The clinical condition of type 1 diabetes mellitus is characterized by chronic hyperglycemia (elevated blood glucose levels) as a result of insufficient production of the hormone insulin. Chronic hyperglycemia in diabetes mellitus leads to damage and dysfunction of various organs and systems, causing late complications such as macro- and microangiopathies (Hodgson et al. 2018). Microangiopathies include damage to large and medium-sized vessels (the morphological basis of which is atherosclerosis), microangiopathies include diabetic retinopathy, diabetic nephropathy, diabetic angiopathy, or diabetic polyneuropathy.
The clinical condition of DKA is characterized by acute diabetic decompensation of metabolism. It is manifested by a sharp increase in glucose levels and the concentration of ketone bodies in the blood, their appearance in the urine, regardless of the degree of violation of the patient’s consciousness (Hodgson et al. 2018). This is an urgent condition that develops as a result of absolute or relative insulin deficiency, characterized by hyperglycemia, metabolic acidosis and electrolyte disorders. The extreme manifestation of diabetic acidosis is ketoacidotic coma.
Assessment of type 1 diabetes mellitus is carried out by measuring the glucose level of venous plasma on an empty stomach and 2 hours after eating (Ramanan et al. 2021). Then the level of glycated (glycosylated) hemoglobin for the last 3 months is established (Ramanan et al. 2021). This indicator reflects the state of carbohydrate metabolism during the last three months, is used to assess the compensation of carbohydrate metabolism in patients receiving treatment. It must be monitored once every 3 months (Ramanan et al. 2021). After that, it is necessary to check for autoantibodies to beta-cell antigens — these are immunological markers of autoimmune insulitis.
Whenever a diabetic patient has one or more of the following symptoms – nausea, vomiting, abdominal pain – it is necessary to immediately determine glycemia and acetonuria. DKA is detected when there are high blood sugar (more than 16-17 mmol / l, and higher) and ketone bodies in urine or serum (Schwartz et al. 2022). If urine cannot be obtained for the study, ketosis is diagnosed by analyzing the patient’s serum. A drop of undiluted serum is placed on a test strip for rapid determination of blood glucose (for example, Glucochrome D) and the resulting staining is compared with a color scale.
For the treatment of type 1 diabetes mellitus, an insulin therapy regimen is used in the mode of multiple injections. Short-acting insulin begins to work already 20-30 minutes after injection, its peak action in the blood occurs after 2-4 hours and ends after 6 hours (Tornese et al. 2020). Ultra-short-acting insulins differ from short-acting insulins in that they act immediately after administration, after 5-15 minutes (Tornese et al. 2020). Such insulins can be administered before meals, during or immediately after meals. Insulin replacement therapy is the only type of etiological treatment of DKA. Only this anabolic hormone can stop the severe generalized catabolic processes caused by its deficiency. To achieve an optimally active serum insulin level (50-100 micro med/ ml), a continuous infusion of 4-12 units of insulin per hour is required (Tornese et al. 2020).
Ineffective communication between medical professionals can lead to serious consequences for the patient. Therefore, the nursing clinical judgment provides recommendations for ensuring effective communication. They also show the experience of successful implementation of an effective communication strategy in a multidisciplinary hospital (Roep et al. 2021). Communication disruption can occur at any stage of the patient’s movement within the medical organization and often leads to undesirable consequences. The nursing clinical judgment provides the main types of errors in patient transfer and strategies for improvement. Although there is currently no generally accepted strategy for reducing communication problems, various options are offered to improve this process.
The nursing clinical judgment also performs an important role clarification with the diabetic specialist nurse (DSN). They prescribe general information about diabetes that a nurse needs to have. The tactics of a nurse with DKA, their role in the prevention of complications is also highlighted. The nursing clinical judgments allow the diabetic specialist nurse (DSN) to study the organization of supervision and care of patients with diabetes mellitus (Goldenberg et al. 2019). Various resources allow the nurse to clearly determine the order of interventions when problems arise in a patient with diabetes mellitus.
Evidence-based practice demonstrates the decision-making process in situations where it is especially necessary to act quickly (for example, when a patient is hospitalized with DKA). In this case, it is necessary to clearly understand the NEWS2 track and trigger (Grant 2018). The nurse in case of emergency conditions of the patient works according to the algorithm. A practical guide to the initial general assessment of the patient’s health status helps to determine the leading symptom and pathological manifestation that comes to the fore (Taysum et al. 2020). Further, with the help of current relevant frameworks, it is possible to monitor the main vital signs of the body and carry out the necessary manipulations using the presented indicators.
