7Nursing Care Plan on diabetes with nursing Diagnosis

Nursing intervention

Assess hypovolemia by monitoring I&O, specific gravity, and vital signs (VS) hourly. Check weight daily.

Rationale

Signs of hypovolemic include weight loss, inadequate fluid intake to balance output, thirst, poor skin turgor, decreased specific gravity, furrowed tongue, hypotension, and tachycardia.

Nursing intervention

Immediately report the following to the physician. 

A diuresis greater than 200 mL in each of 2 consecutive hours. 

Urine output greater than 500 mL in any 2-hour period.

Urine specific gravity less than 1.002.

Rationale

These are signs of extreme diuresis. 

Diuresis can result in hypotension, hypokalemia, and dehydration, resulting in very viscous blood. The

Patient is at increased risk for hypovolemic shock, stroke, dysrhythmias and myocardial infarction.

Nursing intervention

Keep the water pitcher full and within easy reach of the patient. Explain the importance of consuming as much water as the patient can tolerate.

Rationale

The main danger for patients with DI is dehydration due to the inability to take in adequate fluids to balance excessive urine output. Water is the best substitute, and patients should avoid excessive intake of salt, sugar and artificial sweeteners

Nursing intervention

Assess VS and report significant changes. 

Rationale

Significant changes, such as elevation of systolic blood pressure (SBP) by more than 20 mm Hg from baseline SBP or increase in HR by more than 20 bpm from baseline HR, are signs of vasoconstriction, which is an undesirable effect when vasopressin is used solely as ADH.

Nursing intervention

Assess for changes in mental status or LOC, confusion, weight gain, headache, seizures, and coma.

Rationale

These are signs of water intoxication caused by fluid retention.

Nursing intervention

If  LOC, confusion, weight gain, headache, seizures, and coma. signs occur, discontinue vasopressin, restrict fluids, and notify the healthcare provider. Establish appropriate safety measures and redirect the patient as needed.

Rationale

Water intoxication causes significant dilution of circulating electrolytes, resulting in the effects seen in electrolyte disorders such as hyponatremia, hypokalemia, and hypochloremia.

Nursing intervention

Monitor blood glucose before meals and at bedtime.

Rationale

This monitors the effectiveness of blood glucose control at times when the patient’s glucose is not increased by digestion of food.

Nursing intervention

Assess for changes in mentality, apprehension, erratic behavior, tremors, slurred speech, staggering gait, and seizure activity. Treat hypoglycemia as prescribed.

Rationale

These are signs of hypoglycemia. Patients with hypoglycemia may experience vasodilation and decreased myocardial contractility, which decreases cerebral circulation and impairs cognition.

Nursing intervention

Administer basal, prandial, and correction insulin doses as prescribed.

Rationale

Adherence to the therapeutic regimen is essential to promote optimal tissue perfusion. Progression of vascular disease and neuropathy, including blindness, renal failure, gastroparesis, myocardial infarction, and stroke, is the leading cause of all DM complications. By keeping serum glucose in a more normal range, the vascular endothelium receives better nutrition within the cells and will be less likely to deteriorate.

Nursing intervention

Encourage and teach the patient to perform regular home blood glucose monitoring.

Rationale

Monitored Blood glucose before meals, at bedtime, and possibly at night (3:00 AM) to assess whether a correction dose of short-acting insulin is needed. Self-monitoring by patients is very helpful in reducing complications.

Nursing intervention

As indicated, orient the patient to the location of items such as water, tissues, glasses, and the call light.

Rationale

This orientation provides necessary information and a safe environment for patients with decreased vision caused by diabetic retinopathy.

Nursing intervention

Assess temperature every 4 hours. Alert healthcare personnel of elevations. 

Rationale

Infection is the most common cause of DKA. Fever may indicate the presence of infection.

Nursing intervention

Maintain meticulous sterile technique when changing dressings, performing invasive procedures or handling indwelling catheters.

Rationale

Non-intact skin and invasive procedures and catheters put patients at risk for bacterial entry.

Nursing intervention

Fever, chills, cough with sputum production, crackles, rhonchi, dyspnea, pharyngeal swelling and sore throat.

Rationale

These are indicators of upper respiratory tract infection.

Nursing intervention

Burning or painful urination, cloudy or foul-smelling urine, tachycardia, diaphoresis, nausea, nausea and vomiting. Diaphoresis, nausea, vomiting and abdominal pain.

Rationale

These are indicators of urinary tract infection (UTI). Patients with DM often have a neurogenic bladder, which increases the likelihood of UTI caused by urine retention.

Nursing intervention

Hypothermia, flushed skin and hypotension.

Rationale

These are indicators of systemic sepsis.

Nursing intervention

Erythema, swelling, purulent drainage and warmth at IV sites. 

Rationale

Indicators of localized infection.

Nursing intervention

Consult the physician about obtaining culture specimens of blood, sputum and urine during temperature spikes or for urine culture specimens during temperature spikes or for wounds that produce purulent drainage. purulent drainage.

Rationale

Infection may be present in blood, urine, sputum or wounds. Occult infection may also be present outside of these sources.

Nursing intervention

Assess skin integrity and evaluate lower extremity reflexes by testing deep tendon reflexes of the knee and ankle, proprioceptive sensations, two-point discrimination, and vibration sensation.

Rationale

These assessments monitor for the presence or degree of neuropathy and vascular pathology. In addition to the higher risk areas of the extremities and pressure points, the skin of the legs is most at risk and is often the first to show problems. If sensations are altered, it is likely that the patient will not be able to respond adequately to stimuli.

