NURSING CARE PLAN ON DM

NURSING CARE PLAN ON DIABETES MELLITUS

NURSING CARE PLAN ON DIABETES MELLITUS

Definition: Diabetes mellitus (DM) is a chronic metabolic disorder characterized by elevated blood glucose levels (hyperglycemia) resulting from defects in insulin production, insulin action, or both. Insulin, a hormone produced by the pancreas, is essential for glucose uptake by cells to provide energy.

Types of Diabetes Mellitus:

1. Type 1 Diabetes Mellitus (T1DM):
   1. Autoimmune destruction of insulin-producing beta cells in the pancreas.
   1. Usually diagnosed in children and young adults.
   1. Patients require lifelong insulin therapy.
2. Type 2 Diabetes Mellitus (T2DM):
   1. Characterized by insulin resistance and relative insulin deficiency.
   1. More common in adults, especially those with obesity, sedentary lifestyle, and genetic predisposition.
   1. Managed with lifestyle changes, oral hypoglycemic agents, and sometimes insulin.
3. Gestational Diabetes:
   1. Occurs during pregnancy when the body cannot produce enough insulin to meet the increased demand.
   1. Typically resolves after childbirth but increases the risk of developing T2DM later in life.
4. Other Specific Types:
   1. Diabetes can also result from genetic defects, diseases of the pancreas, infections, or medications (e.g., corticosteroids).

Nursing Care Plan for Diabetes Mellitus

Nursing Diagnosis 1: Deficient Knowledge Related to Disease Process and Management

Assessment Data:

• Patient reports confusion about blood glucose monitoring and insulin administration.
• History of poorly controlled blood sugar levels.

Goal:

• Patient will demonstrate understanding of diabetes management by correctly performing blood glucose monitoring and insulin administration within 48 hours.

Nursing Interventions:

1. Assess the patient’s knowledge of diabetes, including blood glucose monitoring, diet, exercise, and medication regimen.
2. Provide education on the disease process, importance of blood glucose control, and long-term complications (e.g., neuropathy, retinopathy, cardiovascular disease).
3. Demonstrate the correct technique for blood glucose monitoring and insulin administration, allowing the patient to perform a return demonstration.
4. Discuss the importance of adhering to the prescribed diet, including the role of carbohydrates and the need for regular meals to avoid hypoglycemia or hyperglycemia.
5. Encourage regular physical activity appropriate to the patient’s health condition to enhance insulin sensitivity and improve glycemic control.
6. Provide written materials on diabetes management and available community resources, such as support groups.

Evaluation:

• Patient is able to correctly monitor blood glucose and administer insulin.
• Patient verbalizes understanding of the need for dietary control and regular activity.

Nursing Diagnosis 2: Imbalanced Nutrition: More than Body Requirements Related to Sedentary Lifestyle and Poor Dietary Habits

Assessment Data:

• Body mass index (BMI) above normal range.
• Reports of consuming high-calorie, high-fat diet.

Goal:

• Patient will demonstrate weight reduction or stabilization and improved dietary habits within 4 weeks.

Nursing Interventions:

1. Assess the patient’s current dietary habits and knowledge of appropriate nutrition for diabetes.
2. Collaborate with a dietitian to develop a personalized meal plan that focuses on reducing calorie intake and improving food choices, including low glycemic index foods.
3. Encourage the patient to keep a food diary to track daily intake and promote accountability.
4. Educate on the relationship between diet and blood glucose levels, emphasizing the importance of portion control and healthy food options.
5. Encourage regular exercise, starting with low-impact activities (e.g., walking) and gradually increasing duration and intensity as tolerated.
6. Monitor weight weekly to track progress and adjust the plan as necessary.

Evaluation:

• Patient reports improved dietary habits and demonstrates a decrease in weight or BMI.
• Blood glucose levels are within target range more consistently.

Nursing Diagnosis 3: Risk for Unstable Blood Glucose Levels Related to Insufficient Insulin or Oral Hypoglycemic Agents

Assessment Data:

• History of frequent hypoglycemic or hyperglycemic episodes.
• Blood glucose levels fluctuate widely.

Goal:

• Patient will maintain blood glucose levels within the target range as prescribed by the healthcare provider.

Nursing Interventions:

1. Monitor blood glucose levels as ordered, and report significant fluctuations to the healthcare provider.
2. Educate the patient on the signs and symptoms of hypoglycemia (e.g., sweating, shakiness, confusion) and hyperglycemia (e.g., excessive thirst, frequent urination, blurred vision).
3. Provide education on adjusting insulin or oral medication doses according to blood glucose levels, food intake, and activity levels as directed by the provider.
4. Teach the patient to carry a source of fast-acting glucose (e.g., glucose tablets or juice) at all times in case of hypoglycemia.
5. Collaborate with the healthcare team to adjust insulin or oral hypoglycemic agents based on blood glucose monitoring results.

Evaluation:

• Patient’s blood glucose levels remain stable within the prescribed range.
• Patient is able to recognize and manage early signs of hypo- and hyperglycemia.

Nursing Diagnosis 4: Risk for Infection Related to Hyperglycemia and Decreased Immune Function

Assessment Data:

• History of recurrent infections (e.g., urinary tract infections, skin infections).
• Poorly controlled blood glucose levels.

Goal:

• Patient will remain free from infection during hospitalization and after discharge.

Nursing Interventions:

1. Monitor for signs of infection (e.g., fever, redness, swelling, pain, or discharge from wounds).
2. Educate the patient on proper hygiene, including regular handwashing and foot care, to reduce the risk of infections.
3. Instruct the patient to inspect the skin and feet daily for any signs of injury or infection and report abnormalities promptly.
4. Encourage blood glucose control, as hyperglycemia can increase the risk of infection.
5. Administer antibiotics as prescribed and monitor for side effects.

Evaluation:

• Patient remains free from infections.
• Blood glucose levels improve, reducing the risk of future infections.