Management Of Diabetic Ketoacidosis Nursing Essay

Management Of Diabetic Ketoacidosis Nursing Essay Diabetes UK (2008) explains that Diabetic Ketoacidosis (DKA) occurs when blood glucose levels are consistently high. When there is lack of glucose in the blood, the bodys cells use fat stores to acquire energy, this process produces an acid called ketones. As ketones are potentially harmful to the body, it tries to get rid of them by excreting them in the urine. If the level of ketones in the bloodstream continue to rise, ketoacidosis occurs whereby the blood turns acidic. as a consequence, patients may feel nauseous, have blurred vision and have very rapid breathing. Because people vomit, the body becomes dehydrated and it is harder for the body to flush out the ketones, if this happens and is left untreated, the patient will fall into a coma which can be fatal. As Daniel was suffering from a chest infection, he was at high risk of developing DKA as his body was releasing more glucose into the bloodstream and stop insulin from working efficiently, this is a triggered response to the infection (Moore, 2004). How is DKA managed? Kisiel and Marsons (2009) explore the regime which is usually carried out in hospitals faced with patients like Daniel. Firstly, a diagnosis of DKA would have been made alongside hypoglycaemia (high blood glucose levels). His urine would have been tested for ketones as standard regime. Arteirial blood gas measurement may also have been performed to demonstrate the level of acidity. A series of blood tests would have been taken to measure Daniels urea and creatinine levels (measures of kidney function), markers of infection would also have been measured such as white blood cell count. Fluid replacement would have been commenced, insulin administered and his potassium level would have also been monitored in the high dependency unit. What could have influenced Daniels rising BMs? It should be taken into consideration that Daniels rising blood sugar levels could be influenced by a number of factors and Jo should take these into account. Jo should check the equipment supplying Daniels insulin as it may be faulty or the pump may not be functioning correctly. She should also ensure that the line is properly connected to the cannula and that it is not leaking or that there is no blockage along the line, or that the cannula has not tissued. Daniels cannula site should be inspected on every shift to check for Phlebitis using the Visual Infusion Phelbitis score (VIP) in line with local policy. Nursing decisions Many factors could have contributed to both Jo and the Senior Nurses decisions and the decision made either way could impact on Daniels condition. If Jo had decided not to increase the insulin and the senior nurse had not increased it either, Daniel may have slipped back into a coma as his blood glucose levels had been rising over time. This would have led to more complications and could have been fatal. However, increasing the insulin may also have had a negative result for Daniel. As it was not prescribed, it may have been increased too much and the blood sugar level could be reduced to an unsafe level and he may suffer a hypoglycaemic episode. Although this is unlikely, it should be mentioned that the senior nurses decision to alter the prescription without it being prescribed was wrong. Accountability According to the NMCs code of professional conduct (2008), as a professional, you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions. As the senior nurses made a decision to alter the insulin infusion without it being prescribed, she is personally accountable to what happens to that patient as a consequence of doing so. On the other hand, Jo is also accountable for her omissions so it could be seen that both of the nurses are responsible for what they do or dont do in this situation. The senior nurse may have thought she was acting in the best interests of the patient, following the NMC code of conduct standard à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. Accountability is the fundamental aspect to professional practice (NMC 2008) and nurses need to be able to justify why they made any decision in practice. Nurses do make judgments based on a number of influences which include their professional knowledge/skills, evidence based practice and acting on the patients best interests. In this situation, the senior nurse may have been a nurse prescriber who had the authority to prescribe drugs from a limited group in the nurse prescribers formulary (McHale 2003). This would have allowed her to alter Daniels prescription without a doctor. She may also have had background knowledge of Daniels condition and thought the best decision to make was to change the insulin dose so that the patient would not have deteriorated further. The senior nurse should be working within her acquired job description which would have included expectations and limitations to what she was required to do as part of her job. Vicarious liability comes into mind in this instance; Richardson (2002) explains that as the employer is responsible for any torts which are committed by an employee during their employment. Torts are described as any legal wrongs for which the law provides a remedy. In this case, the senior nurse has preformed a tort and the person employing her is liable. As Jo was the nurse who was looking after Daniel that day, she also has responsibility to what happens to the patient whilst in her care. This raises the question of who actually is accountable for what happens to Daniel; the nurse looking after him or the nurse who performed the alteration. As it states that Jo is newly qualified, it can be assumed that she may need support from her peers. She would have had a supernumerary period, where she was allocated patients but support was there when she needed it. Also known as preceptorship, newly qualified nurses are accompanied by an experienced nurse who acts as a role model and resource (Ashurst 2008). If the senior nurse was Jos preceptor, she would not have been setting a good example to her. The NMC code of conduct states that you must work cooperatively within teams and respect the skills, expertise and contributions of your colleagues, the senor nurse was clearly not being cooperative with Jo and did not allow her to share