APA format with References

Case Study 

Diabetic Ketoacidosis

Patient Profile.

N.B., a 34 year-old Native American man, was admitted to the emergency department after he was found unconscious by his wife in their home.

Subjective Data

· Was diagnosed with type 1 diabetes mellitus 12 months ago

· Was taking 50 units of insulin daily; 5 units of lispro insulin with breakfast, 5 units with lunch and 10 units with supper plus 30 units of glargine insulin at bedtime

· Has a history of flu for 1 week with vomiting and anorexia

· Stopped taking insulin 2 days ago when he was unable to eat

Objective Data

Physical Examination

· Breathing is deep and rapid

· Acetone smell on breath

· Skin flushed and dry

Diagnostic Studies

· Blood glucose level of 730 mg/dL (40.5 mmol/L)

· Blood pH of 7.26

Discussion Questions

1. Briefly explain the pathophysiology of the development of diabetic ketoacidosis (DKA) in this patient

2. What clinical manifestations of DKA does this patient exhibit?

3. What factors precipitated this patient’s DKA?

4. Priority Decision: What is the priority nursing intervention for N.B.?

5. What distinguishes this case history from one of hyperosmolar hyperglycemic syndrome (HHS) or hypoglycemia?

6. Priority Decision: What is the priority teaching that should be done with this patient and his family?

7. What role should N.B.’s wife have in the management of his diabetes?

8. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?

APA format 3 references please use 2 from the discussion post 1 page long

Simulated Learning Experiences

                Simulation learning provides students the opportunity to practice and master their skills in a structured setting.  Students who engage in simulation learning activities demonstrate both personal and professional growth (Swanson, Schaeffer-Fraase, & Riggins, 2019).  The purpose of this discussion is to describe a previous learning experience and to explain how simulation learning would enhance my learning experience and would more effectively achieve the same objectives. 

Nursing Education in 1984

                My nursing school did not incorporate simulation centers or structured skills labs in their curriculum.  Instead, we learned our skills on live people – either a classmate or a hospitalized patient. I learned how to give injections and perform venipunctures on my classmates.  However, the first time I inserted a foley catheter or a nasogastric tube was on a patient.  Even worse, as nursing students, we were assigned relatively stable patients during our clinical rotations.  While it is logical to assign a stable patient to a student, this practice ensured nursing students were unable to learn their learning skills before entering the profession.  As a result of this educational approach, I did not learn how to start an IV, prepare and hang IV solutions, draw blood, connect a patient to telemetry, perform wound care or any of the other essential nursing skills until I was on the job.  This complete lack of preparation for my role as a nurse created a steep learning curve.  However, I was not alone in my struggles as the clinical education I received was typical of nursing school at that time.

Retroactively Improving Nursing Education in 1984

                Simulation learning using mannequins was introduced in 1911 when a life-sized doll was made to teach nurses how to turn, transfer, and dress patients (Aebersold, 2016).  Just three years later, in 1914, the mannequin was upgraded to allow nurses to learn injection skills (Aebersold, 2016).  However, even though these mannequins were introduced over 70 years before I entered nursing school, the nursing schools in my area had yet to include simulation learning in their curriculum.  I entered the nursing profession fully aware that I did not possess the skills I needed to provide quality patient care.  Students who engage in simulation learning are provided the opportunity to develop their skills in a controlled setting (Cant & Cooper, 2017).  Although simulation technology in 1984 was limited compared what is available today, my nursing school could have placed a hospital bed in a room along with the basic equipment found in an inpatient hospital room and a mannequin. Additionally, rather than practicing simple skills such as turning and repositioning the patient, the faculty could have created scenarios for the students to address such as finding the patient on the floor and Code Blue situations.  Students who engage in simulation learning activities have increased clinical self-efficacy and decreased anxiety (Shahsavari et al., 2017).  Additionally, a direct correlation has been identified between simulation performance and clinical practice (Judd, Fethney, Alison, Waters, & Gordon, 2018).  Had I been prepared with the skills and critical thinking skills provided in simulation learning, I would have been a much safer and more accomplished graduate nurse. 

Summary

                Simulation learning has become an integral part of nursing education.  However, as with all teaching methods, simulation learning methods must continually be evaluated and modified to ensure the activities are appropriate, and learning objectives are met.  After all, not only does the nursing student benefit from simulation learning, but their future clinical settings and patients do so as well.   

References

Aebersold, M. (2016). The history of simulation and its impact on the future. AACN Advanced Critical Care, 27(1), 56-61. doi:10.4037/aacnacc2016436  

Cant, R. P., & Cooper, S. J. (2017). Use of simulation-based learning in undergraduate nurse education: An umbrella systematic review. Nurse Education Today, 49, 63-71. doi:10.10 16/j.nedt.2016.11.015

Judd, B., Fethney, J., Alison, J., Waters, D., & Gordon, C. (2018). Performance in simulation is associated with clinical practice performance in physical therapist students. Journal of Physical Therapy Education, 32(1), 94-99. doi:10.1097/JTE.0000000000000024

Shahsavari, H., Ghiyasvandian, S., Houser, M. L., Zakerimoghadam, M., Kermanshahi, S. S., & Torabi, S. (2017). Effect of a clinical skills refresher course on the clinical performance, anxiety and self-efficacy of the final year undergraduate nursing students. Nurse Education in Practice, 27, 151-156. doi:10.1016/j.nepr.2017.08.006

Swanson, K., Schaeffer-Fraase, K., & Riggins, J. (2019). Peer teachers: Learning in the nursing skills lab. In Sigma’s 30th International Nursing Research Congress. Calgary, Canada: Author.