Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition Adolescent With Diabetes Mellitus (DM) Case Studies The patient, a 16-year-old high-school football player, was brought to the emergency room in a coma. His mother said that during the past month he had lost 12 pounds and experienced excessive thirst associated with voluminous urination that often required voiding several times during the night. There was a strong family history of diabetes mellitus (DM). The results of physical examination were essentially negative except for sinus tachycardia and Kussmaul respirations. Studies Results Serum glucose test (on admission), p. 227 1100 mg/dL (normal: 60–120 mg/dL) Arterial blood gases (ABGs) test (on admission), p. 98 pH 7.23 (normal: 7.35–7.45) PCO2 30 mm Hg (normal: 35–45 mm Hg) HCO2 12 mEq/L (normal: 22–26 mEq/L) Serum osmolality test, p. 339 440 mOsm/kg (normal: 275–300 mOsm/kg) Serum glucose test, p. 227 250 mg/dL (normal: 70–115 mg/dL) 2-hour postprandial glucose test (2-hour PPG), p. 230 500 mg/dL (normal: <140 mg/dL) Glucose tolerance test (GTT), p. 234 Fasting blood glucose 150 mg/dL (normal: 70–115 mg/dL) 30 minutes 300 mg/dL (normal: <200 mg/dL) 1 hour 325 mg/dL (normal: <200 mg/dL) 2 hours 390 mg/dL (normal: <140 mg/dL) 3 hours 300 mg/dL (normal: 70–115 mg/dL) 4 hours 260 mg/dL (normal: 70–115 mg/dL) Glycosylated hemoglobin, p. 238 9% (normal: <7%) Diabetes mellitus autoantibody panel, p. 186 insulin autoantibody Positive titer >1/80 islet cell antibody Positive titer >1/120 glutamic acid decarboxylase antibody Positive titer >1/60 Microalbumin, p. 872 <20 mg/L Diagnostic Analysis The patient’s symptoms and diagnostic studies were classic for hyperglycemic ketoacidosis associated with DM. The glycosylated hemoglobin showed that he had been hyperglycemic over the last several months. The results of his arterial blood gases (ABGs) test on admission indicated metabolic acidosis with some respiratory compensation. He was treated in the Case Studies Copyright © 2018 by Elsevier Inc. All rights reserved. 2 emergency room with IV regular insulin and IV fluids; however, before he received any insulin levels, insulin antibodies were obtained and were positive, indicating a degree of insulin resistance. His microalbumin was normal, indicating no evidence of diabetic renal disease, often a late complication of diabetes. During the first 72 hours of hospitalization, the patient was monitored with frequent serum glucose determinations. Insulin was administered according to the results of these studies. His condition was eventually stabilized on 40 units of Humulin N insulin daily. He was converted to an insulin pump and did very well with that. Comprehensive patient instruction regarding selfblood glucose monitoring, insulin administration, diet, exercise, foot care, and recognition of the signs and symptoms of hyperglycemia and hypoglycemia was given. Critical Thinking Questions 1. Why was this patient in metabolic acidosis? 2. Do you think the patient will eventually be switched to an oral hypoglycemic agent? 3. How would you anticipate this life changing diagnosis is going to affect your patient according to his age and sex? 4. The parents of your patient seem to be confused and not knowing what to do with this diagnoses. What would you recommend to them? 

Acute Kidney Injury (AKI) is highly prevalent in ICU settings and requires significant consideration.  AKI is rarely attributed to a single factor, and most critically ill patients who develop AKI have coexisting conditions.

Many forms of AKI are preventable and patients at risk should be evaluated early according to clinical condition and biomarkers.  Discuss AKI prevention and pharmacological treatment strategies.  Include specific recommendations for preventing or treating drug-induced AKI. 

Instructions:

Post your discussion to the Moodle Discussion Forum.  Initial post must be made by Day #3.  Word limit 500 words.  Reply to at least two other student posts with a reflection of their response.  Please make sure to provide citations and references (in APA, 7th ed. format) for your work.  

