Diabetes

Nursing Care Plans for Diabetes

Diabetes Nursing Care Plans Diagnosis

Diabetes is a medical condition that involves excessive glucose (sugar) levels in the blood due to the little or no production of the hormone insulin, or the presence of insulin resistance.

Despite not having a cure, diabetes can be controlled by effective medical and nursing management, as well as the patient’s strict adherence to prescribed medication, lifestyle changes, and blood sugar monitoring.

The following nursing care plans can be used to assess, plan, manage, and monitor the symptoms and effects of diabetes to a patient.

Diabetes Nursing Care Plans

  1. Nursing Diagnosis: Deficient Knowledge related to new diagnosis of Type 2 diabetes as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of Type 2 diabetes and its management.

InterventionsRationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)To address the patient’s cognition and mental status towards the new diagnosis of diabetes and to help the patient overcome blocks to learning.
Explain what diabetes is, its types (specifically type 2 diabetes mellitus), and how it affects the vital organs such as the heart, kidneys, brain, and blood vessels. Avoid using medical jargons and explain in layman’s terms.To provide information on diabetes and its pathophysiology in the simplest way possible.
Educate the patient about hyperglycemia and hypoglycemia.  Inform him/her the target range for his/her blood sugar levels to be classified as “well-controlled”.To give the patient enough information on the risks of blood sugar control (e.g. too much insulin dose may result to hypoglycemia, while too little insulin dose may lead to hyperglycemia). It is important to inform the patient the desired range for blood glucose level because this helps the patient and healthcare provider decide on the appropriate insulin dosage.  
Demonstrate how to perform blood sugar monitoring.To empower patient to monitor his/her blood sugar levels at home.  
Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to control blood sugar levels, and explain how to properly self-administer each of them. Ask the patient to repeat or demonstrate the self-administration details to you.To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
Use open-ended questions to explore the patient’s lifestyle choices and behaviors that can be linked to the development of diabetes. Teach the patient on how to modify these risk factors (e.g. smoking, excessive alcohol intake, high sodium and/or cholesterol diet, obesity, sedentary lifestyle, etc).To assist the patient in identifying and managing modifiable risk factors related to diabetes.
Diabetes Care Plan 1
  • Nursing Diagnosis: Fatigue related to decreased metabolic energy production as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized weakness, blood sugar level of  210 mg/dL, and shortness of breath upon exertion

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.To gradually increase the patient’s tolerance to physical activity.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.
Diabetes Care Plan 2
  • Nursing Diagnosis: Risk for Fluid Volume Deficit due to osmotic diuresis

Desired Outcome: The patient will demonstrate adequate hydration and balanced fluid volume

InterventionsRationales
Assess vital signs and signs of dehydration.Hyperglycemia may cause Kussmaul’s respirations and/or acetone breath. Hypotension and tachycardia may result from hypovolemia, or low levels of intravascular volume.
Commence a fluid balance chart, monitoring the input and output of the patient.To monitor patient’s fluid volume accurately and effectiveness of actions to monitor signs of dehydration.
Start intravenous therapy as prescribed. Encourage oral fluid intake of at least 2500 mL per day if not contraindicated.To replenish the fluids lost from polyuria and to promote better blood circulation around the body.
Educate the patient (or guardian) on how to fill out a fluid balance chart at bedside.To help the patient or the guardian take ownership of the patient’s care, encouraging them to drink more fluids as needed, or report any changes to the nursing team. 
Monitor patient’s serum electrolytes and recommend electrolyte replacement therapy (oral or IV) to the physician as needed.Sodium is one of the important electrolytes that are lost when a person is passing urine. Hyponatremia or low serum sodium level may cause brain swelling.
Diabetes Care Plan 3
  • Nursing Diagnosis: Risk for Disturbed Sensory Perception

Desired Outcome: The patient will recognize any changes in sensory perception and effectively cope with them.

InterventionsRationales
Assess vital signs and perform an initial head-to-toe assessment, particularly checking visual acuity, presence of tingling or numbness in the extremities, and response to pain stimuli.Retinopathy and peripheral neuropathy are some of the complications of diabetes.  
Educate the patient for the need to monitor and report any visual disturbances or other sensory changes.To facilitate early detection and management of disturbed sensory perception.
Create a daily routine for the patient, as consistent as possible.To keep the patient in touch with reality and maintain safety.
Monitor blood sugar levels regularly.Uncontrolled levels of blood glucose may lead to serious complications such as neuropathy and retinopathy.
Diabetes Care Plan 4
  • Nursing Diagnosis: Risk for Infection

Desired Outcome: The patient will be able to avoid the development of an infection.

InterventionsRationales
Assess vital signs and observe for any signs of infection.Ketoacidotic state in diabetic patients may increase their risk for infection.
Perform an initial head-to-toe assessment, particularly checking for the presence of any wounds and cuts.Diabetic patients suffer from slow wound healing. Any wound or cut needs to be managed early and appropriately to prevent infection which may spread and may lead to amputation of the affected toe, finger, or limb.
Educate the patient for the need to monitor and report any signs of infection or new wounds and cuts.To facilitate early detection and management of infection and to provide proper wound management as needed.
Teach the patient how to perform proper hand hygiene.To maintain patient safety and reduce the risk for cross contamination.
Provide careful skin care. Massage the limbs and keep the skin dry. Provide wrinkle-free linens.To reduce the risk of skin breakdown that may lead to infection. To facilitate a better peripheral blood circulation.
Diabetes Care Plan 5

With proper use of the nursing process, a patient can benefit from various nursing interventions to assess, monitor, and manage diabetes and promote client safety and well being.

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