NR 507 Week 5: Discussion Part One

Chamberlain University NR 507 Week 5: Discussion Part One– Step-By-Step Guide

This guide will demonstrate how to complete the Chamberlain University NR 507 Week 5: Discussion Part One assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NR 507 Week 5: Discussion Part One

Whether one passes or fails an academic assignment such as the Chamberlain University NR 507 Week 5: Discussion Part One depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NR 507 Week 5: Discussion Part One

The introduction for the Chamberlain University NR 507 Week 5: Discussion Part One is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NR 507 Week 5: Discussion Part One

After the introduction, move into the main part of the NR 507 Week 5: Discussion Part One assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NR 507 Week 5: Discussion Part One

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NR 507 Week 5: Discussion Part One

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NR 507 Week 5: Discussion Part One

Ms. Blake is an older adult with diabetes and has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. She has a history of Type I diabetes. On admission her laboratory values show:

Sodium (Na+)	156 mEq/L
Potassium (K+)	4.0 mEq/L
Chloride (Cl–)	115 mEq/L
Arterial blood gases (ABGs)	pH- 7.30; Pco2-40; Po2-70; HCO3-20

Normal values
Sodium (Na+)	136-146 mEq/L
Potassium (K+)	3.5-5.1 mEq/L
Chloride (Cl–)	98-106 mEq/L
Arterial blood gases (ABGs)	pH- 7.35-7.45 Pco2- 35-45 mmHg Po2-80-100 mmHg HCO3–22-28 mEq/L

What is the etiology of Diabetic Ketoacidosis?
Describe the pathophysiological process of Diabetic Ketoacidosis.
Identify the hallmark symptoms of Diabetic Ketoacidosis.
Identify any abnormal lab results provided in the case and explain why these would be abnormal given the patient’s condition.
What teaching would you provide this patient to avoid Diabetic Ketoacidosis symptoms?

In addition to the textbook, utilize at least one peer-reviewed, evidence based resource to develop your post.

You did a great job explaining the etiology and pathophysiology of Diabetic Ketoacidosis. I would like to touch upon the patient teaching component of this week’s topic discussion. You make a good point about teaching diabetes patients to test their glucose levels more often. Glucose monitoring is a big topic among diabetes researchers and clinicians, even more so is the topic of self-monitoring blood glucose (SMBG) levels. Schnell, Hanefeld, & Monnier (2014) state SMBG is a critical for the optimization of diabetes treatment in insulin-treated diabetes patients. SMBG is beneficial because it helps diabetes patients hit their hemoglobin A1c (HbA1c) targets, minimizes glucose variability, and helps to predict and prevent hypoglycemia (Schnell, Hanefeld, & Monnier, 2014). SMBG also positively influences lower morbidity and all-cause mortality rates among Type I and II diabetes patients (Schnell, Hanefeld, & Monnier, 2014). Those who check their blood glucose levels often are proactively changing their lifestyles for the better. SMBG prompts patients to eat healthier meals, exercise lightly more often, minimize stress, stay hydrated, and follow their medication regimen. Checking glucose levels at least 4 to 5 times a day will heighten patients’ awareness to avoid the type of lifestyle that advance DK symptoms.

Effectively managing blood glucose levels and maintaining glycemic control includes monitoring ketones levels. FNPs can encourage their diabetes patients to add this action after checking their blood glucose levels. FNPs can help educate diabetes patients on ketones, proper ketone levels, how ketones level get too high (above 3.0 mmol/L) or too low (below 1.5 mmol/L), and what actions to take to avoid hypoglycemia if ketone levels get too low. Patients at risk for DK may be interested in adopting a ketogenic diet, a low-carbohydrate, high-fat, adequate-protein diet that reduces one’s chances of inducing DK (Urbain & Bertz, 2016).

References

Schnell, O., Hanefeld, M., & Monnier, L. (2014). Self-Monitoring of Blood Glucose: A Prerequisite for Diabetes Management in Outcome Trials. Journal of Diabetes Science and Technology, 8(3), 609–614. http://doi.org/10.1177/1932296814528134

Urbain, P., & Bertz, H. (2016). Monitoring for compliance with a ketogenic diet: what is the best time of day to test for urinary ketosis? Nutrition & Metabolism, 13, 77. http://doi.org/10.1186/s12986-016-0136-4

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Sample Answer 2 for NR 507 Week 5: Discussion Part One

What is the etiology of Diabetic Ketoacidosis?