her concerns. Castledine (1999) explains how newly qualified nurses are sometimes expected to fit into the system of the ward very quickly and in addition, adapt to a whole range of situations that they have never experienced before. Jo may have been feeling unsupported by her senior and her confiden ce may have been knocked due to the attitude and response of the senior nurse. Documentation As the senior nurse did change the prescription, it needs to be documented somewhere in line with the NMC code. In this situation it could be questioned who documents the alteration of the insulin and where in the nursing notes it should be written. Medication administration arguably carries the biggest risk for nurses (Elliot Liu 2010). This particular scenario could be described as a medication error as the change in prescription was not verified by a doctor. Elliot and Liu (2010) confirm the fact that nurses must only administer the dose prescribed by the medical officer, and that the nurse who administers the medication must sign the medication chart. It should also be documented in the nursing notes as well as signing the chart, and should include the reason for administration and the desired effect (Elliot Liu 2010). Woodrow (2007) stipulates that nurses should be aware of the legal responsibility of accuracy of documentation. So in this situation, the senior nurse should wri te in the nursing notes why she gave the unprescribed dose to Daniel, and Jo should comment why she did not, as well as outlining what happened. Incident Reporting Patient Safety Jo could think about writing an incident form in this situation to voice her concerns. The scenario could be seen as a near miss as the patient may well have suffered dire consequences from either of the decisions made by the nurses. The Reporting of Injuries, Diseases and Dangerous Occurances Regulations (RIDDOR 1995) places a legal responsibility to employers, self employed people and people in control on premises, to report any dangerous occurrence/near miss (Ashurst 2007). Jo could include on the form that she was not happy with the senior nurses decision to alter the insulin pump, and therefore cover herself. By completing an incident report, Jo is following local and national policy and it could also bring to light other problems such as rushed transfers, doctor shortage and lack of support. RIDDOR coordinates its work with the NPSA. The National Patient Safety Agency (NPSA) was formed in 2001 following two publications of patient safety in the NHS. These incorporated research conducted by Vincent et al (2001) which showed that 10% of patients admitted to hospital suffered some kind of patient safety incident. The NPSA has produced a guide to good practice called Seven Steps to Patient Safety (NPSA, 2003) Steps include; building a safer culture, leading and supporting your practice team, integrating your risk management activity, promoting reporting, involving and communicating with patients and the public, learning and sharing safety lessons and implementing solutions to prevent harm. Dimond (2002) explains how the NPSA aims to ensure that adverse events will be identified, reported, analyzed and recorded to make a change to local and national policies and procedures. Jo could refer to this guide and also make others aware of it and improve the patient safety of not only Daniel but every patient on the ward. Inter-professional Working There are several benefits of inter-professional working, the senior nurse and Jo should be aware of these in order to work together and provide effective care. Benefits of inter-professional working which were identified in a report by Cook et al (2001) showed that the team members had more confidence in their decision making as they had encouragement and support from their colleagues. This allowed team members to make better contributions to the overall service in which they were a part of, consequently providing a more effective service to the patients in their care. Jo would have increased her confidence in dealing with similar situations in the future if the senior nurse had spoke to her and answered her questions. There is a great deal of literature which discusses the barriers and difficulties associated with inter-professional collaboration. It should not be assumed that simply instructing professionals to work together will be sufficient to result in effective teams which provide improved services to their patients. A variety of barriers to interdisciplinary working exist that delay the developments of close collaborative working relationships. Hudson (2002) outlines some barriers to effective inter-professional working in terms of relationships between members of different professions such as nurse and doctors. One barrier that he notes is that the character of professional identity is such that where members of a certain profession have similar or shared values, perceptions and experiences, there will be more agreement between members of a profession than between members of different professions. This disagreement shapes inter-professional relationships, and is likely to cause problems wi thin multi-disciplinary team working. In Jos case, she could have bleeped the doctor herself and asked him about the prescription, but as mentioned if he was busy he may have been reluctant to take the call. The senior nurses reaction to Jo demonstrated the hierarchical struggle between a more senior nurse and a very junior member of staff. Although inter-professional working has much potential to enhance care, it can also produce tensions and concerns within the health care team (Peate 2006). It is also important to note that some barriers are organisational or structural such as merging or Trusts, relocation and withdrawal of services. In this scenario, the main barrier is that there are two different skill mixes with conflicting ideas. Irvine et al (2002) also consider some organisational difficulties and barriers to the effectiveness of inter-professional practice. They identify that differences in working hours may hinder the development of close working relationships between professionals. Also the time different professionals take to carry out particular work may cause difficulties. For example doctors may be making decisions regarding clients on a day-to-day basis