 In dealing with cultural differences/potential conflict in nursing/healthcare, what assessments and strategies would you incorporate to gain compliance from your culturally diverse client(s). Provide examples of the culture(s) discussed, as well as, your evidenced-based strategies.

• Sections of the assignment must include:
  Introduction
  Focus points covered in the discussion posts
  Any arguments and rationales for your stance
  Conclusion or Summary
• The components of your APA Assignment includes the following:
  The assignment must be completed on a word document.
  Your APA Assignment must include a title page (Refer to Purdue OWL).
  All in-text citations must be used when paraphrasing or quoting a previous author.
  All references must reflect the in-text citations used.
  All reference sources must be within the past 5 years unless it is the works of a nurse theorist or a significant reference material.
  The length of the assignment must be 750-1000 words. Please pay attention to spelling and grammar. Points are deducted for repeat offenders.
  Upon completion of the assignment, you must submit it via Turnitin.com and please note that your plagiarism score should be no more than 20%. If you score higher, please make adjustments.

Respond using APA, at least 2 scholarly references

Leadership and a Healthy Work Environment

    Leadership involves the relationship between a leader and followers with the behaviors or attributes of the leader influencing whether employees consider a work environment to be healthy. Various theories exist about the way leaders and followers construct a social order in organizations leading to a healthy work environment (Vidman & Stromberg, 2020). My perception of a healthy work environment is one in which employees are satisfied with their work, work towards a common goal, and there is no conflict with managers or other employees. Leadership is the single most important factor influencing the employee’s work environment in an organization.

    One insight from the literature about leadership is that managers who inspire workers to do their best contribute to a healthy work environment. Transformational leadership theory proposes that the way leaders use a positive relationship with followers can inspire others to adopt a common goal and voluntarily work towards achieving the goal (Pourbarkhordari et al., 2016). An element of transformational leadership is inspirational motivation by the leader that involves encouraging and motivating employees. The concept of transformational literature gave me insight into the way a manager at a part time job where I worked was able to motivate employees. The manager was always optimistic about the future even when the job we were assigned seemed impossible to do in the time allowed. The manager helped us understand that if the staff worked together as an efficient team, we could meet the deadline even though it seemed difficult. The manager also showed us how to perform tasks more rapidly. Because of these behaviors, we felt like a team and were always focused on helping each other. Even though the work was difficult, the work environment seemed positive and friendly.

    I gained another insight about leadership from literature focusing on authentic leadership theory. The theory defines authentic leadership as altruistic and transparent behaviors, which also has an association with a healthy work environment (Giordano-Mulligan & Eckhardt, 2019). Authentic leaders consistently act on their values and beliefs and demonstrate integrity. The leadership approach also involves followers in decision-making about the best approach to perform tasks. On another part-time job that I once had, the manager was responsible for a group of employees that work her floor. A rule set by the manager was that all employees should be on time for work to avoid unfairly burdening the other employees. One of the employees, however, was always late. The manager terminated the employee and took the employees place until a replacement could be hired. The manager created a healthy work environment by fairly addressing a personnel problem consistent with stated values and beliefs while minimizing the burden of the decision on other employees.   

References

Giordano-Mulligan, M., & Eckhardt, S. (2019). Authentic nurse leadership conceptual framework. Nurse Administration, 43(2), 164-174. https://doi.org/10.1097/NAQ.0000000000000344    

Pourbarkhordari, A., Zhou, E., & Poukarimi, J. (2016). Role of transformational leadership in creating a healthy work environment in business setting. European Journal of Business and Management, 8(3), 57-70. https://core.ac.uk/download/pdf/234627054.pdf 

Vidman, A., & Stromberg, A. (2020).  Leadership for a healthy work environment- a question of who, what, and how. Leadership in health Services, 34(1), 1-15. https://doi.org/10.1108/LHS-06-2020-0041       

 What is your definition of spiritual care? How does it differ or accord with the description given in the topic readings? Explain.