Type 2 diabetes is a chronic metabolic disorder characterized by high blood glucose levels due to insulin resistance or insufficient insulin production. This nursing diagnosis is crucial for managing patients with type 2 diabetes, as it often correlates with other nursing diagnoses such as risk for infection, impaired skin integrity, and ineffective health maintenance.
Causes (Related to)
Type 2 diabetes can result from various factors that affect insulin production or utilization. Common causes include:
- Obesity: Excess body fat, especially around the abdomen, can lead to insulin resistance.
- Sedentary lifestyle: Lack of physical activity contributes to weight gain and insulin resistance.
- Genetics: A family history of diabetes increases the risk of developing the condition.
- Age: The risk of type 2 diabetes increases with age, particularly after 45.
- Ethnicity: Certain ethnic groups, including African Americans, Hispanics, and Native Americans, have a higher risk.
- Gestational diabetes: Women who had diabetes during pregnancy are at increased risk.
- Polycystic ovary syndrome (PCOS): This hormonal disorder is associated with insulin resistance.
- High blood pressure and abnormal cholesterol levels: These conditions often coexist with type 2 diabetes.
Signs and Symptoms (As evidenced by)
Type 2 diabetes can manifest with various signs and symptoms. During a physical assessment, a patient with type 2 diabetes may present with one or more of the following:
Subjective: (Patient reports)
- Increased thirst (polydipsia)
- Frequent urination (polyuria)
- Blurred vision
- Fatigue
- Slow-healing wounds
- Recurring infections
- Numbness or tingling in hands or feet
Objective: (Nurse assesses)
- Elevated blood glucose levels (fasting plasma glucose ≥126 mg/dL or HbA1c ≥6.5%)
- Unexplained weight loss
- Dry, itchy skin
- Acanthosis nigricans (dark, velvety patches of skin)
- Frequent yeast infections
- Peripheral neuropathy symptoms
- Retinopathy on eye examination
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for type 2 diabetes:
- The patient will maintain blood glucose levels within the target range.
- The patient will demonstrate proper techniques for blood glucose monitoring and insulin administration (if applicable).
- The patient will verbalize understanding of the diabetic diet and the importance of regular physical activity.
- The patient will exhibit no signs of diabetes-related complications.
- The patient will demonstrate improved self-management skills for diabetes care.
- The patient will report improved energy levels and overall well-being.
Nursing Assessment
The first step in nursing care is the assessment, during which the nurse gathers physical, psychosocial, emotional, and diagnostic data. The following section covers subjective and objective data related to type 2 diabetes.
1. Obtain a comprehensive health history.
Gather information about the patient’s medical history, family history of diabetes, lifestyle habits, and any current symptoms related to diabetes.
2. Perform a physical examination.
Assess the patient’s overall appearance, weight, and body mass index (BMI). Check for any signs of diabetes-related complications, such as skin changes or foot ulcers.
3. Monitor blood glucose levels.
Check the patient’s blood glucose levels regularly, including fasting and postprandial levels. Assess the patient’s ability to self-monitoring blood glucose (SMBG).
4. Evaluate HbA1c levels.
Review the patient’s HbA1c levels, which provide an average of blood glucose control over the past 2-3 months. The target HbA1c for most adults with diabetes is <7%.
5. Assess for complications.
Examine the patient for signs of diabetes-related complications, including:
- Cardiovascular issues (hypertension, abnormal lipid profile)
- Nephropathy (check urine albumin levels)
- Retinopathy (refer for regular eye examinations)
- Neuropathy (assess peripheral sensation and reflexes)
- Foot problems (perform a comprehensive foot examination)
6. Review medication regimen.
Assess the patient’s medications, including oral hypoglycemic agents and insulin (if prescribed). Evaluate the patient’s understanding of medication purpose, dosage, and administration.
7. Evaluate dietary habits.
Assess the patient’s diet, including meal patterns, food choices, and portion sizes. Determine the patient’s knowledge of carbohydrate counting and meal planning.
8. Assess physical activity level.
Evaluate the patient’s current exercise habits and any barriers to physical activity. Determine the patient’s understanding of the importance of regular exercise in diabetes management.
9. Assess psychosocial factors.
Evaluate the patient’s emotional state, support system, and ability to cope with the diagnosis of type 2 diabetes. Screen for depression, which is common in patients with diabetes.
10. Review self-management skills.
Assess the patient’s knowledge and skills related to diabetes self-management, including blood glucose monitoring, medication administration, foot care, and recognition of hypoglycemia and hyperglycemia symptoms.
Nursing Interventions
Nursing interventions and care are essential for the successful management of type 2 diabetes. In the following section, you’ll learn about possible nursing interventions for this patient.