whereas social workers need to undertake longer term casework to meet their clients needs. Also, financial constraints can influence the ability of a team to practice effective collaborative working. McCray notes that when budgets and resources are limited, the issue of who will pay for the intervention can also create tension within teams. Even if practitioners wish to work collaboratively, their managers may be less able to facilitate this due to budgeting constraints, and may therefore place restrictions on the amount of collaboration that can tak e place. Irvine et al (2002) considers that differing value systems between professions may also contribute to problems with the determining of priority of certain cases. The senior nurse may have decided that she would prioritise Daniels well-being over the values of Jo. Different professions or grades will see patients needs as being at different levels of importance as their aims and goals for the patient will be dissimilar. This can create problems and sources of conflict between different grades of nurses and some, such as the senior nurse may feel as though their patients needs are being ignored or devalued mainly in this situation by Jo or the doctor who is looking after Daniel. Hudson (2002) also explains that issues relating to professional status also have implications for inter-professional relationships. Health and social care professions in particular have very different levels of training, education and legal restriction. In this case, it seems that the senior nurse is devaluing Jos opinions and knowledge and sticking to her own. All the barriers discussed can create stress and tension between team members. Irvine et al (2002) state that professional structures are differentiated by demographics; the size of the occupations membership; gender composition; the class of origin of its members; educational attainment; status and the relative size and source of primary income. These differences are all quoted as barriers to inter-professional working. What have I learnt? By analysing this scenario I have learnt many attributes which contribute to effective patient care and working in a team.

Brian Thorne Counselling Review

Louise, a young woman, presented to Brian Throne with a great deal of physical and mental pain and had been subjected to cyclical depression for a umber of years, usually occurring during the month of February. Before providing details under a number of skills subheadings I would like to make a general comment on Throne's capacity to summaries that which had been said by Louise at various stages throughout the session.A common criticism of the person-centered approach is that it is merely re-hashing what the client has Just said, resulting in a very slow and not very dynamic process, Brian Throne shows here how both reflection and summarizing can have very quick and positive impact on the client, when carried out tit skill. When Throne summarizes he manages somehow to add an extra layer of understanding and complexity to his summary. Which seems to allow the client to not only agree but open to further exploration.At one point during the session, Louise physically changes her posture and facial expression when Throne managed to not only reflect what had just been said but also added a layer of meaning that seemed hidden to the client. It is as if his reflection and summarizing has a synergistic and additive affect. In one particular instance he does this with a single word, ‘Personae? [22:01]. On other occasions he deftly follows his summaries with a gentle probing and allows the client enough silence and space to contemplate on what has been said and subsequently offer a reply.I can only hope that someday I can apply even a tiny fraction of the skill shown by Brian Throne. Attending and Active Listening I have combined examples of these two skills since as Throne seamlessly applies these skills throughout the session. His body language, which includes a forward- leaning posture, mirroring of Louse's facial expressions and genuine laughter at the appropriate times, all show a counselor staying in the present moment with his client throughout. He frequentl y verbalizes that he understands what she is saying and follows this up with impressive reflection and summarizing.Reflective skills Although Throne applies this throughout I have chosen a particular time [37:38], which I believe is a good example of this skill. Throne says ‘It doesn't seem genuine to you to plan anything? ‘ he Is asking this question since Louise describes how she has learned to adopt strategies in order to cope socially. She has done this for so long hat she is no longer sure which is the real her. She is taken aback by this summary and Throne Immediately states that he Is merely ‘holding it up to you'.Although this almost literal example of reflecting skills, I believe it is very apt. Being Concrete Louise finds it difficult to start the session and Throne Immediately Jumps in to Empathy When Louise describes her constant planning and strategist for every social situation, Throne replies with ‘That's so wearying? [23:38]; this to me is one of many obvious displays of empathy, which almost always get a positive response from the linen. Probing Throne probes throughout, always in a gentle and non threatening way.These probes are almost always preceded by a brief summary and/or reflection. A very good example of this is when Throne asks Louise Why did you want to drink alcohol on the train? [27:07]. Asked by another counselor, this question might elicit a defensive response but Louise tentatively supplies an answer, which is subsequently expanded on after more gentle probing. Feedback When Louise asks Throne why he asked the question about why she wanted alcohol n the train, he provides succinct but gentle feedback, which allows the session to enter a new area.He replies by saying ‘Because it seemed to me that you wanted to escape. ‘ [28:17]. Conclusion There are other examples of the skills described above throughout the session but I have tried to include the ones I felt allowed for a deeper relationship b etween counselor and client. I enjoyed this session very much and it has focused my attention on the skills required to help our clients acquire a greater awareness of themselves and their environments.

