Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by elevated blood glucose levels due to insufficient insulin production or ineffective insulin utilization.
This condition affects millions worldwide. Diabetes requires comprehensive nursing care to manage symptoms, prevent complications, and improve patient outcomes.
Understanding Diabetes Mellitus
Before delving into nursing diagnoses, it’s crucial to understand the types of diabetes:
- Type 1 Diabetes: An autoimmune condition where the body attacks insulin-producing beta cells in the pancreas, resulting in little to no insulin production.
- Type 2 Diabetes: The most common form, characterized by insulin resistance or inadequate insulin production.
- Gestational Diabetes: Develops during pregnancy and usually resolves after childbirth but increases the risk of type 2 diabetes later in life.
- Prediabetes: Blood glucose levels are higher than normal but not high enough to be classified as type 2 diabetes.
Nursing Assessment for Diabetes
A thorough nursing assessment is crucial for developing an effective care plan. Key components include:
- Health History Review:
- Assess for symptoms like polyuria, polydipsia, polyphagia, unexplained weight loss, fatigue, and blurred vision.
- Inquire about the duration of diabetes, current treatment, and previous management strategies.
- Investigate risk factors such as family history, obesity, sedentary lifestyle, and comorbidities.
- Physical Assessment:
- Monitor vital signs, including blood pressure and respiratory rate.
- Perform a comprehensive foot examination, checking for ulcers, calluses, or signs of neuropathy.
- Assess skin integrity, paying attention to slow-healing wounds or infections.
- Evaluate neurological status, including sensory and motor function.
- Diagnostic Tests:
- Review blood glucose levels, including fasting glucose and HbA1c.
- Assess lipid profile and renal function tests.
- Monitor for microalbuminuria to detect early signs of diabetic nephropathy.
Nursing Diagnoses for Diabetes
Based on the assessment findings, nurses can identify several potential nursing diagnoses for patients with diabetes. Here are five comprehensive nursing care plans addressing common issues in diabetes management:
- Ineffective Health Management
Nursing Diagnosis Statement: Ineffective Health Management related to insufficient knowledge of diabetes self-management as evidenced by unstable blood glucose levels and verbalized uncertainty about diet and medication regimen.
Related factors/causes:
- Lack of understanding of diabetes pathophysiology and management
- Complex treatment regimen
- Cultural or language barriers
- Cognitive impairment
Nursing Interventions and Rationales:
- Assess the patient’s current knowledge of diabetes and self-management skills. Rationale: Identifying knowledge gaps allows for tailored education.
- Provide comprehensive diabetes education, including blood glucose monitoring, medication administration, diet, and exercise. Rationale: Enhanced understanding promotes better self-management and glycemic control.
- Demonstrate and have the patient demonstrate blood glucose monitoring and insulin administration techniques. Rationale: Hands-on practice improves skill acquisition and confidence.
- Collaborate with a dietitian to develop an individualized meal plan. Rationale: Personalized nutrition guidance supports better glycemic control and overall health.
- Introduce the patient to diabetes management apps or tools. Rationale: Technology can help track blood glucose, medications, and dietary intake.
Desired Outcomes:
- The patient verbalizes understanding of diabetes management principles within one week.
- The patient demonstrates the proper technique for blood glucose monitoring and medication administration.
- The patient maintains blood glucose levels within the target range (typically 80-130 mg/dL before meals and less than 180 mg/dL two hours after meals) for 80% of readings over two weeks.
- Risk for Unstable Blood Glucose Level
Nursing Diagnosis Statement: Risk for Unstable Blood Glucose Level related to inconsistent dietary intake and physical activity as evidenced by fluctuating blood glucose readings.
Related factors/causes:
- Irregular meal patterns
- Lack of consistent exercise routine
- Stress or illness
- Medication non-adherence
Nursing Interventions and Rationales:
- Teach the patient to recognize signs and symptoms of hyper- and hypoglycemia. Rationale: Early recognition allows for prompt intervention and prevention of complications.
- Assist the patient in developing a consistent meal and snack schedule. Rationale: Regular eating patterns help maintain stable blood glucose levels.
- Encourage regular physical activity and teach how to adjust insulin or food intake accordingly. Rationale: Exercise improves insulin sensitivity but can also lower blood glucose, requiring management adjustments.
- Instruct on proper sick-day management, including more frequent blood glucose monitoring and medication adjustments. Rationale: Illness can significantly impact blood glucose levels, necessitating closer monitoring and care.
- Provide education on the importance of medication adherence and strategies to remember doses. Rationale: Consistent medication use is crucial for maintaining stable blood glucose levels.
Desired Outcomes:
- The patient maintains blood glucose levels within the target range for 90% of readings over one month.
- The patient verbalizes an understanding of factors affecting blood glucose levels and appropriate management strategies.
- Patient demonstrates proper use of sick-day guidelines during periods of illness.
