Heartbreak to Happiness: Striving to Improve Outcomes for the Patient in Diabetic Ketoacidosis
Article first published online: 14 JUN 2012
© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Special Issue: 2012 Convention Proceedings
Volume 41, Issue s1, pages S169–S170, June 2012
How to Cite
Gelato, J., Holleran, D. and Skinner, N. (2012), Heartbreak to Happiness: Striving to Improve Outcomes for the Patient in Diabetic Ketoacidosis. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41: S169–S170. doi: 10.1111/j.1552-6909.2012.01363_12.x
- Issue published online: 14 JUN 2012
- Article first published online: 14 JUN 2012
- diabetic ketoacidosis;
- intrauterine fetal demise
Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that warrants prompt recognition and a multidisciplinary approach to provide intensive management and monitoring of both mother and fetus. DKA is estimated to occur in 1 to 2% of pregnancies complicated by preexisting diabetes, with 10 to 30% of women having a serum glucose less than 250 mg/dl upon diagnosis, and it poses a significant risk for the fetus, with perinatal mortality rates reported between 9% and 35%. Factors that increase the risk of DKA in pregnant patients include stress, trauma, infection, poor patient compliance, insulin pump failure, accidental omission of insulin, and medications utilized in the obstetric setting. It is crucial that nurses are familiar with the clinical signs of DKA so that prompt and appropriate treatment can be initiated to optimize outcomes for both the pregnant woman and her fetus. To better understand the signs and symptoms of DKA, an outline of the multisystem effects of a patient in DKA will be provided.
The presentation follows the case of a patient who recently gave birth to a healthy 38-week male infant. Her previous pregnancy and birth resulted in an intrauterine fetal demise following an episode of DKA. We will present a timeline
that outlines the course of both pregnancies and the patient's progression from grief to acceptance.
A problem solving method aimed to identify the root cause of an event, known as a Root Cause Analysis, was conducted utilizing a multidisciplinary team to review and discuss the case. Opportunities were presented to improve patient care and patient outcomes of the diabetic patient admitted with a diagnosis of uncontrolled blood sugars in recognition of DKA. The team decided to develop a Diabetic Ketoacidosis MD order set and to provide online education and education in the formal classroom setting for resident and nursing staff.