diabetes

Diabetes Nursing Diagnosis Care Plan

Diabetes Nursing Diagnosis Care Plan NCLEX Review

Diabetes mellitus, simply known as diabetes, is a group of metabolic disorders that involve the abnormal production of insulin or response to it, affecting the absorption of glucose in the body.

Glucose (blood sugar) is the main source of energy for brain cells, body tissues, and muscles. There are different types of diabetes, but all of them lead to the buildup of excess glucose in the bloodstream.

This condition can cause serious complications if left uncontrolled. Diabetes cannot be cured, but is manageable through treatment and lifestyle changes.

Types of Diabetes

  1. Prediabetes. This occurs when the blood glucose level is higher than normal, but not as high enough to diagnose as diabetes. People with prediabetes may eventually have type 2 diabetes if the condition is left untreated.
  2. Type 1 Diabetes. Also known as insulin-dependent diabetes, type 1 diabetes is an autoimmune disorder that results from the antibodies’ attack to the pancreas. When the pancreas is damaged, it cannot make insulin. Type 1 diabetes was used to be called juvenile diabetes, as most cases begin during childhood.
  3. Type 2 Diabetes. Also called non-insulin dependent diabetes, type 2 diabetes happens when the pancreas is able to create some insulin, but not enough to lower the amount of glucose in the blood. Insulin resistance is also evident in this type of diabetes. Most cases of diabetes mellitus are type 2, and most people who have type 2 diabetes are overweight or obese.
  4. Gestational Diabetes. Pregnant women might experience insulin resistance, usually during the second or third trimester. Once the baby is delivered, gestational diabetes usually goes away. The baby is at a higher risk than the mother, as the glucose can travel via the placenta. This can make the baby overweight or have trouble breathing. Cesarean section might be necessary to deliver the baby.

Despite having a similar name, diabetes insipidus is not a type of diabetes mellitus. Both of them have polyuria (increased amount of urine) and polydipsia (excessive thirst).

However, diabetes insipidus involves the inability to retain hormone due to the dysfunction of the antidiuretic hormone vasopressin.


Signs and Symptoms

  • Polydipsia – Increased / excessive thirst
  • Polyuria  – Frequent urination and increased amount of urine
  • Polyphagia – Extreme hunger
  • Fatigue
  • Irritability
  • Blurred vision
  • Slow-healing wounds or sores
  • Presence of ketones in the urine
  • Unexplained weight loss – especially in type 1 diabetes
  • Tingling and/or numbness of extremities

Causes

The pancreas is a gland located below the stomach and is responsible for producing and secreting the hormone insulin into the bloodstream. Insulin facilitates the entry of blood glucose into the cells of the body, which results to the lowering of its amount in the bloodstream.

Normally, when the blood glucose level goes down, the insulin production is also slowed down in the pancreas.

In Type 1 diabetes, the immune system produces antibodies that destroy the insulin-producing cells of the pancreas, leaving the organ to produce little or no insulin to help transport the glucose into the cells that need it. On the other hand, the cells of people with prediabetes and type 2 diabetes develop insulin resistance.

The pancreas is not able to create enough insulin to surpass this insulin resistance, resulting to the buildup of glucose in the blood. In gestational diabetes, the placenta secretes hormones that are vital for pregnancy but may form insulin resistance in the mother’s cells.

Complications

Untreated or poorly controlled diabetes may lead to the development of serious complications that may disabling or fatal to the patient. These include:

  1. Heart diseases and stroke. The high glucose levels in the blood may damage the blood vessel walls, including the arteries of the heart. This increases the risk for angina, coronary artery disease, diabetic cardiomyopathy, myocardial infarction (heart attack), and stroke (brain attack).
  2. Diabetic coma. This is a reversible form of coma resulting from either a severely high blood sugar level ( diabetic ketoacidosis in type 1 diabetes;  hyperosmolar nonketotic coma in type 2 diabetes) or low blood sugar levels (hypoglycemia in type 1 diabetes with insulin replacement doses).
  3. Neuropathy. Capillaries can be damaged by excess glucose in the blood. This deprives the nerves the nourishment they need. It eventually causes nerve damage or neuropathy, as evidenced by tingling and/or numbness of fingers and toes, spreading upward to the whole extremities.
  4. Nephropathy. Kidneys can also be damaged due to poorly controlled diabetes.
  5. Retinopathy. Excess glucose may damage the blood vessels located in the eye.
  6. Foot infections. Poor blood flow and/or nerve damage in the feet increase the risk for blisters and cuts. If the wounds are infected, the diabetic patient may eventually require amputation due to poor wound healing.

