Hypoglycemia Nursing Diagnosis and Nursing Care Plans

Hypoglycemia Nursing Care Plans Diagnosis and Interventions

Hypoglycemia NCLEX Review and Nursing Care Plans

Hypoglycemia is a condition wherein blood glucose is below the average level. It is also a prevalent, potentially preventable side effect of diabetes medication overdose, and it is a significant barrier to commencing or increasing antihyperglycemic therapy to obtain optimal glucose control.

Thus, the most crucial determinant of future incidents is the treatment regimen and a history of hypoglycemia. Numerous risk factors also cause hypoglycemia, including renal failure, old age, and medical history of hypoglycemia-related autonomic dysfunction.

In addition, the reported prevalence of hypoglycemia varies significantly between studies based on research design, interpretations used, and the population included.

Although it is more usual in type 1 diabetes, hypoglycemia is also clinically relevant in type 2 diabetes. Moreover, patients’ symptoms differ from each individual, and many occurrences remain undiagnosed.

Causes of Hypoglycemia

Low blood glucose levels are more prevalent in insulin users, but hypoglycemia can also happen if the patient is on some oral diabetes treatments.

Hypoglycemia is caused by a variety of factors, which include:

  • Taking an excessive amount of insulin or oral antidiabetic medicine
  • Not getting enough food
  • Putting off or skipping a meal or snack
  • Increasing physical activity or exercise without increasing the food intake or changing the medications
  • Consuming excessive alcoholic beverages

Related Factors to Hypoglycemia

Below are some of the related factors to hypoglycemia:

  • Insulin-using individuals
  • People who are taking diabetes medications that are taken orally (sulfonylureas)
  • Adults and children of all ages
  • Liver or kidney problems
  • Those who have had diabetes for a more extended period
  • Those who are not experiencing low blood sugar symptoms (hypoglycemia unawareness)
  • Those who are taking several drugs
  • Anyone with a handicap that hinders them from reacting quickly to low blood glucose levels
  • Those who consume alcoholic beverages

Signs and Symptoms of Hypoglycemia

Symptoms of hypoglycemia might vary from each individual from one episode to the next. If the blood glucose drops too low, here are the typical manifestations:

  • Arrhythmia or irregular heartbeat
  • Lethargy
  • Pale skin
  • Tremor
  • Anxiety
  • Dripping with sweat
  • Extreme feeling of hunger
  • Lack of energy
  • Tingling sensation or numbness of the cheek, lips, or tongue

As hypoglycemia progresses, the following signs and symptoms may appear:

  • Anxiety, bizarre behavior, or both, such as the incapacity to accomplish ordinary tasks
  • Visual impairment such as refractive error or blurred vision
  • Convulsions or Tremors
  • Syncope or temporary loss of consciousness

Diagnosis of Hypoglycemia

  • Blood glucose levels – diabetic patients use a blood glucose meter to help determine their blood sugar levels and direct their insulin or other diabetes medication as needed. If the test shows low blood glucose level which is less than 70 mg/dL, the patient should seek medical help.
  • Patient interview – if the patient does not use any hypoglycemic drugs, the healthcare provider will want to know the following:
    • What indications and symptoms did the patient experience?
    • If there are no noticeable signs or symptoms of hypoglycemia during the first visit to the doctor, he may ask the patient to fast overnight or for longer. This assessment will help him detect hypoglycemia signs and make a diagnosis. Furthermore, the patient must fast for an extended time in a hospital. Alternatively, if the symptoms develop after eating, the healthcare professional will test the glucose levels after meals.
    • When symptoms arise, what is the blood sugar level? The physician will take a blood sample to be analyzed in a laboratory.
    • Do the symptoms go away when the blood sugar levels rise?

A physical examination will be done, as well as an evaluation of the medical records.

Treatment for Hypoglycemia

  1. Reversal of hypoglycemic episode. If the patient experiences signs and symptoms of hypoglycemia, the management include:

