Multidisciplinary Conference 4.1

Multidisciplinary team meetings, conferences, or rounds are mechanisms through which care providers from different specialties (physicians, nursing, case management, social work, quality, pharmacy, and other ancillary services) meet to communicate, coordinate patient care, make joint decisions, and manage responsibilities. These can occur either during bedside rounds or in a team meeting.

This week we are covering diabetes management and exploring chronic diseases associated with the kidney.

Managing Diabetes

Jerry Thomas is a 26-year-old type 1 diabetic. He was originally diagnosed at the age of 14 and currently manages his disease with an intensive regimen of insulin injections. Jerry is employed as a schoolteacher and soccer coach. He presents today with a two-day history of vomiting and diarrhea. He has been closely monitoring his blood glucose and is using regular insulin for high blood glucose levels. He has only been able to tolerate liquids such as Gatorade, but today he is unable to even tolerate that and comes to the clinic for evaluation of possible diabetic ketoacidosis (DKA).

Discuss the following:

1. Describe the pathophysiology of DKA and why it occurs in patients with type 1 diabetes.
2. Based on the diagnosis of DKA, what assessment findings does the nurse correlate to this disorder?
3. The physician orders a complete metabolic panel and Jerryàblood glucose is 425. Other lab values include serum sodium of 152, serum potassium of 3.0, and BUN of 64. What is your assessment of these results?
4. Explain why it is important for Jerry to continue to take his insulin even though his oral intake is decreased.
   

   Kidney Disease Management

   Arief Aslan, a male, 67-year-old patient, is three days postoperative after a coronary artery bypass graft operation. The patient has a history of hypertension, type 1 diabetes, coronary artery disease, and end-stage kidney disease, which is treated with hemodialysis three times per week. The patient has a left atriovenous (AV) shunt. The patient is taking the following medications:

   • Sevelamer (Renagel): two capsules with each meal
   • Vitamin D, B12, and iron supplements: with meals
   • Calcium carbonate (OS-Cal): three tablets with each meal
   • Procrit (epoetin alfa): 100 U/kg/dose subcutaneously every Monday, Wednesday, and Friday (dialysis days)
   • 70/30 NPH and regular insulin 30 U twice daily (Fingerstick blood sugars taken before meals and at bedtime, and regular insulin given per sliding scale)
   • Coreg (carvedilol): 12.5 mg twice daily
   • Lanoxin: 0.125 mg (every other day, on even days)
   • Acetaminophen with Codeine No. 3: one to two tablets every six hours
   • Diphenhydramine hydrochloride (Benadryl): 25 mg every eight hours PRN for itching
   • Docusate sodium (Colace): 100 mg b.i.d.

   Discuss the following:

   1. The patient is ordered to have daily dialysis. What is the rationale for this order?
   2. The patient is going to hemodialysis at 9 a.m. on an odd day. Which medication or medications should the nurse hold before sending the patient?
   3. What nursing management considerations should be made for this patient?