1. Provide diabetes education.
Educate the patient about type 2 diabetes, including its causes, symptoms, and potential complications. Teach the importance of blood glucose monitoring, medication adherence, and lifestyle modifications.
2. Teach blood glucose monitoring.
Instruct the patient on proper techniques for self-monitoring of blood glucose (SMBG). Demonstrate the use of a glucometer and discuss target blood glucose ranges.
3. Administer medications as prescribed.
Administer oral hypoglycemic agents or insulin as ordered. Teach the patient about proper medication administration, including timing and potential side effects.
4. Develop a meal plan.
Collaborate with a registered dietitian to create an individualized meal plan. Teach the patient about carbohydrate counting, portion control, and healthy food choices.
5. Encourage regular physical activity.
Discuss the benefits of regular exercise in managing blood glucose levels. Help the patient develop a safe and appropriate exercise plan for their fitness level.
6. Perform foot care.
Teach the patient proper foot care techniques, including daily foot inspections, nail trimming, and appropriate footwear. Emphasize the importance of prompt treatment for any foot injuries.
7. Monitor for complications.
Regularly assess for signs of diabetes-related complications, such as changes in vision, numbness or tingling in extremities, or slow-healing wounds.
8. Provide psychosocial support.
Offer emotional support and encourage the patient to express concerns about living with diabetes. Refer to a mental health professional if needed.
9. Teach hypoglycemia management.
Educate the patient about the signs and symptoms of hypoglycemia and how to treat it promptly. Ensure the patient always carries a fast-acting source of glucose.
10. Promote stress management.
Discuss stress reduction techniques, as stress can affect blood glucose levels. Teach relaxation methods such as deep breathing or meditation.
11. Encourage smoking cessation.
If applicable, provide resources and support for smoking cessation, as smoking increases the risk of diabetes-related complications.
12. Schedule follow-up appointments.
Arrange regular follow-up appointments with healthcare providers, including endocrinologists, ophthalmologists, and podiatrists, as needed.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find examples of nursing care plans for type 2 diabetes.
Nursing Care Plan 1: Ineffective Health Maintenance
Nursing Diagnosis Statement:
Ineffective Health Maintenance related to insufficient knowledge of diabetes management.
Related factors/causes:
- Lack of understanding about diabetes self-management
- Complexity of diabetes care regimen
- Limited access to diabetes education resources
Nursing Interventions and Rationales:
- Assess the patient’s current knowledge of diabetes management.
Rationale: Identifies gaps in knowledge and areas for focused education. - Provide comprehensive diabetes education, including blood glucose monitoring, medication administration, diet, and exercise.
Rationale: Empowers the patient with essential knowledge for effective self-management. - Demonstrate and have the patient demonstrate blood glucose monitoring and insulin administration techniques.
Rationale: Ensures proper technique and increases patient confidence in self-care skills. - Collaborate with a dietitian to develop an individualized meal plan.
Rationale: Promotes better blood glucose control through appropriate dietary choices. - Discuss the importance of regular physical activity and help develop an exercise plan.
Rationale: Regular exercise improves insulin sensitivity and aids in blood glucose control.
Desired Outcomes:
- The patient will verbalize understanding of diabetes self-management principles within 3 days.
- The patient will demonstrate proper technique for blood glucose monitoring and medication administration before discharge.
- The patient will identify three lifestyle modifications to improve diabetes management within 1 week.
Nursing Care Plan 2: Unstable Blood Glucose
Nursing Diagnosis Statement:
Risk for Unstable Blood Glucose Level related to inconsistent dietary intake and medication adherence.
Related factors/causes:
- Irregular meal patterns
- Poor understanding of carbohydrate counting
- Inconsistent medication adherence
- Limited self-monitoring of blood glucose
Nursing Interventions and Rationales:
- Establish a consistent schedule for blood glucose monitoring and medication administration.
Rationale: Promotes regular assessment and timely intervention for blood glucose management. - Teach carbohydrate counting and its impact on blood glucose levels.
Rationale: Improves the patient’s ability to make informed food choices and adjust insulin dosage if needed. - Implement a medication reminder system (e.g., phone alarms, pill organizers).
Rationale: Enhances medication adherence and consistent blood glucose control. - Educate about the signs, symptoms, and management of hypoglycemia and hyperglycemia.
Rationale: Enables prompt recognition and appropriate response to blood glucose fluctuations. - Collaborate with the patient to develop a meal plan that fits their lifestyle and preferences.
Rationale: Increases likelihood of adherence to dietary recommendations.