  • Consume 15 to 20 grams of quick-acting carbohydrates. These are sugary foods that contain no protein or fat and are quickly converted to glucose in the body.
  • Glucose tablets or gel, fruit juice, regular and not diet soft drinks, honey, and sugary candy are excellent options.
  • Recheck the blood glucose levels 15 minutes after intervention.
  • If the blood glucose level is still less than 70 mg/dL (3.9 mmol/L), take or drink another 15 to 20 grams of fast-acting carbohydrate and keep checking it for 15 minutes. Repeat the same process until the blood glucose level exceeds 70 mg/dL (3.9 mmol/L).
  • Eat a sweet treat or a portion of food. Once the blood glucose becomes normal, eating a snack or meal can help maintain it and regenerate glycogen stores in the body.
  1. Management of underlying health conditions. To prevent repetitive incidents of hypoglycemia, the doctor must first assess and diagnose the underlying medical condition. Depending on the underlying cause, management may be any of the following:
  • Medications. If a particular medication causes hypoglycemia, the healthcare provider will most likely recommend replacing or discontinuing the medication or making adjustments on the dosage.
  • Cancer treatment.  A pancreatic tumor is treated surgically by removing the tumor. In some cases, a portion of the pancreas must be removed if it causes severe hypoglycemia.

Nursing Diagnosis for Hypoglycemia

Hypoglycemia Nursing Care Plan 1

Unstable Blood Glucose Level

Nursing Diagnosis: Unstable Blood Glucose Level related to insufficient checking of blood sugar levels and lack of compliance to proper diabetes management secondary to hypoglycemia as evidenced by fatigue and tremors.

Desired Outcome: The patient must have a blood sugar level reading of less than 180 mg/dL, fasting blood glucose levels of less than 140 mg/dL, and a hemoglobin A1C  (HbA1C) level of less than 7%.

Nursing Interventions for HypoglycemiaRationale
Assist the patient in recognizing eating habits that should be changed.    This intervention serves as the foundation for highly personalized diet recommendations related to the clinical health status contributing to blood glucose fluctuations.
Consult a registered nutritionist and dietician for personalized diet recommendations.  A personalized meal plan depends on the patient’s body, muscle mass, blood sugar levels, activity levels, and health status. Adjustments in the patient’s diet will help to control blood glucose levels.
Educate the patient who is enduring hypoglycemia about raising blood glucose levels.  Throughout most instances of hypoglycemia, consuming foods can raise blood glucose levels. People who have diabetes should consume an incredibly quickly absorbed source of carbohydrates.    
Discuss to the patient the significance of a balanced diet and regular exercise.  Strength training helps in balancing glucose levels by expediting glucose uptake into cells. The patient must comprehend the correlation between workouts, food consumption, and blood sugar levels.    
Refer the patient to an exercise physiologist, physiotherapist, or cardiac rehabilitation nurse for particular exercise guidelines.  Specialized workouts can be prescribed based on the patient’s physical capability. This intervention will help the patient know the appropriate workout for his condition.

Hypoglycemia Nursing Care Plan 2

Fatigue

Nursing Diagnosis: Fatigue related to severely diminished metabolic energy production and changes in body chemistry, such as a deficiency of insulin secondary to hypoglycemia as evidenced by immense exhaustion, failure to sustain daily routines, reduced productivity, deficient ability to focus, lethargy, and reduced interest in surroundings.

Desired Outcome:The patient will learn to demonstrate an increase in energy and prove an enhanced ability to engage in desired daily activities.

Nursing Interventions for HypoglycemiaRationale
Explain the need for activity with the patient. Strategize the patient’s routine and identify activity that causes exhaustion—however, alternate activity intervals with rest periods and uninterrupted sleep.  Even if the patient typically feels too weak, proper education about the essential things can motivate them to increase their activity level. On the other hand, the patient must rest between activities to avoid excessive fatigue.    
Discuss energy-saving techniques for bathing, transferring, and other activities to the patient.  The patient will be able to achieve more with minimal energy consumption.
Advise the patient to do deep breathing techniques and help ensure they have enough air circulation.      This intervention aids in stress relief and adequate oxygenation.
Make provisions for comfort and safety for the patient.  This intervention aims to avoid injury while participating in physical activity.
As considered acceptable, boost the patient’s involvement in activities of daily living (ADLs).    This approach increases self-esteem, assertiveness, and tolerance.

Hypoglycemia Nursing Care Plan 3

Risk for Disturbed Sensory Perception

Nursing Diagnosis: Risk for Disturbed Sensory Perception related to intrinsic chemical changes such as glucose, insulin, or electrolyte insufficiency secondary to hypoglycemia as evidenced by leg or foot hyperesthesia, discomfort, or loss of sensation.

Desired Outcome: This intervention aims to maintain normal mentation levels while also acknowledging and trying to compensate for emerging sensory impairments

.

