NURS FPX4025 Assessment 3 Applying the PICO(T) Process – Applying the PICO(T) Process: Diabetic Ketoacidosis (DKA)
Diabetic ketoacidosis (DKA) is a potentially fatal metabolic complication of diabetes mellitus, which is marked by hyperglycemia, metabolic acidosis, and ketosis (Lizzo et al., 2023). In the Sentinel U simulation, Jose Sanchez showed typical signs of DKA such as high blood glucose, Kussmaul breathing, dehydration, and altered mental status. The PICO(T) framework is a structured approach that enables nurses to develop focused clinical questions and efficiently
search for relevant evidence to guide patient care. This paper uses the PICO(T) process on DKA management, establishes a gap in the existing literature, and examines the evidence to guide best clinical practices.
Diagnosis Overview: Outcomes, Risks, and Complications
DKA is linked to a high level of morbidity and mortality when not timely identified and managed. As Elendu et al. (2023) states, DKA is one of the most common causes of mortality in patients with diabetes, especially in under-resourced environments where the mortality rate can be as high as 24%. Typical complications are acute renal failure, electrolyte imbalances (particularly potassium disorders), cerebral edema, and cardiac arrhythmias. The laboratory results in the case of Jose Sanchez, including high creatinine levels and irregular potassium levels, indicate the possibility of a kidney problem and heart instability. DKA disproportionately
affects the vulnerable populations. Jose Sanchez has a high risk of poor outcomes and delayed diagnoses due to limited access to health care, low health literacy, and language barriers.
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Wysham et al. (2025) also highlights that patients with inadequate glycemic regulation, infection, or non- adherence to insulin therapy are at an increased risk. Healthcare disparities such as inadequate education and access to culturally sensitive care have a significant role in frequent DKA episodes. For example, a lack of interpreter services can result in the misunderstanding of discharge instructions, which increases the chances of readmission.
Development of the PICO(T) Question
A review of the literature reveals a gap in patient-centered outcomes related to fluid resuscitation choices, particularly in how fluid type affects recovery time and complications in adult DKA patients. Although 0.9 percent normal saline is commonly used in the traditional management, there is evidence to indicate that balanced electrolyte solutions (BES) can yield better results.
PICO(T) Question:
In adult patients with diabetic ketoacidosis (P), how does fluid resuscitation with balanced
electrolyte solutions (I), compared to 0.9% normal saline (C), affect time to DKA resolution and
electrolyte balance (O) within the first 24–48 hours of treatment (T)?
• P (Population): Adult patients with DKA
• I (Intervention): Balanced electrolyte solutions
• C (Comparison): 0.9% normal saline
• O (Outcome): Faster DKA resolution and improved electrolyte balance
• T (Time): 24–48 hours
Literature Search Strategy
A comprehensive literature search was conducted using PubMed, CINAHL, and Google Scholar. Search terms such as diabetic ketoacidosis, fluid resuscitation, balanced electrolyte solutions, normal saline, and DKA outcomes were key search terms. To obtain up-to-date evidence, filters were used to limit the search to peer-reviewed articles published in the past five years. The search process was narrowed down by using Boolean operators (AND/OR) and restricting the search results to systematic reviews, meta-analyses, and clinical trials. Factors of credibility that were taken into consideration were peer-reviewed status, expertise of authors,
reputation of journals, and the publication date. The search process resulted in several pertinent articles, and three of them were chosen to be analyzed in detail because of their direct connections with the PICO(T) question.
Analysis of Evidence
Elendu et al. (2023) provides a comprehensive overview of DKA, emphasizing that prompt treatment with IV fluids, insulin, and electrolyte replacement is critical for survival. Although the article does not provide a direct comparison of fluid types, it sets the precedent of fluid resuscitation as a fundamental step in the management of DKA. The article is also reliable as it is peer-reviewed and is a synthesis of numerous studies, thereby being very relevant in comprehending the basics of management. Wysham et al. (2025) performed a systematic review that analyzed the burden of DKA in type 2 diabetes. The researchers point out high complication
rates, such as acute kidney injury and extended stay. Notably, it also reveals gaps in prevention and management interventions, which justify better intervention methods, including optimized fluid therapy. The sample is quite large (197 studies), and the results can be widely extended to various patient groups. Szabó et al. (2024) provides the most direct evidence for the PICO(T) question. This meta-analysis and systematic review compared balanced electrolyte solutions to
0.9% saline in the management of DKA. The study found that BES resulted in a faster resolution of DKA (by approximately 5.36 hours) and improved electrolyte profiles, including lower chloride and higher bicarbonate levels. Despite the observed risk of bias, particularly in the included observational studies, and in some small-sample size randomized controlled trials, the overall results can be considered clinically meaningful. The article is very believable and closely
applicable in the enhancement of clinical outcomes among patients with DKA.
Synthesis and Answer to the PICO(T) Question
The evidence suggests that balanced electrolyte solutions are more effective than 0.9% normal saline in achieving faster resolution of DKA and improving electrolyte balance. Szabó et al. (2024) provide strong evidence supporting this conclusion, while Elendu et al. (2023) and
Wysham et al. (2025) reinforce the importance of timely and effective fluid management in reducing complications. One of the assumptions made in this analysis is that the quicker DKA is resolved, the better the patient outcome in terms of reduced hospitalization and decreased chances of complications. The literature supports this assumption, as it associates long-lasting DKA with morbidity. Therefore, adopting BES as a first-line fluid may enhance patient recovery and reduce healthcare burdens.