Ednas Awakening In The Awakening Novel - Free Essay Example

Sample details Pages: 5 Words: 1388 Downloads: 10 Date added: 2019/10/30 Category Literature Essay Level High school Tags: The Awakening Essay Did you like this example? In The Awakening by Kate Chopin, Ednas awakening and how it affects her is an example of situational irony. Situational irony is when something occurs that is unexpected and does not follow an assumed outcome. Throughout this novella, Edna Pontellier makes an attempt to discover herself in many distinct aspects of her own being. Don’t waste time! Our writers will create an original "Ednas Awakening In The Awakening Novel" essay for you Create order She grows cold and distant to her husband and children as she focuses on herself completely. She has multiple affairs with Mr.Pontellier and eventually ends up living on her own after buying herself an apartment. Most readers would be left believing that Edna would be satisfied with discovering herself in being that she spends all of her time within the novella trying to do so. Most would believe that this independent-minded woman with radical thinking for her time would find it easy to have peace in knowing that she did not have to rely on anyone but herself for it. But, in the long run, Edna ends up being dissatisfied with her discoveries. She finds herself upset with the fact that she struggles to care for her children and love her own husband. These discoveries eventually lead her to kill herself. While there are other smaller instances of irony in the novella such as instances of verbal irony, this is by far the most ironic part of the story. DYNAMIC CHARACTER In The Awakening by Kate Chopin, the character of Edna Pontellier can be considered dynamic. A dynamic character is defined as a character that undergoes a change in personality or perspective throughout the course of a story. Their counterpart is the static character. A static character remains unchanged throughout a story in most/every aspect. At the start of the novella, Edna was submissive to her husband. She was his obedient prized possession; she did all that he asked of her even if she did not believe he asked of her was necessary. A good example of this is in Chapter 3 (pg. 7), stating Mr.Pontellier returned to his wife the information that Raoul had a high fever and needed looking after Mrs.Pontellier was quite sure Raoul had no fever Even though Edna was sure that her son did not have a fever because he held no symptoms and did not complain of anything before he went off to bed, she still went to check on Raoul simply because her husband had told her to. But as the story pr ogresses, the once obedient Edna grows to defy the commands of her husband. In Chapter 11 (pg. 42), Edna refuses to return inside when her husband calls for her. She does not just say no either; she boldly turns him down, stating, Leonce, go to bed I mean to stay out here. I dont wish to go in, and I dont intend to. Dont speak to me like that again; I shall not answer you. This is a drastic change in personality in comparison to how she was just a few chapters early in the story. She is more independent and outspoken than she had ever been. Along with not submitting to her husbands commands, Edna has also gone from being a half decent mother completely isolating herself from her family. She went from doing the tasks that most mothers of that time were accustomed to doing to living away from home and cheating on her husband. CHAPTER QUOTATION EXPLAINED   Ã‚  Ã‚   Throughout The Awakening by Kate Chopin, Edna Pontellier gradually isolates herself both mentally and physically from her family, especially her husband. Although Edna seems to be quick to push Robert away at the beginning of the story, she begins to grow closer to him during her awakening. At the beginning of the novella, Mrs.Pontellier was loyal to her husband, regardless of what he demanded if her. She followed whatever he told her to do, even if she knew that nothing would come from his requests. An example of this (as previously stated) is in Chapter 3 when Mr.Pontellier asks Edna to go and check on their son, Raoul, because he believes that he has a fever. Edna does so even though she knows for sure that Raoul could not possible have a fever. As the novella progresses, she starts to recognize her true feelings for Robert and easily strays away from Mr.Pontellier and their marriage. In Chapter 13 (pg. 50-51), Edna speaks of how she has fallen asleep for a long time and has awoken to a world where it is just her and Robert, stating, How many years have I slept?   The whole island seems changed Although nothing has physically changed, Ednas state of mind has. This quote allows the reader to clearly see that Edna has changed mentally, for better or for worse. She has changed from an obedient, robot-minded wife to a self-discovery obsessed woman who is completely hooked on another man that she is willing to forget the world for him. SHORT SCENE ANALYSIS   Ã‚  Ã‚   In The Awakening by Kate Chopin, Chapter 17 proves itself to be important as it shows further character development of both Mrs. and Mr. Pontellier. The chapter begins with Mr.Pontellier returning home for dinner. He expects for his wife to tell him of her reception day only to find that she had spent the day out instead of abiding by her normal duties. Again, this scene shows Ednas progressive and more blatant defiance of her husbands wishes. The interaction between the