Desired Outcomes:
- The patient will maintain blood glucose levels within the target range (fasting 80-130 mg/dL, 2 hours postprandial <180 mg/dL) 80% of the time within two weeks.
- The patient will demonstrate accurate carbohydrate counting for meals within five days.
- The patient will report taking medications as prescribed 100% of the time within one week.
Nursing Care Plan 3: Deficient Knowledge
Nursing Diagnosis Statement:
Deficient Knowledge related to long-term complications of type 2 diabetes.
Related factors/causes:
- Lack of exposure to information about diabetes complications
- Misunderstanding about the seriousness of diabetes
- Cognitive limitations or language barriers
Nursing Interventions and Rationales:
- Assess the patient’s current understanding of potential diabetes complications.
Rationale: Identifies knowledge gaps and misconceptions to guide education. - Provide education on long-term complications of diabetes, including cardiovascular disease, neuropathy, nephropathy, and retinopathy.
Rationale: Increases awareness of potential risks and motivates adherence to the management plan. - Discuss the importance of regular health screenings and follow-up appointments.
Rationale: Promotes early detection and management of complications. - Teach strategies for preventing complications, such as foot care and smoking cessation.
Rationale: Helps the patient take proactive steps to prevent complications. - Provide written materials and reputable online resources for ongoing education.
Rationale: Offers references for reinforcement of learning and future questions.
Desired Outcomes:
- The patient will verbalize understanding of at least three potential long-term complications of diabetes within three days.
- The patient will identify at least two strategies for preventing each discussed complication within five days.
- The patient will schedule necessary follow-up appointments (e.g., eye exam, foot exam) before discharge.
Nursing Care Plan 4: Imbalanced Nutrition: More Than Body Requirements
Nursing Diagnosis Statement:
Imbalanced Nutrition: More Than Body Requirements related to poor dietary choices and sedentary lifestyle.
Related factors/causes:
- Limited knowledge of proper nutrition for diabetes management
- Cultural food preferences high in carbohydrates and fats
- Lack of regular physical activity
- Emotional eating patterns
Nursing Interventions and Rationales:
- Assess the patient’s dietary habits, including food preferences and eating patterns.
Rationale: Provide baseline information for developing an appropriate nutrition plan. - Collaborate with a registered dietitian to create an individualized meal plan.
Rationale: Ensures the nutrition plan is tailored to the patient’s needs, preferences, and cultural background. - Teach the plate method for meal planning (1/2 plate non-starchy vegetables, 1/4 plate lean protein, 1/4 plate complex carbohydrates).
Rationale: Provides a simple visual guide for balanced meal composition. - Discuss strategies for healthy eating out and reading food labels.
Rationale: Empower the patient to make informed food choices in various settings. - Encourage regular physical activity and help develop an exercise plan.
Rationale: Promotes weight management and improves insulin sensitivity.
Desired Outcomes:
- The patient will demonstrate an understanding of the diabetic diet by planning a sample day’s menu within three days.
- The patient will report making at least two healthy dietary changes within one week.
- The patient will engage in at least 30 minutes of moderate physical activity five days a week within two weeks.
Nursing Care Plan 5: Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to poor circulation and decreased sensation in extremities.
Related factors/causes:
- Peripheral neuropathy resulting in decreased sensation
- Poor circulation in extremities
- Elevated blood glucose levels impacting wound healing
- Lack of knowledge about proper foot care
Nursing Interventions and Rationales:
- Perform a comprehensive foot assessment, including inspection of skin integrity and sensation testing.
Rationale: Establishes baseline and identifies areas at risk for skin breakdown. - Teach proper foot care techniques, including daily inspection, appropriate cleansing, and moisturizing.
Rationale: Promotes early detection of skin issues and maintains skin health. - Educate about appropriate footwear and the importance of avoiding barefoot walking.
Rationale: Reduces the risk of foot injuries and pressure points that could lead to ulcers. - Demonstrate proper toenail trimming technique.
Rationale: Prevents accidental cuts and ingrown toenails that could lead to infections. - Discuss the importance of blood glucose control in maintaining skin health and wound healing.
Rationale: Motivates adherence to diabetes management plan for overall health benefits.
Desired Outcomes:
- The patient will demonstrate proper foot care techniques, including daily inspection, within three days.
- The patient will verbalize understanding of the relationship between blood glucose control and skin health within two days.
- The patient will report wearing appropriate footwear 100% of the time within one week.
References
- American Diabetes Association. (2022). Standards of Medical Care in Diabetes—2022. Diabetes Care, 45(Supplement_1), S1-S2.
- Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., … & Uelmen, S. (2020). Diabetes self-management education and support in adults with type 2 diabetes: a consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. The Diabetes Educator, 46(4), 350-369.
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