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Nursing Care Plan for Diabetes

Pathophysiology

Diabetes Mellitus is when blood glucose (sugar in the blood) is unable to move into the cells and help in the making of ATP…AKA energy. The body makes insulin to assist with this process. Insulin is a hormone that allows the sugar in the blood to move across the cell wall so the body can use to to produce ATP. There are two types of diabetes. Type I and Type II.

 

Type I is an autoimmune disorder where the cells attack the insulin producing cells in the pancreas. Thus the body is producing very little or no insulin leaving the sugar in the blood and the cells starve.  

 

Type II is when the cells don’t respond to the insulin trying to get sugar into them, called insulin resistance. Thus the sugar stays in the blood and the cells starve.

Etiology

The cause for Type I diabetes is unknown, but hypothesized to be potentially genetic or triggered by a virus. The cause for Type II diabetes is caused by a storm of events culminating such as weight gain, lack of activity, genetics, and stress levels.

Desired Outome

Blood sugar control with minimal side effects.

Diabetes Mellitus (Type I and Type II) Nursing Care Plan

Subjective Data:

Hyperglycemia: BG >180 mg/dL

Polydipsia

Polyphagia

Polyuria

Blurred vision

Dry mouth

Increased tiredness

Leg pain

Nausea/Vomiting

 

 

Hypoglycemia: <70 mg/dL

Confusion

Weakness

Numbness around the mouth

Nervousness/Anxiety

Hungry

Headaches

Nightmares

Groggy

Objective Data:

Hyperglycemia:

-Hot and Dry, Sugar High.

 

Hypoglycemia:

-Cold and clammy give them some candy!

 

Sweaty

 

Tachycardia

 

Irritability

 

Slurring words


Nursing Interventions and Rationales:

  1. Blood sugar monitoring: Normal range 70-180 mg/dL *patient may have a different target blood sugar level, make sure to know what each patient’s target is.
    • The physician will make a target blood glucose level. Teach the patient that they need to monitor their blood glucose.They need to call their primary care physician if they have blood glucose levels higher than their target for multiple days or if they have 2 readings of greater than 300 mg/dL.

      Teach the patient how to use their glucometer and record their results.
  2. Insulin administration -Rapid Acting: Humalog Novolog -Fast/short Acting: Regular -Intermediate Action: NPH -Long Acting:’ Lantus Levemir
    • It is important to know which insulin to give and how they work. Each institution has guidelines and each insulin has guidelines. Following the guidelines, make sure you know the onset, peak and duration of each type of insulin.

      -Rapid Acting
      Onset: 10-30 minutes
      Peak: 30 minutes- 3 hours
      Duration: 3-5 hours

      -Fast/short Acting
      Onset: 30 minutes-1 hour
      Peak: 2-5 hours
      Duration: Up to 12 hours

      -Intermediate Action
      Onset:1.5-4 hours
      Peak: 4-12 hours
      Duration: Up to 24 hours

      -Long Acting
      Onset:1-4 hours
      Peak: minimal peak
      Duration: Up to 24 hours

      To administer insulin, teach the patient to rotate injection sites and to clean the site with alcohol prior to inserting needle.
  3. Educate about nutritional changes and monitoring
    • This would be a good time to get the dietician involved. The patient needs to learn at a minimum, how to count carbs and which foods to avoid such as beer.

      A patient’s glucose should be checked once when the patient wakes up, before meals, and before going to bed.

      If the patient is hypoglycemic, and they are able to eat or drink, give them some OJ and graham crackers with peanut butter.

      Increase water intake if the patient has hyperglycemia
  4. Monitor feet and educate about monitoring feet
    • Both decreased blood flow to the feet as well as neuropathy occur to make the feet something the patient really needs to watch. Wounds are hard to heal so if they are having a hard time feeling their feet and they become injured, the wounds will be worse than with someone without diabetes.

      Teach the patient to check their feet everyday. Washing their feet, cutting their toenails straight across, and scrubbing off calluses gently are a couple of points to make with the patient.

      The patient may have a podiatrist involved in their care as well.

      As a nurse, you will need to be checking the patient’s feet as well and monitor any wounds.
  5. Monitor Blood Pressure (BP) Normal Blood Pressure: 120/80 mmHg
    • It is vital to keep someone with diabetes within normal limits for their blood pressure.

      Placing strain on the cardiovascular system wrecks havoc on other organ systems. Being diabetic makes the chances of that system having issues worse. A patient can lose their vision, kidney function, have a stroke or heart attack.
  6. Educate about maintaining a healthy weight and keeping active
    • With a healthy weight, the patient is likely also implementing a healthy diet as well as implementing more movement. These three things (weight, diet, exercise) can help to manage or even reverse diabetes.

      Healthy weights are calculated based on height and sex of the patient. Other ways to monitor the size of the patient is to use a BMI calculator or measure waist circumference.

References

Date Published - Jun 2, 2017
Date Modified - Jun 30, 2017