two is quite reminiscent of how a rebellious teen might interact with their parents. Mr.Pontellier seems more confused than upset at Edna. Mrs.Pontellier does not give him a reason to why she left. She simply states that she just wanted to go out: like a defiant child rebelling just to rebel. One of the more important parts of this chapter though, following the interaction scene between Edna and Mr.Pontellier, is Ednas tantrum. After Mr.Pontellier heads off to the club, Edna returns to her room. It state s, Once she stopped, and taking off her wedding ring, flung it upon the carpet. When she saw it lying there, she stamped her heel upon it, striving to crush it. But her small boot heel did not make an indenture, not a mark upon the little glittering circlet (pg. 71). This scene is very important in the discovery of Ednas character specifically. It makes it clear to the reader that Edna will not be able to leave her marriage to be with Robert so easily. This is shown through Ednas inability to destroy her wedding ring as easily as she did her handkerchief and a glass vase. THE CREOLES OF LOUISIANA   Ã‚  Ã‚   The most respected of social classes in Louisiana (specifically the New Orleans area) at the time was that of the French Creoles. This upper class group of people were descendants of wealthy French settlers. They were thought of highly even though when, looking back at them now, many can recognize that how they treated women was unacceptable. The French Creoles of Louisiana were respected for their upkeep. They held what was considered to be perfect families at the time: a stay at home wife, disciplined children, and of course, a husband who left his wife to do most everything. Women were to be married as soon as possible. Typically these marriages were forced and held no love with the women being treated as just a necessary aspect in creating a perfect Creole family. Once married, they were left to complete a multitude of daily tasks in their new homes such as devote their lives to their husbands and children, obey every and all commands given by their husbands, take up appealing hobbies and much more. Women were encouraged to keep their feelings, specifically negative and thought-provoking ones, buried deep down within them for the better of their families. So, in my opinion, I agree with Edna wanting to isolate and distance herself from her Creole lifestyle. Although she tends to be a bit brash when it comes to how she rebels against the Creole way of life, it is understandable to why she reacted in such a way. No one deserves to be repressed in such a manner. Women deserve just as much respect as men, especially in context to the Creoles. In their society, women do so much but get so little in return.

Negative Effect on Media Sex and Violence - 3139 Words

It is literally known on media entertainment that sex and violence were there. Whereas people who enjoyed it will release their tensions and aggression . Highly sexual TV shows and intensely violent Web sites and video games may be affecting teenagers behavior, according to three studies published in Pediatrics. Sex on TV and teen pregnancy. A total of 2,003 teens (ages 12 to 17 years) were asked how often they watched 23 popular TV shows that portrayed passionate kissing, sexual talk, and sexual intercourse. One to three years later they were interviewed again; 744 teens reported being sexually active. Those who watched the most TV shows with sexual content were two to three times more likely to become pregnant or to impregnate†¦show more content†¦This outweighed the sexual violence itself, giving credence to what Ferguson calls the Buffy Effect—named after the popular television show Buffy the Vampire Slayer and its strong lead female character. Although sexual and violent content tends to get a lot of attention, I was surprised by how little impact such content had on attitudes toward women. Instead it seems to be portrayals of women themselves, positive or negative that have the most impact, irrespective of objectionable content. In focusing so much on violence and sex, we may have been focusing on the wrong things, Ferguson said. While it is commonly assumed that viewing sexually violent TV involving women causes men to think negatively of women, the results of this carefully designed study demonstrate that they do so only when women are portrayed as weak or submissive, added Journal of Communication editor and University of Washington Professor Malcolm Parks. Positive depictions of women challenge negative stereotypes even when the content includes sexuality and violence. In this way Ferguson reminds us that viewers often process popular media portrayals in more subtle ways than critics of all political stripes give them credit for. Sex and Violence on Television and Movies should be Restricted Sex and violence is one of the most popular issues in today’s society. In the world today, up to 70 percent of adults love to watch action movies that have a lot of sex and violence in it eitherShow MoreRelatedViolence And Sex On Television898 Words   |  4 Pages Violence and Sex on Television: Effects on the Younger Audience In today’s society, the media is used greatly for communication, advertisement, information, and for numerous other reasons. The world has evolved by technological advances as well as by the type of content that is put out on the internet, radio, and especially on television. 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