Risk for Unstable Blood Glucose Level

Risk for Unstable Blood Glucose Level 5 Nursing Care Plans

5 Nursing Care Plans for Risk for Unstable Blood Glucose Level

Glucose is a very important nutrient in the human body. It serves as the source of energy for cells to function. There are different mechanisms to regulate glucose level, including the hormone insulin which is produced by the pancreas.

The normal level of blood glucose in the body is between 90-120 mg/dL. Any level below or beyond this range can put a patient at risk for unstable blood glucose level.

Hypoglycemia and hyperglycemia both refer to abnormal blood glucose levels. Hypoglycemia refers to a blood glucose level below 90mg/dL, while hyperglycemia is abnormally high blood glucose level of >120 mg/dL. Both of these conditions may arise from different etiologies, with diabetes mellitus being the most common cause.

Signs and Symptoms of Unstable Blood Glucose Level

The signs and symptoms of unstable blood sugar may include the following:

  • Confusion
  • Sweating
  • Irritation
  • Thirst
  • Hunger
  • Tremors
  • Dizziness
  • Visual changes
  • Headache

Causes of Unstable Blood Glucose Level

The causes of unstable blood glucose level are as follows:

  • Diabetes Mellitus – a disease characterized by the body’s inability or reduced ability to produce insulin to regulate blood sugar
  • Use of medications – several medications are known to affect blood sugar levels (e.g., corticosteroids, beta blockers, and thiazide diuretics)
  • Excessive alcohol intake
  • Fasting or starvation
  • Adrenal insufficiency
  • Eating disorders
  • Surgery
  • Excessive carbohydrates intake

Nursing Care Plans for Risk for Unstable Blood Glucose Level

Nursing Care Plan 1

Diabetes Mellitus

Nursing Diagnosis: Risk for Unstable Blood Glucose Level related to diabetes mellitus

(A risk diagnosis does not require evidence or signs and symptoms).

      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. Note that 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.
Advise 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.

Nursing Care Plan 2

Side effect of Medications

Nursing Diagnosis: Risk for Unstable Blood Glucose Level related to steroid use (steroid-induced diabetes)

 Desired Outcome: The patient will maintain a blood glucose level of less than 180 mg/dL.

InterventionRationale
1. 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
2. For a patient without pre-existing diabetes, monitor blood glucose levels at least once a day, ideally before lunch or evening meal.
For a patient with pre-existing diabetes, monitor capillary blood glucose level 4 times a day – before or after meals and before bedtime.
To ensure that the blood glucose level is within target range.
3. Commence diabetic management as prescribed. This can be either: Non-insulin therapy – administer sulphonyureas which promote insulin release from the beta cells of the pancreas, orInsulin therapy – administration of subcutaneous basal human insulin in the morningTo keep the glucose levels within normal range, effectively controlling steroid-induced 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 as set by the diabetes specialist dietitian.Low fat, low calories, and high fiber foods are ideal for patients steroid-induced diabetes.
Advise 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.
Inform the patient that the blood glucose levels may gradually return to normal once the steroid dose is tapered down and stopped.To provide re-assurance to the patient and carer that blood glucose concentrations may become normal after steroid therapy.

Nursing Care Plan 3

Hypoglycemia

Nursing Diagnosis: Risk for unstable blood glucose level related to non-adherence to the therapeutic regimen for diabetes

Desired Outcome: The patient will demonstrate adherence to the diabetes regimen as evidenced by a reduction to less than 3 episodes hypoglycemic episodes a week.