Nursing intervention

Minimize the patient’s activities and incorporate progressive passive and active exercises into the daily routine. Discourage prolonged periods of rest in the same position.

Rationale

These measures relieve acute discomfort and prevent hemostasis.

Nursing intervention

Wash feet daily with mild soap and warm water; check water temperature with a thermometer or elbow.

Rationale

Patients with decreased sensitivity are at risk for burns if they are unaware that the water temperature is too hot. Hot water and strong soaps can also promote dry skin, which can become irritated and break.

Nursing intervention

Inspect the feet daily for the presence of erythema, discoloration or trauma, using mirrors if necessary for proper visualization

Rationale

These are signs that the skin needs vigilant evaluation and preventive care. When the skin is no longer intact, the patient is at risk for infection that can eventually lead to amputation.

Nursing intervention

Change socks or stockings daily and wear white cotton or wool blends.

Rationale

These measures prevent infection from moisture or dirt in contact with non-intact skin. The white fabric allows patients to more easily see any blood or exudate from the non-intact skin.

Nursing intervention

Immediately attend to any foot injury and seek medical attention. 

Rationale

Diabetes can cause slow wound healing. Prompt attention can prevent a minor injury from becoming more serious.

Nursing intervention

Discuss with the client the need for activity. Plan the schedule with the client and identify activities that cause fatigue.

Rationale

Education can provide motivation to increase the level of activity even if the client feels too weak at first.

Nursing intervention

Alternate activity with periods of uninterrupted rest and sleep.

Rationale

Avoid excessive fatigue.

Nursing intervention

Monitor pulse, respiratory rate and blood pressure before and after activity.

Rationale

Indicates physiological tolerance levels.

Nursing intervention

Discuss ways to conserve energy when bathing, transferring, etc.

Rationale

The client will be able to accomplish more with less energy expenditure.

Nursing intervention

Increase client participation in ADLs, as tolerated.

Rationale

Increase confidence level, self-esteem and tolerance level.

Nursing intervention

Assess the patient’s health literacy. Assess culture and information needs.

Culturally specific information needs.

Rationale

This assessment helps ensure that information is selected and presented in a culturally and educationally appropriate manner.

Nursing intervention

Teach the patient to check the expiration date on the insulin vial and to avoid using it if it is expired.

Rationale

Insulin may lose potency if the vial has been open for more than 30 days.

Nursing intervention

Also, teach proper storage of insulin and the importance of avoiding temperature extremes.

Rationale

Extreme temperatures destroy insulin.

Nursing intervention

Suggest that the patient ask his or her health care provider if the prescribed insulin is available in an insulin pen.

Rationale

An insulin pen eliminates the possibility of making mistakes, as the pen is a self-contained dosing system, in which the patient applies a new needle and sets the dose using a dial on the pen.

Nursing intervention

Caution the patient to avoid shaking the insulin bottle. 

Rationale

Shaking produces air bubbles that can interfere with accurate dose measurement.

Nursing intervention

Ensure that the patient understands and demonstrates the technique and timing for home blood glucose monitoring using a commercial kit.

Rationale

A commercial kit provides continuous data reflecting the degree of control and can identify necessary changes in diet and medication before serious metabolic changes occur. Self-monitoring by patients is extremely useful in reducing complications, especially in patients with type 1 DM who require tighter control of serum glucose levels. Self-monitoring also allows for patient self-management and psychological safety.

Nursing intervention

Teach the patient the importance of following a diet controlled in simple carbohydrates, consisting of complex carbohydrates, low in fat and high in fiber.

Rationale

Adequate nutrition, along with carbohydrate and calorie control, is essential to maintain normoglycemia in these individuals. A low-fat, high-fiber diet is an effective means of controlling blood fats, especially cholesterol and triglycerides. Complex carbohydrates are metabolized more slowly than simple carbohydrates. Consistent consumption of complex carbohydrates prevents blood glucose spikes after consumption. Diet is the only method of control for many individuals with type 2 DM. Typically, three meals a day and an evening snack are prescribed. Some fat and protein should be present at all meals and snacks to curb postprandial blood glucose elevation. The addition of 10-15 g of fiber will slow the digestion of monosaccharides and disaccharides. For all types of diabetes, refined and simple sugars and carbohydrates (white bread and crackers made with processed flour) should be reduced and complex carbohydrates (whole-grain products such as bread, cereals, pasta, legumes, beans and lentils) should be encouraged.

Nursing intervention

Teach the signs, symptoms and reasons for hyperglycemia. 

Rationale

Hyperglycemia can be caused by increased food intake, insufficient insulin, decreased exercise, infection or illness, and emotional stress. Signs and symptoms of hyperglycemia (polydipsia, polyuria, polyphagia, fatigue, fruity breath) may appear within hours or even several days. Hyperglycemia will be detected during routine self-monitoring of blood glucose.

Nursing intervention

Explain the role of exercise in patients with DM.

Rationale

Exercise is as important as diet and insulin in the treatment of DM. It lowers blood glucose levels, helps maintain normal cholesterol levels, and decreases insulin resistance at muscle receptor sites. These effects increase the body’s ability to metabolize glucose and help reduce the therapeutic dose of insulin in most patients. The exercise program should be consistent and individualized (especially for individuals with type 1 DM). Patients should undergo a complete physical examination and be encouraged to incorporate acceptable activities as part of their daily routine. Note: If the blood glucose level is above 250 mg/dL, exercise can act as a stressor in patients who are not accustomed to exercise, causing blood glucose to increase rather than decrease. Patients should check blood glucose levels with a monitoring device before beginning an exercise program.