To assess how disturbed the patient’s condition is, various scales are used within the NEWS2 track and trigger. The practical recommendations demonstrate how, in accordance with the collaborative tactics of nurses, to determine the difficult condition of all patients in the shortest possible time. Before begining to help the patient, it is necessary to determine what type of diabetes the patient suffers from. Hypoglycemia, characterized by a decrease in the concentration of glucose in the blood, is a threat to life (Lernmark 2018). It is dangerous because it can develop into a hyperglycemic coma. In scientific papers, it is sanctified how to help a patient with such a diagnosis in accordance with NEWS2 track and trigger.
The nursing clinical judgments provide nurses with relevant frameworks of the basic principles of the ABCDE assessment framework of a patient in a deteriorating or critical condition, such as DKA (Suwanwongse & Shabarek 2021). The basic rules are to assess the patency of the respiratory tract (Airway), Breathing, Circulation, central nervous system functions (Disability), Exposure, in order to diagnose and treat the patient accordingly. Evidence-based practice also acts as a guide when conducting a full introductory assessment and repeating it regularly.
The ABCDE assessment framework can be used to evaluate the results of treatment of life-threatening conditions before proceeding to the next stage of nursing (Dias et al. 2021). The advantages of this method are to demonstrate the active participation of all members of the resuscitation team, which allows several procedures to be performed simultaneously, for example, examination, monitoring, intravenous access. In addition, the use of evidence-based practice allows you to recognize the need to call additional help and call it in a timely manner.
The advantages of when promoting collaborative patient care are, first of all, mastery in performing procedures and rapid achievement of high qualifications. There is also a large contingent of service by a small staff. In addition, the exchange of information with doctors is simplified and control by the nurse supervisor is facilitated (Verma et al. 2020). Due to this, the efficiency of decision-making allows to take timely and effective actions. Collaborative organization of nursing care is the simplest. In the frame of the sstrictly regulated management process, the nurse forms an exemplary discipline within the team.
Each nurse focuses on solving a specific task, so that they can perform it most efficiently. Collaborative patient care guarantees a high level of specialization of each nurse and transparency of the structure of the hierarchical ladder. At the same time, all the functions of middle-level medical staff are equally important, which ensures work productivity (Clotman et al. 2018). Moreover, employees of a medical organization are encouraged to take responsibility and specialize in certain tasks. They feel their contribution to the work and their own importance.
Challenges encountered when promoting collaborative patient care include the lack of responsibility for fully meeting all patient needs. In addition, there is a risk of nurses losing the skills and abilities of other work and the possibility of disappointment in work due to the uniformity of tasks. Moreover, the challenge may be, on the one hand, the lack of a complete understanding of the patient among nurses. On the other hand, the patient may also experience discomfort from the absence of a specific nurse with whom they could discuss problems. Due to the high probability of constant workload of the diabetic specialist nurse (DSN), nurses often have the need for independent decision-making (Garg et al. 2018). Disagreements between employees can slow down or suspend work, resulting in slow decision-making. In addition, in some cases, the DSN may use its official position for personal purposes. There is a high risk of confusion in the work team due to lack of communication.
Reference List
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Dias, K. J., Shoemaker, M. J., Lefebvre, K. M. and Heick, J. D. (2021) ‘A knowledge translation framework for optimizing physical therapy in patients with heart failure’, Physical Therapy, 101(6), pp. 10–12.
Garg, S. K., Peters, A. L., Buse, J. B. and Danne, T. (2018) ‘Strategy for mitigating DKA risk in patients with type 1 diabetes on adjunctive treatment with SGLT inhibitors: A stich protocol’, Diabetes Technology & Therapeutics, 20(9), pp. 571–575.
Goldenberg, R. M., Gilbert, J. D., Hramiak, I. M., Woo, V. C. and Zinman, B. (2019) ‘Sodium-glucose co-transporter inhibitors, their role in type 1 diabetes treatment and a risk mitigation strategy for preventing diabetic ketoacidosis: The STOP DKA Protocol’, Diabetes, Obesity and Metabolism, 21(10), pp. 2192–2202.
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