InterventionRationale
Assess the patient’s blood sugar diary readings with a focus on the following:The number of hypoglycemic episodesThe number of hyperglycemic episodesThe patient’s blood sugar levels give healthcare workers an idea of the patient’s activities and practices surrounding his/her diabetes. To begin with, signifying the number of times the patient tests his/her blood sugar level. Also, the number of hypoglycemia or hyperglycemia can indicate the number of times the patient may have missed his/her medications. The patient’s diary can also give information if his/her hypoglycemic episodes were treated properly and if there is a pattern as to when the abnormal readings occur.
Assess and record the patient’s diabetes medications and other medications.Patients with diabetes require a regular review of their diabetes medications including any other medications for other conditions. This allows for the assessment of the appropriateness of medications to manage the patient’s diabetes and blood glucose levels. Other medications are also recorded and reviewed to make sure no untoward drug interactions occur. Also, other medications can affect blood sugar levels.
Assess the patient’s understanding of their diabetes management.Diabetes can occur at any age. A thorough understanding of the condition allows for a better prognosis and management of the disease. Lack of understanding of the disease is associated with reduced commitment to the treatment regime leading to unstable blood glucose levels.
Explore the patient’s practices in hypoglycemia management.Hypoglycemia can lead to serious complications such as hypoglycemic coma if left untreated. It is recommended that it is treated with 10-20g of quick-acting carbohydrate followed by a long-acting carbohydrate drink or food.
Ask for any concerns regarding his/her medication regime, injection sites and techniques, and anything related to his/her condition.Diabetes is a lifelong condition. Anxiety and stress are commonly associated with the disease. Discussing concerns with the patient can help identify the possible cause or causes of non-compliance to the treatment regime. 
Assess the patient’s injection techniques, injection sites and understanding of the signs, and symptoms of hypoglycemia.Hypoglycemia is not only caused by missed medications but also by improper insulin injection techniques, and injecting insulin on lipohypertrophy. Also, the inability to recognize the symptoms of hypoglycemia prevents proper treatment of the condition.
Discuss the importance of adhering to the prescribed treatment regime in maintaining a normal blood sugar level.A discussion of the importance of the disease process and the compliance to the prescribed medication regime using easy-to-understand words can help the patient realize what he/she can do to improve his/her general control.

Nursing Care Plan 4

Gestational Diabetes

Nursing Diagnosis: Risk for unstable blood glucose level related to stress secondary to gestational diabetes mellitus

Desired Outcome: The patient will demonstrate understanding of the disease process and the importance of adhering to the treatment plan as evidenced by an increased frequency in blood sugar monitoring.

InterventionRationale
Assess the patient’s understanding of gestational diabetes. Also, include the assessment of whether the patient has a history of diabetes prior to pregnancy.Gestational diabetes can occur in women without a history of diabetes pre-pregnancy. In these cases, the patients’ knowledge of the condition can be very little.
Discuss any concerns that the patient may have related to her condition.Pregnancy can be different for everyone. Anxiety and stress are quite common and pregnant women will usually have a lot of questions. Taking time to discuss these concerns can help identify the areas that need further teaching and discussion.
Assess the patient’s ability to test blood sugar levels.For women without a history of diabetes, testing can be tricky and difficult. Also, some women are needle-phobic hence they only rely on other people to do the testing for them. In the absence of their help, testing may not be possible for the patients to do on their own.
Discuss gestational diabetes with the patient in simple terms.A thorough discussion of the patient’s condition can help improve her understanding of the disease and the importance of adhering to the treatment plan. Include possible complications of the disease to the patient and the unborn child.
Encourage the patient to keep a record or diary of her blood sugar readings including the date and time the readings were taken.A blood sugar diary is a helpful way of reminding women to regularly check their blood sugar levels. It also allows self-assessment of how well they are doing or what and when their blood sugar level tends to rise or fall.

Nursing Care Plan 5

Pancreatic Cancer

Nursing Diagnosis: Risk for unstable blood glucose level related to lack of knowledge on insulin management of pancreatic cancer

Desired Outcome: The patient will demonstrate proper use of a blood glucose monitoring machine.

InterventionRationale
Assess the patent’s understanding of the condition including the normal blood sugar levels.unstable blood sugar level may occur as a result of pancreatic disease. In pancreatic cancer, the body’s ability to regulate insulin and glucagon may be affected leading to dysregulation of blood sugar. The patient may be unaware that this may occur as a complication. A thorough discussion of the disease using easy-to-understand words can help the patient make sense of what is happening in his/her body which can further promote compliance to the management regime. It is also important that the discussion includes the normal values of blood sugar to guide the patient in his/her management.
Assess the patient’s ability to use a blood sugar testing machine.glucose testing machines can be different depending on the manufacturer. However, their functions are mostly similar to one another. Demonstrate the proper use of a blood sugar testing machine in case the patient is unable to correctly use it.
Discuss the importance of blood sugar testing, keeping a record, and adhering to the prescribed frequency of testing.The care needs of a patient with pancreatic cancer can change over time. Having a record of the blood sugar readings can help plan the treatment in the future.
Allow time for discussion of concerns and questions related to the condition.The patient may have plenty of questions related to the condition. Allowing time for question and answer can improve understanding and compliance to treatment.

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

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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