Conclusion
The use of the PICO(T) process in the case of diabetic ketoacidosis demonstrates that evidence-based decision-making is a crucial component of the nursing practice. This analysis proves that balanced electrolyte solutions can possibly provide better results than the traditional saline treatment. The findings are particularly relevant for high-risk patients like Jose Sanchez, where timely and effective interventions are critical. Incorporating this evidence into practice can improve patient outcomes, reduce complications, and support high-quality, patient-centered care.
References
Elendu, C., David, J. A., Udoyen, A.-O., Egbunu, E. O., Ogbuiyi-Chima, I. C., Unakalamba, L.
O., Temitope, A. I., Ibhiedu, J. O., Ibhiedu, A. O., Nwosu, P. U., Koroyin, M. O., Eze, C.,
Boluwatife, A. I., Alabi, O., Okabekwa, O. S., Fatoye, J. O., & Ramon-Yusuf, H. I.
(2023). Comprehensive review of diabetic ketoacidosis: An update. Annals of Medicine
and Surgery, 85(6), 2802–2807. https://doi.org/10.1097/ms9.0000000000000894
Lizzo, J. M., Goyal, A., & Gupta, V. (2023). Adult diabetic ketoacidosis. PubMed; StatPearls
Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560723/
Szabó, G. V., Szigetváry, C., Turan, C., Engh, M. A., Terebessy, T., Fazekas, A., Farkas, N.,
Hegyi, P., & Molnár, Z. (2024). Fluid resuscitation with balanced electrolyte solutions
results in faster resolution of diabetic ketoacidosis than with 0.9% saline in adults – A
systematic review and meta‐analysis. Diabetes/Metabolism Research and Reviews, 40(5).
https://doi.org/10.1002/dmrr.3831
Wysham, C., Bindal, A., Levrat‐Guillen, F., Kostadinova, D., & Poon, Y. (2025). A systematic
literature review on the burden of diabetic ketoacidosis in type 2 diabetes mellitus.
Diabetes, Obesity, and Metabolism. https://doi.org/10.1111/dom.16282
NURS FPX4025 Assessment 3 Applying the PICO(T) Process
This course has been completed and no further assessments may be submitted.
Create a 3–5 page submission in which you develop a PICO(T) question for the diagnosis you worked with in the first two assessments and analyze the evidence you locate to answer the question.
Introduction
PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.
It stands for:
P – Patient/population/problem.
I – Intervention.
C – Comparison (of potential interventions, typically).
O – Outcomes.
T – Time frame (if time frame is relevant).
The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell & Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are beginning to apply an evidence-based model. By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search. When applying the PICO(T) approach, the nurse can isolate the interventions of interest and compare to other existing interventions for the evidenced impact on the outcome of the concern.
Reference
Boswell, C., & Cannon, S. (2015).
Introduction to nursing research
. Jones & Bartlett Learning.
Professional Context
As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of
enhancing clinical reasoning and judgement skills
. When reliable and relevant evidence-based findings are utilized, patients, healthcare systems, and nursing practice outcomes are positively impacted.
PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related to the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question. When writing a PICO(T)-formatted research question, you want to focus on the impact of the intervention and the comparison on the outcome you desire.
Scenario
For this assessment, please use the diagnosis you worked with in the first two assessments.
NURS FPX4025 Assessment 3 Applying the PICO(T) Process Instructions
After reviewing the materials you created to research a specific diagnosis in the first two assessments, apply the PICO(T) process to develop a research question and research it.
Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest. After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source’s specific findings and best practices related to your chosen diagnosis, and explain how the evidence would help you plan and make decisions related to your question.
If you need some structure to organize your initial thoughts and research, the PICO(T) Question and Library Search template (accessible from the
Create PICO(T) Questions
page) might be helpful.
In your submission, make sure you address the following:
Review the PICO(T) process.
Explain your diagnosis from Assessment 1 in terms of outcomes, risks, and complications. In your explanation, be sure to include the risks and complications for vulnerable populations or those affected by healthcare disparities and the impact of those disparities.
Consider your diagnosis from Assessment 1. Develop a research question using the PICO(T) process to address an issue of your choosing related to your diagnosis.
Properly format your PICO(T) question to guide your search of the literature.
Describe your search of the literature, noting search engines, key words, and credibility factors.
Locate evidence that explores your intervention and comparison of your PICO(T) question with an emphasis on your specific outcome (at least three diagnosis-issue-specific sources of evidence (scholarly articles)).
Explain the content of each of your scholarly articles.
NURS FPX4025 Assessment 3 Applying the PICO(T) Process
Explain the credibility and relevance of each of the articles you chose to your diagnosis issue.
Analyze the evidence. Determine the answer to your PICO(T) question based on your analysis of the evidence.
Additional Requirements
Your assessment should also meet the following requirements:
Length of submission
:
Create a 3–5-page submission focused on defining a research question and interpreting evidence relevant to answering it.
Number of references
:
Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.
APA formatting
: Format references and citations according to the current APA style.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.
Describe a search of the literature noting search engines, key words, and credibility factors.
Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
Explain a diagnosis in terms of outcomes, risks, and complications, including the risks and complications for vulnerable populations or those affected by healthcare disparities, and the impact of those disparities.
Explain the content of at least three sources of evidence, including the credibility and relevance of the articles to a specific diagnosis issue.
Competency 4: Plan care based on the best available evidence.
Describe a research question developed using the PICO(T) process to address a chosen issue related to a diagnosis.
Analyze evidence to explain the answer to a PICO(T) question.
Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
Apply APA formatting to in-text citations and references, exhibiting adherence to most aspects of APA format.
NURS FPX4025 Assessment 3 Applying the PICO(T) Process