Diabetic ketoacidosis is a severe complication of diabetes that occurs when your body produces high levels of blood acids called ketones. “Diabetic ketoacidosis (DKA) develops when there is an absolute or relative deficiency of insulin and an increase in the levels of counterregulatory insulin hormones” (McCance, 2013). This disease commonly found in patients with type 1 diabetes. However, it can also occur in type 2 diabetes. The most common triggering aspect for DKA is other illness, such as infection, trauma, surgery, or myocardial infarction. Interruption of insulin administration also may result in DKA. (McCance, 2013).

The condition develops when your body can’t produce enough insulin. Insulin usually plays a crucial role in helping sugar (glucose) — a significant source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. (Mayo clinic staff, 2018).

Describe the pathophysiological process of Diabetic Ketoacidosis.

Diabetic ketoacidosis characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. Insulin deficiency is the main precipitating factor. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases arising in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to 50 years of age, and 36 percent in persons younger than 30 years. The case fatality rate is 1 to 5 percent. About one-third of all cases are in persons without a history of diabetes mellitus. (Westerberg, 2013). According to, McCance, 2013. In a state of relative insulin deficiency, there is an increase in the concentrations of insulin counterregulatory hormones including catecholamines, cortisol, glucagon, and GH. “These counterregulatory hormones antagonize insulin by increasing glucose production and decreasing tissue use of glucose. Profound insulin deficiency results in decreased glucose uptake increased fat mobilization with the release of fatty acids and accelerated gluconeogenesis and ketogenesis. “(McCance, 2013).

Identify the hallmark symptoms of Diabetic Ketoacidosis.

Hallmark symptoms include polyuria with polydipsia (98 percent), dehydration, weight loss (81 percent), fatigue (62 percent), dyspnea (57 percent), vomiting (46 percent), preceding febrile illness (40 percent), abdominal pain (32 percent), and polyphagia (23 percent). Other symptoms of diabetic ketoacidosis include Kussmaul respirations (hyperventilation to compensate for the acidosis), postural dizziness, central nervous system depression, ketonuria, anorexia, nausea.

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Identify any abnormal lab results provided in the case and explain why these would be abnormal given the patient’s condition.

Sodium (Na+) 156 mEq/L elevated normal range 136-146 mEq/L. The American Diabetes Association criteria for the diagnosis of DKA are: (1) a serum glucose level >250 mg/dl, (2) a serum bicarbonate level <18 mg/dl, (3) a serum pH <7.30, (4) the presence of an anion gap, and (5) the presence of urine and serum ketones. Arterial blood gases (ABGs) Pco2-40; Po2-70; HCO3-20. Metabolic acidosis confirmed by arterial blood gas (ABG) analysis is one of the diagnostic criteria for diabetic ketoacidosis (DKA). Given the direct relationship between end-tidal carbon dioxide (ETCO2), arterial carbon dioxide (PaCO2), and metabolic acidosis, measuring ETCO2 may serve as a surrogate for ABG in the assessment of possible DKA. (Soeimanpour et al., 2013). These labs are abnormal because the body is compensating for the high level of glucose in the renal system and the loss of glucose in the urine. Ms. Blake has not been eating and probably has been taken her insulin as she was before she got sick. When you have diabetes and don’t get enough insulin and get dehydrated, your body burns fat instead of carbs as fuel, and that makes Ketones. Lots of ketones in your blood turn it acidic. People who drink much alcohol for a long time and don’t eat also enough build up ketones. It can happen when you aren’t eating at all, too. This condition can all lead to or be a predictor of existing Ketoacidosis.

What teaching would you provide this patient to avoid Diabetic Ketoacidosis symptoms?

First, I would emphasize the importance of managing her insulin regimen, instruct her that DKA is a life-threatening condition. I would teach Ms. Blake to Monitor her blood sugar levels closely, especially if you have an infection, are stressed, or experience trauma. Check your blood sugar levels often. You may need to check at least three times each day. If your blood sugar level is too high, give yourself insulin as directed by your healthcare provider. Manage your sick days. When you are sick, you may not eat as much as you usually would. You may need to change the amount of insulin you give yourself. You may need to check your blood sugar level more frequently than typical. Strategize with your healthcare provider about how to manage your diabetes when you are sick.

References

Mayo clinic staff (2018). Diabetic ketoacidosis/ Symptoms & causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby.