- Ineffective Peripheral Tissue Perfusion
Nursing Diagnosis Statement: Ineffective Peripheral Tissue Perfusion related to microvascular complications of diabetes as evidenced by diminished peripheral pulses and delayed wound healing.
Related factors/causes:
- Chronic hyperglycemia leading to vascular damage
- Peripheral neuropathy
- Peripheral arterial disease
- Smoking or a sedentary lifestyle
Nursing Interventions and Rationales:
- Assess peripheral pulses, capillary refill time, and skin temperature regularly. Rationale: Early detection of circulatory problems allows for timely intervention.
- Teach proper foot care, including daily inspection, appropriate footwear, and moisturizing. Rationale: Good foot care practices can prevent injuries and promote early detection of problems.
- Encourage smoking cessation and provide resources for support. Rationale: Smoking exacerbates vascular damage and impairs wound healing.
- Promote regular exercise, mainly walking or swimming. Rationale: Physical activity improves circulation and overall cardiovascular health.
- Collaborate with a wound care specialist for any existing ulcers or non-healing wounds. Rationale: Specialized wound care can promote healing and prevent complications.
Desired Outcomes:
- Patient demonstrates improved peripheral circulation as evidenced by strong, palpable pulses and capillary refill time <3 seconds within three months.
- The patient performs daily foot inspections and reports any abnormalities promptly.
- The patient engages in regular physical activity for at least 150 minutes per week.
- Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis Statement: Imbalanced Nutrition: Less Than Body Requirements related to dietary restrictions and altered metabolism as evidenced by unintentional weight loss and poor wound healing.
Related factors/causes:
- Strict dietary restrictions leading to inadequate intake
- Altered metabolism due to diabetes
- Gastrointestinal issues (e.g., gastroparesis)
- Depression or eating disorders
Nursing Interventions and Rationales:
- Conduct a nutritional assessment, including a 24-hour dietary recall and anthropometric measurements. Rationale: Comprehensive assessment helps identify specific nutritional deficits.
- Collaborate with a registered dietitian to develop a balanced meal plan that meets nutritional needs while supporting glucose control. Rationale: Expert nutritional guidance ensures adequate intake while managing blood glucose levels.
- Teach carbohydrate counting and its relationship to insulin dosing. Rationale: Understanding carbohydrate impact on blood glucose helps in meal planning and insulin management.
- Monitor weight regularly and adjust caloric intake as needed. Rationale: Weight trends can indicate the effectiveness of the nutritional plan.
- Screen for and address any eating disorders or psychological factors affecting nutrition. Rationale: Mental health issues can significantly impact dietary habits and overall diabetes management.
Desired Outcomes:
- The patient achieves and maintains a healthy body weight (BMI 18.5-24.9) within six months.
- The patient demonstrates proper carbohydrate counting techniques for 90% of meals.
- The patient reports improved energy levels and wound healing within two months.
- Risk for Impaired Skin Integrity
Nursing Diagnosis Statement: Risk for Impaired Skin Integrity related to neuropathy and compromised circulation secondary to diabetes.
Related factors/causes:
- Peripheral neuropathy leads to decreased sensation
- Poor circulation affecting wound healing
- Dry skin due to autonomic neuropathy
- Increased risk of infections
Nursing Interventions and Rationales:
- Perform a comprehensive skin assessment, paying attention to bony prominences and feet. Rationale: Regular assessment allows for early detection of skin breakdown or infections.
- Teach proper skin care techniques, including gentle cleansing, moisturizing, and protection from extreme temperatures. Rationale: Good skin care practices help maintain skin integrity and prevent complications.
- Instruct on proper foot care, including nail trimming, appropriate footwear, and daily inspections. Rationale: Foot care prevents diabetic foot ulcers and other complications.
- Educate on the importance of blood glucose control in maintaining skin health. Rationale: Good glycemic control supports proper skin function and wound healing.
- Demonstrate proper techniques for offloading pressure points, especially for patients with limited mobility. Rationale: Pressure relief helps prevent skin breakdown and ulcer formation.
Desired Outcomes:
- Patient maintains intact skin, free from breakdown or ulceration, over six months.
- The patient demonstrates proper skin and foot care techniques during the return demonstration.
- The patient reports prompt identification and management of any skin changes or injuries.
Conclusion
Effective nursing care for patients with diabetes requires a comprehensive approach that addresses multiple aspects of the condition.
References
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- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care. F.A. Davis.
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- Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., … & Vivian, E. (2020). Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 46(4), 350-361.
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- Bonner, T., Foster, M., & Spears-Lanoix, E. (2021). Type 2 diabetes-related foot care knowledge and foot self-care practice interventions in the United States: a systematic review of the literature. Diabetic Foot & Ankle, 7(1), 1263142.
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- Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., … & IDF Diabetes Atlas Committee. (2019). Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas. Diabetes Research and Clinical Practice, 157, 107843.
