assess the degree of dehydration a variety of specific contemplations will need to be carried out including observing neck veins, skin turgor, mucous membranes, tachycardia, hypotension, capillary refill and urine output (JBDS, 2012). A strict fluid balance chart will need to be in place to monitor input and output (Mooney, 2007).To observe with gradual rehydration and restoration of consume electrolytes after the first 1000ml bag of 0.9% sodium chloride has been plowed to Mr Jones over one hour a second 1000ml bag of 0.9% sodium chloride will be commenced over twain hours and a thir d bag will and then follow over another two hours (JBDS, 2012) . Following these two hourly bags of fluid another two bags of sodium chloride will follow at a rate of four hours and then another two bags will be commenced over six hours consecutively to ensure complete rehydration (JBDS, 2012).Pharmacology InterventionThe medication that was needed to resolve Mr. Joness acidosis and to prevent metabolic shock will be discussed in this intervention. A fixed rate intravenous insulin infusion is recommended by The Joint British Diabetes Society (2012) and stated on the NHS foundation trust DKA guidelines to reverse DKA.An intravenous insulin infusion via a pump should contain 50 units of actrapid insulin in 50mls 0.9% sodium chloride at a continuous fixed rate of 0.1 units/kg/hour (JBDS, 2012). If you are unable to weigh the patient an estimated incubus will need to be made to calculate the units per kg per hour (JBDS, 2012).Whilst the infusion is running ketones and capillary blood glucose will be monitored hourly to screen for improvement (JBDS, 2012). Preedy (2010) and guidelines to DKA both state that if the patient normally takes long acting insulin (e.g. Lantus, Levemir) this should be continued at their usual dose and time. According to The Joint British Diabetes Society (2012) it is no longer advised to administer abolus dose of insulin at the time of diagnosis of DKA to allow rapid correction of blood sugar. Intravenous fluid resuscitation alone will reduce plasma glucose levels by two methods it will dilute the blood glucose and also the levels of counter-regulatory hormones (JBDS, 2012).If the blood glucose befalls too slowly, the insulin rate should be doubled every hour until the target decrease is met (JBDS, 2012). If the blood glucose falls too quickly, the insulin rate can be halved to 0.05unit/kg/hour, but for a short time only, as a rate of 0.1 units/kg/hour is needed to faulting off ketone production (JBDS, 2012).If hypoglycaemia occurs p rior to complete resolution of DKA, the insulin infusion should not be stopped, but extra glucose should be added to the IV fluids alternatively (JBDS, 2012). Diabetes Daily (2013) explain that if necessary, kilobyte should be administered to correct for hypokalemia (low blood thousand concentration), and sodium bicarbonate to correct for metabolic acidosis, if the pH is less than 7.0.For Mr. Jones uncomplete of these was needed to correct his acidosis. JBDS (2012) can justify this as they clarify that intravenous bicarbonate is very rarely necessary. Similarly, Diabetes Care (2004) proposes the use of bicarbonate in DKA remains controversial. At a pH 7.0, insulin activity blocks lipolysis and resolves ketoacidosis without any added bicarbonate. Potassium is often high on admission but falls precipitously upon treatment with insulin (JBDS, 2012).Potassium levels can fluctuate severely during the treatment of DKA, because insulin decreases thousand levels in the blood by redistri buting it into cells (JBDS, 2012). A large part of the shifted extracellular potassium would have been lost in Mr. Joness urine because of osmotic diuresis (Dugdale, 2012). Hypokalemia increases the risk of dangerous irregularities in the heart rate (Dugdale, 2012). so, continuous observation of the heart rate is recommended as well as repeated metre of Mr. Joness potassium levels and addition of potassium to the intravenous fluids once levels fall below 5.3 mmol/l (JBDS, 2012). By 24 hours Mr. Jones had improved and was able to eat and drink. The guidelines state that by 24 hours the ketonaemia and acidosis should have resolved but you should continue intravenous fluids if the patient is not yet drinking as per clinical judgement (JBDS, 2012).The guidelines also suggest if blood glucose becomes lower than 14 mmol/L then 10% glucose should be prescribed to run alongside the sodium chloride (JBDS, 2012). Also, if Mr Jonesspotassium had of dropped below 3.5mmol/L in the first 24 hour s of treatment then additional potassium would have needed to be given (JBDS, 2012).Psychological InterventionA third intervention would be intercourse needs to reduce patient anxiety and keep the patient feeling secure. conversation plays an important part in the holistic care plan and biopsycho genial approach to care. concern can be a barrier to communication therefore, it is important to intercommunicate with Mr. Jones clearly and supportively in order to make him feel free to discuss his fears and to allow him to participate in the decisions made in his care. According to Sarafino (2008) anxiety appears to be caused by an interaction of biopsychosocial factors, including vulnerability, which interact with situations, stress, or trauma to produce added anxieties for the patient.The nurse should take a step by step approach to build a plan of care and voice the plan of care to Mr. Jones so he does not become overwhelmed by the extensiveness of the treatment (Sarafino, 2008). Communication is identified as one of the essential skills that health care professionals essential acquire (NMC, 2010). The Nursing and Midwifery Council (2010) stipulate that, within the domain for communication and interpersonal skills, all nurses must do the following communicate safely and effectively, build therapeutic relationships and take