Nursing Interventions for HypoglycemiaRationale
When the level of consciousness (LOC) is impaired, ensure the protection of the patient by preventing or reducing restraints as needed. Lower the bed and pad the bed rails if the patient is highly prone to convulsions.  Patients with impaired sensory perceptions are more vulnerable to injury, particularly at night, and safety measures must be taken as needed. Seizure precautions must be followed as required to prevent severe trauma, aspiration, and falls.    
Keep an eye on the following laboratory values: Blood glucose levelsSerum osmolalityHb/Hct (Hemoglobin or Hematocrit Test)BUN/Cr (Blood Urea Nitrogen or Creatinine Test)  Imbalances can hinder judgment. It should be noted that if the fluid is replaced too rapidly, excess water may fill brain cells and cause an alteration in the level of consciousness.  
Educate the patient about the treatment regimen for Diabetic Ketoacidosis (DKA) as advised. .  Once the hyperosmolar state is rectified, any modifications in thought processes typically ameliorate the possibilities for seizure activity
Examine the patient and look into reports of hyperesthesia, discomfort, or loss of sensation in the feet or legs. Examine for lesions, inflamed areas, trigger points, and a loss of pedal pulses.  Peripheral neuropathies can produce catastrophic discomfort, disturbance of sensory perception, increased risk of subcutaneous injury, and loss of balance.  
Maintain as much consistency as possible in the patient’s daily routine. As much as probable, encourage active participation of the patient in activities of daily living (ADLs).  This method aids in keeping the patient in touch with reality and oriented to his or her surroundings.

Hypoglycemia Nursing Care Plan 4

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to unfamiliarity with proper insulin injection and lack of comprehension of the signs and symptoms of the condition secondary to hypoglycemia as evidenced by the emergence of avoidable complications.

Desired Outcome: The patient will learn about the proper adherence to the treatment regimen and avoid acquiring severe complications.

Nursing Interventions for HypoglycemiaRationale
Confirm that the patient understands and knows the procedure and frequency of home monitoring of blood glucose.    Monitoring gives information on the extent of glucose control and reveals the necessity for adjustments in insulin dosage.
Educate the patient to strictly follow a diet low in refined sugar, low in fat, and high in fiber and whole grains. .A low-fat and high-fiber diet minimizes cholesterol and triglyceride levels. Three daily meals and a midnight snack are advised. Simple and refined sugars should be minimized, and substantial carbohydrates, such as grains and rice, should be maintained
Educate the patient on managing hypoglycemia with crackers, a snack, or administering glucagon.  A carbohydrate snack should be consumed to treat hypoglycemia. Examples are teaspoons of sugar, hard candies, soda, fruit juice, or commercially prepared glucose tablets. If the patient is unconscious, a nurse or caregiver should administer glucagon intramuscularly (IM) or subcutaneously (SC).
Teach the patient how to acknowledge hypoglycemia symptoms.  Tremors, perspiration, anxiousness, lack of strength, hunger, and alteration in level of consciousness are all manifestations of hypoglycemia. Hypoglycemia happens when blood glucose levels fall below 60 mg/dL. It is beneficial to explain to patients that hypoglycemia occurs with too much insulin, not enough food, too many oral hypoglycemic medications, or too much physical activity.  
Provide the patient with written diabetes management information that he or she can review.      This method fortifies knowledge about the condition while conveying the most important information possible.

Hypoglycemia Nursing Care Plan 5

Risk for Injury

Nursing Diagnosis: Risk for Injury related to neurological effects, sensory loss, and mobility impairment secondary to hypoglycemia as evidenced by changes in muscle control and gait, as well as seizures and alterations in level of consciousness.

Desired Outcome: These interventions aim to prevent the patient from any injury brought about by the health condition.

Nursing Interventions for HypoglycemiaRationale
Examine the patient for factors that increase the risk of injury.    This intervention aims to provide the baseline information necessary for the growth of individualized care. The variety of factors identified increases the risk of injury.  
Examine the patient for signs of infection.    Infection may be the catalyst for inevitable amputation. Pain and tenderness symptoms may be absent due to neuropathy. Therefore, examine the area for erythema, drainage, and inflammation.  Examine the presence of edema.  Edema is a significant risk factor for ulceration. The decline of vasomotor reflexes and swelling in the foot are symptoms of autonomic neuropathy.  
Advise the patient to wear safety footwear at all times and never go barefoot.  This approach is beneficial since keeping the feet covered prevents foot injuries.    
Take note of any callus formation or corns.  Pressure on bony prominences causes callus formation, resulting in skin breakdown formation.    

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Nursing Stat Facts
Nursing Stat Facts

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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