Soleimanpour,H., Taghizadieh, A., Niafar, M., Rahmani, F., Golzari, S.E.J., Estanjani, R.M. (2013). Predictive Value of Capnography for Suspected Diabetic Ketoacidosis in the Emergency Department. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876300/

Westerberg, D.P. (2018). Diabetic Ketoacidosis: Evaluation and Treatment. Retrieved fromhttps://www.aafp.org/afp/2013/0301/p337.html

Sample Answer 3 for NR 507 Week 5: Discussion Part One

I enjoyed reading your post and agree with the fact that would point out the importance of managing the patient’s insulin regimen and telling her that diabetic ketoacidosis (DKA) is a life threatening emergency. I would like to add that poor insulin regimen adherence is the main cause of (DKA) in most individual. Many lifestyle behaviors, social economic, psychosocial and educational determinants impact to low adherence (Halepian, Saleh, Hallit & Khabbaz, 2018). According to a study based on the Kaiser Permanente hospital population, the study found that a high percentage of patients who did not start their insulin regimen felt that their medical providers ineffectively disclosed the risks and advantages of insulin (Halepian et al., 2018). More counseling by medical providers is required to educate the patient about the probable aftereffects that may result with insulin regimen and most imperatively about the potency of insulin (Halepian et al., 2018). Emphasizing the benefits of insulin regimen at the time of prescribing, as well as clarifying the possibility of an adverse aftereffects occurring and its significance can enhance how patients comprehend information from different sources (Halepian et al., 2018). Second level of schooling was negatively linked with less trust in physician scores (Halepian et al., 2018). This may clarify why the patients with higher education accomplishment are more involved in the health decision making process and confirm reliability of information offered by their providers (Halepian et al., 2018). As advanced practice nurses it is important to recognize these factors and institute culturally competent intervention and patient education may reduce the reoccurrence of DKA.

References

Halepian, L., Saleh, M.B., Hallit, S., & Khabbaz, L. R. (2018). Adherence to insulin, emotional distress and trust in physician among patients with diabetes. Diabetes Therapy, 9(2), 713-726. doi: 10.1007/s1333000-018-0389-1

Sample Answer 4 for NR 507 Week 5: Discussion Part One

References

Sample Answer 5 for NR 507 Week 5: Discussion Part One

Great post and thank you for sharing you made some very informative points. Timely management of diabetic ketoacidosis (DKA) is essential to avoid lengthy hospitalizations and poor clinical outcomes (Joyner-Blair, Hamilton & Spurlock, 2018). There is often an absence of ownership for glycemic management in hospitalized patients, most notably in those with a diagnosis other than diabetes. This lack of ownership supports the use of evidence-based DKA protocols. Joyner-Blair, Hamilton & Spurlock (2018) conducted a project to determine whether utilization of an evidence-based order set versus an individualized provider approach for the treatment and management of DKA decreases resolution time and occurrences of hypoglycemia and improves clinical outcomes.

They retrospectively reviewed electronic medical record of 150 non-pregnant adult patients diagnosed with DKA, pre and post-interventions, for retrieval of relevant outcome data. They concluded that implementation of the institutionally approved evidence-based order set affirmed anticipated outcomes (Joyner-Blair, Hamilton & Spurlock, 2018). Results showed improvements (Joyner-Blair, Hamilton & Spurlock, 2018) in the (a) total length of stay, (b) arrival to intravenous fluid time, (c) intravenous insulin initiation to discontinuation (resolution) time, (d) arrival to subcutaneous insulin administration time, (e) time from initial to sequential laboratory testing, (f) use of a basal, prandial, and correction insulin approach (physiological mimic), and (g) the incidence of hypoglycemia. Outcomes substantiate the importance and need for maintaining an evidence-based and systems approach for the management of DKA. Although hyperosmolar hyperglycemic state can be confused with DKA, ketone levels are low or absent in persons with hyperosmolar hyperglycemic state. Other causes of high anion gap metabolic acidosis, such as alcoholic ketoacidosis and lactic acidosis, must be ruled out.

Reference

Joyner Blair, A. M., Hamilton, B. K., & Spurlock, A. (2018). Evaluating an Order Set for Improvement of

Quality Outcomes in Diabetic Ketoacidosis. Advanced Emergency Nursing Journal, 40(1), 59-72. doi:10.1097/TME.0000000000000178