Nursing Care Plan for Diabetes Mellitus

Nursing Care Plan for Diabetes Mellitus

Diabetes mellitus is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. This high blood sugar produces the symptoms of frequent urination, increased thirst, and increased hunger. Untreated, diabetes can cause many complications. Acute complications include diabetic ketoacidosis and nonketotic hyperosmolar coma. Serious long-term complications include heart disease, stroke, kidney failure, foot ulcers and damage to the eyes.

There are three main types of diabetes mellitus:

• Type 1 DM results from the body's failure to produce enough insulin. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is unknown.
• Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop. This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The primary cause is excessive body weight and not enough exercise.
• Gestational diabetes, is the third main form and occurs when pregnant women without a previous history of diabetes develop a high blood glucose level.

Nursing Assessment
1. Family Health History

• Are there families who suffer from illnesses such as client ?

2. Patient Health History and Previous Treatment

• How long suffered from DM client, how to handle, get what kind of insulin therapy, how to take the medicine whether regular or not, what is done to cope with illness clients.

3. Activity / Rest:

• Tired, weak, hard Moves / walking, muscle cramps, decreased muscle tone.

4. Circulation

• Is there a history of hypertension, AMI, claudication, numbness, tingling in the extremities, ulcers on the feet long healing time, tachycardia, changes in blood pressure

5. Ego Integrity

• Stress, anxiety

6. Elimination

• Changes in the pattern of urination (polyuria, nocturia, anuria), diarrhea

7. Food / Fluids

• Anorexia, nausea, vomiting, do not follow the diet, weight loss, thirst, the use of diuretics.

8. Neurosensory

• Dizziness, headache, numbness, muscle weakness numbness, paraesthesia, visual disturbances.

9. Pain / Leisure

• Abdominal strain, pain (is / weight)

10. Respiratory

• Cough with or without purulent sputum

11. Security

• Dry skin, itching, skin ulcer.

Nursing Diagnosis and Nursing Intervention

Deficient Fluid volume related to osmotic diuresis from hyperglycemia
Goal :
The patient will demonstrate adequate hydration.

Nursing Intervention - Deficient Fluid volume for Diabetes Mellitus
1.Monitor orthostatic blood pressure changes.
Rational : Hypovolemia may be manifested by hypotension and tachycardia.
2.Assess peripheral pulses, capillary refill, skin turgor, and mucous membrane.
Rational : Indicators of level of dehydration, adequacy of circulating volume.
3.Monitor respiratory pattern like Kussmaul’s respirations and acetone breath.
Rational : Lungs remove carbonic acid through respirations, producing a compensatory respiratory alkalosis for ketoacidosis.
4. Monitor input and output. Note urine specific gravity.
Rational : Provides ongoing estimate of volume replacement needs, kidney function, and effectiveness of therapy.
5. Promote comfortable environment. Cover patient with light sheets.
Rational : Avoids overheating, which could promote further fluid loss.
6. Monitor temperature, skin color and moisture.
Rational : Fever, chills, and diaphoresis are common with infectious process; fever with flushed, dry skin may reflect dehydration.