Date of Completion of Thesis/SIP

Spring 6-4-2020

Document Type

Scholarly Inquiry Paper (SIP)

Degree Name

Master of Science in Nursing (MSN)

Department

Nursing

First Advisor

Kimberly Langer

Abstract

Diabetes mellitus (DM) is an endocrine disorder that affects the metabolism of glucose, for which there were an estimated 415 million cases world-wide. There are two common types of DM, Type 1 and Type 2. A significant difference between the two types of DM is the underlying cause of the disease but the two disease processes have similar characteristics. Both Type 1 and Type 2 DM can be associated with severe complications. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are two of the most common medical emergencies. DKA is commonly found in those with Type 1 DM and can be characterized by elevated serum glucose levels, decreased serum pH, and the presence of ketones the serum and urine. HHS is more commonly found in those with Type 2 DM and can be characterized by serum glucose levels > 600 mg/dl and serum osmolality > 320 mOsm/kg. Ketones and severe metabolic acidosis are not typically present with HHS. While there are some differences among the two types of complications, the management of DKA and HHS are similar. Major components of management of both conditions includes intravenous fluid resuscitation, electrolyte replacement, and insulin therapy to manage serum glucose levels. Order sets are often used in medicine and in other industries to guide treatment or processes. A comprehensive literature review was conducted to examine the effectiveness of order sets in the treatment of DKA and HHS. Despite a lack of high-level evidence, outcomes showed consistent improvements in patient outcomes status post the implementation of a treatment guided order set. Common outcomes measured included hospital length of stay, intensive care unit length of stay, time to anion gap closure, hypoglycemic events, time to ketone clearance, and compliance with treatment guidelines. The outcomes of focus of this literature review were the hospital and intensive care unit length of stay and time to closure of the anion gap. Since the use of order sets for the treatment of DKA and HHS has been shown to improve patient outcomes, hospitals and hospital groups should work to implement order sets for the treatment of hyperglycemic emergencies.

Included in

Nursing Commons

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