individual differences, capabilities, and needs into account, be able to engage in, maintain, and disengage from therapeutic relationships, use a range of communication skills and technologies, use verbal, non-verbal, and written communication, address communication in diversity, promote eudaemonia and personal safety, and identify ways to communicate.Communicating with Mr. Jones relatives is also important so that they develop an apprehensiveness of his condition and the care he is receiving (Webb, 2011) According to Webb (2011) health professionals who can communicate at an emotional level are seen as warm, caring, and empathetic, and amaze trust in their patients, which encourages disclosure of worries and concerns that patients might otherwise not reveal. Additionally, informatory and useful communication between the practitioner and the patient is shown to encourage patients to take more interest in their condition, bring questions, and develop greater understanding and self-care (Webb, 2011).Webb (2011) explains that this isparticularly so when the patient is given time and encouragement to ask questions and be involved in their treatment decisions. By using the Roper, Logan and Tierneys nursing model (2000) a holistic approach to care was able to be implemented for Mr. Jones by taking into account his biological, psychological and social needs. By establishing a holistic care plan three interventions were identified that were equally vital in treating Mr. Joness DKA to prevent hypovolemic and metabolic shock caused by his acidosis.The first intervention was the management of fluid and electrolytes put in place to achieve the goal of rehydrating Mr. Jones in aim to correct his electrolyte imbalance and clear ketones to prevent hypovolemic and metabolic shock caused by his DKA. The second intervention included pharmacological input which included the constitution of relevant medication to achieve the goal of reversing Mr. Joness raised blood glucose and acidosis. Lastly the third intervention within the holistic care plan addressed Mr. Jones psychological needs by resolving his anxiety by utilising effective communication and interpersonal skills.It can be concluded that the care plan and treatment for Mr. Jones was successful therefore he did not require escalation to the high dependency unit and additional treatment was not necessary. Therefore it is evident from the success of Mr Jones care care planning provides a incorporate and holistic method which in turn addresses all elements of an individuals health and well being.AppendixThe individual chosen for this care plan is Mr. S am Jones (a pseudonym, as explained in the confidentiality statement). This gentleman was chosen for the care plan as caring for diabetic individuals is becoming a more common activity within health care today. Mr. Jones is a 58-year-old builder who was admitted after being found collapsed at his home by his brother.He is 5ft 9 tall and weighs 88 kilograms. Mr. Jones lives alone in a centrally heated two bedroom semi detached house he sleeps on the speeding floor and is very independent and does not require a bundle of care. He has a daughter aged 22 who has two little children and also has a brother aged 64 who lives nearby with his wife.Mr. Jones has been diagnosed with type 1 diabetes since the age of 18 and has struggled with the management of his conditionresulting in legion(predicate) hospital admissions. Mr Jones stated he did not smoke but admitted to having an increased intake of alcohol. On arrival blood monitoring was performed which revealed un-recordable blood sugar levels which gave the clerking impression of diabetic ketoacidosis.The health care team then had the problem of potential death due to hypovolemic and metabolic shock caused by ketoacidosis. On admission to the medical assessment unit (MAU) many assessments needed to be completed to discover the extensiveness of the condition and to provide baseline levels.Firstly, rapid ABC was performed with measurement of pulse, blood pressure, Glasgow coma scale, respiratory rate and pulse oximetry. Urinalysis was performed which registerd the presence of ketones, and glucose and samples were sent for microscopy, culture and sensitivity. The patients full blood count was taken as part of the septic screen.The patients capillary blood glucose was taken and venous blood samples were be sent to the lab for U&Es which is essential in order to assess the baseline potassium as well as giving a biochemical meter reading of dehydration and renal function. Laboratory glucose is also an essential base line probe to identify glucose and evaluate blood sugar concentrations (Association for Clinical Chemistry, 2011).A baseline cardiogram is a mandatory investigation for a patient with DKA (Turner 2012). Blood blow measurements were used to evaluate Mr. Joness oxygenation and acid/base status and from the blood gas a pH result was obtained as well as a bicarbonate levels and PC02 (the amount of carbon dioxide released into the blood) levels (ACC, 2011).The results of the numerous tests confirmed the diagnosis of metabolic acidosis. Metabolic acidosis is characterised by a lower pH and diminish bicarbonate, the blood is too acidic on a metabolic/kidney level. A pH less than 7.4, low bicarbonate and low PC02 will indicate metabolic shock and DKA (ACC, 2011). The assessments that were undertaken on Mr Jones revealed that he fitted the criteria for diagnosis of diabetic ketoacidosis.According to The Joint British Diabetes Society (2012) to diagnose DKA the three of the following must be present blood glucose over 11mmol/l or known diabetic, blood ketones above 3mmol/l or urine ketone ++ or more and venous pH less than 7.3 and/or bicarbonate below 15mmol/l. Once the diagnosis was made, specific, achievable, measurable, realistic and time limited goals of care for Mr. Jones were made.