Other complications may include skin problems, hearing impairment, depression, and Alzheimer’s disease.

Gestational diabetes may cause the baby to grow overly large, a condition known as macrosomia. The mother is also at high risk for pre-eclampsia, a fatal condition during pregnancy.

Diagnosis

  1. Diabetes Screening – blood sugar screening
  2. Age 45 and above
  3. Body mass index of greater than 23 (regardless of age)
  4. Women who has experienced gestational diabetes – screening every 3 years
  5. Prediabetes patients – screening every year
  6. Blood tests
  7. Glycated hemoglobin (A1C) test – to check the average blood glucose level in the last 2-3 months; non-fasting

– A1C below 5.7 – normal

– A1C between 5.7 and 6.4 – prediabetes

-A1C greater than 6.5 – diabetes

  • Random blood sugar test – blood sugar level of 200 mg/dL or 11.1 mmol/L suggests diabetes
  • Fasting blood sugar test – fasting overnight; blood sugar level of greater than 7mmol/L in 2 different test days suggests diabetes
  • Oral glucose test – fasting overnight; patient is asked to drink a sugary liquid, then the nurse tests the blood sugar level for the next 2 hours; a level of more than 200 mg/dL or 11.1 mmol/L suggests diabetes

Treatment

  1. Dietary changes. Low fat, low calories, and high fiber foods are ideal for diabetic patients. The patient is usually referred to a dietitian to ensure that a meal plan that suits the patient’s health goals and preferences is created.
  2. Increase in physical activity. Exercise decreases the blood glucose level as the demand for glucose (energy) in the cells increases with physical activity. It is recommended to have at least 30 minutes of aerobic exercise.
  3. Oral medications. Metformin is prescribed for Type 2 diabetes patients to increase the body’s sensitivity to the effect of insulin.
  4. Insulin therapy. Type 1 diabetes patients require insulin injections to lower the blood sugar levels.
  5. Blood glucose monitoring. To ensure that the patient does not experience hyperglycemia (high blood glucose level) or hypoglycemia (low blood glucose level), patients are educated to check their blood sugar about 3 to 4 times a day, or more depending on their treatment plan.
  6. Transplant of Pancreas. Type 1 diabetes patients may be eligible for a pancreas transplantation.

Nursing Care Plans for Diabetes

  1. Nursing Diagnosis: Risk for Unstable Blood Glucose

              Desired Outcome: The patient will maintain a blood glucose level of less than 180 mg/dL and an A1C level below 5.7

InterventionRationale
Assess for signs of hyperglycemia or hypoglycemia.To determine the appropriate treatment in maintaining target blood glucose levels. Symptoms of Hyperglycemia: 3P’s (polyphagia, polyuria, and polydipsia), fatigue or blurred vision Hypogylcemia: dizziness, headache, fatigue, diaphoresis, and tachycardia
Monitor blood glucose levels. (Frequency of blood glucose checks depends on the treatment plan.)To ensure that the blood glucose level is within target range.
Administer diabetic medication (oral and/or insulin therapy) as prescribed.To keep the glucose levels within normal range, effectively controlling diabetes and reducing the risk for blood vessel damage, nerve damage, kidney injury, and other complications of diabetes.
Encourage the patient to adhere to his/her dietary plan.Low fat, low calories, and high fiber foods are ideal for diabetic patients.
Encourage the patient to increase physical activity, particularly aerobic exercise.Exercise decreases the blood glucose level as the demand for glucose (energy) in the cells increases with physical activity.
Diabetes Nursing Care Plan 1
  • Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to insulin deficiency, as evidenced by unexplained weight loss, increased urinary output, dilute urine, high blood glucose levels, fatigue, and weakness

Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

InterventionRationale
Explain to the patient the relationship between diabetes and unexplained weight loss.To help the patient understand why unexplained weight loss is one of the signs of diabetes.
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term goals of weight loss.To effectively monitory the patient’s daily nutritional intake and progress in weight loss goals.
Help the patient to select appropriate dietary choices to follow a high fiber, low fat diet.Low fat, and high fiber foods are ideal for diabetic patients.  
Refer the patient to the dietitian.To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnoses diabetes.  
DM CP 2

Other Nursing Diagnoses for Diabetes:

  • Deficient Knowledge
  • Risk for Infection
  • Risk for Disturbed Sensory Perception
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