Diabetes mellitus is a metabolic disease characterized by dysregulation of carbohydrate, protein, and lipid metabolism.

The primary feature of this disorder is elevation in blood glucose levels (hyperglycemia), resulting from either a defect in insulin secretion from the pancreas, a change in insulinaction, or both. Sustained hyperglycemia has been shown to affect almost all tissues in the body and is associated with significant complications of multiple organ systems, including the eyes, nerves, kidneys, and blood vessels.

Deficient Fluid Volume

Glucose appears in the urine (glycosuria) because the kidney excretes the excess glucose to make the blood glucose level normal. Glucose excreted in the urine acts as osmotic diuretic and causes excretion of increased amount of water, resulting in fluid volume deficit or polyuria.

Assessment

Nursing Diagnosis

Planning

Nursing Rationale Intervention s Establish rapport Take and record vital signs Friendly relationship with patient and to be able to each others concern To obtain baseline data

Evaluation

Subjective: (none Deficient ) Fluid Objective: Volume r/t intracellula r DHN 2 y elevated the DM II temperature of 38.4C/axill a y increased urine output. y sweating of the skin y thirst y exhaustion y weight loss y dry skin or mucous membrane

Short Term:After 3 of NI, patient shall have verbalized understanding of causative factors and purpose of individual therapeutic interventions andmedications . Long Term:

Short Term:After 3 of NI, patient will have verbalized understanding of causative Monitor the factors and temperature purpose of individual Assess skin therapeutic turgor and To monitor interventions mucous changes in andmedications membranes temperature . for signs of Long Term: dehydration Dry skin After 2 days of Encourage and mucous After 2 days of NI, the patient the patient to membranes NI, the patient shall have increase fluid are signs of will have maintained dehydration maintained intake fluid volume at fluid volume at a functional To replace a functional Administer level as level as fluid loss IVF as evidenced by and prevent evidenced by ordered by individual good the Doctor dehydration individual good skin turgor, skin turgor, moist mucous Administer To replace moist mucous membrane and anti-pyretic electrolytes membrane and stable vital stable vital as prescribed and fluid signs. signs loss by the

Doctor.

To decrease body temperature and will have less occurrence of dehydration .

Imbalanced Nutrition: Less Than Body Requirements

Due to decrease of lack of insulin in the body, the glucose level continuously rises because glucose cant be utilized without the presence of insulin. Glucose is the source of energy, while insulin is the vehicle to transport glucose to the body tissues. Because of decrease insulin level in the blood stream, the cells starved, leading to alteration of metabolism. The body needs glucose for metabolism; there will be a breakdown of energy reserved from adipose tissue, muscles and liver (glucagons). This will result to weight loss. But the energy breaks down, the glucose level continuously increase because there is less amount of insulin. The body tissues need to be fed, this will lead to polyphagia and polydipsia because the tissue are not being fed and need glucose for metabolism.

Assessmen Nursing t Diagnosis Subjective: Imbalanced Nutrition: less Objective: than body requirement r/t insulindeficie Pt. manifested ncy : - poor muscle tone generalized weakness - increased thirst - increased

Planning Short Term: After 3 of NI, patient shall have verbalized understandi ng of causative factors when known and necessary intervention s and identified diabetic client.

Nursing Interventions Establish rapport Ascertain understanding of individual nutritional needs

Rationale

Evaluation Short Term: After 3 of NI, patient will have verbalized understandi ng of causative factors when known and necessary intervention s and identified diabetic client.

Friendly relationship with patient and to be able to each others concern To determine what information Discuss eating to be provided to habits and encourage diabetic client/SO diet as prescribed by the Doctor - To achieve health needs of Document actual the patient with the proper food weight, do not diet for is/her estimate. disease Note total daily - Patient may be intake including patterns and time un aware of their actual weight or

urination polyphagia Pt. may manifest: - loss of weight

Long Term: of eating. After 1-4 months of NI, the patient shall have demonstrat ed weight gain toward goal. Consult dietician/physician for furtherassessment and recommenddation regarding food preferences and nutri-tional support

weight loss due to estimating weight.

Long Term:

After 1-4 months of - To reveal NI, the changes that patient will should be made have in clients dietary demonstrat intake ed weight gain toward goal. - For greater understanding and furtherassessmen t of specific foods.

Fatigue

Diabetes Mellitus is a group of metabolic diseases characterized by increased levels of glucose in the blood resulting from defects in insulin secretion, insulin action, or both. In type 2 diabetes, people have decreased sensitivity to insulin and impaired beta cell functioning resulting in decreased insulin production. Glucose derived from food cannot be stored in the liver thereby remaining into the bloodstream. The beta cells of the islets of Langerhans release glucagon which stimulates the liver to release the stored glucose. After 8 12 hours, the liver forms glucose from the breakdown of noncarboghydrate substances, including amino acids resulting to muscle wasting which results to weakness.

Assessment

Nursing Diagnosis Fatiguerelat ed to decreased muscular strength

Planning

Nursing Rationale Interventio ns -Assess response to activity -Asses muscle strength of patient and functional level of activity. -Discuss with patient the need for activity -Response to an activity can be evaluated to achieve desired level of tolerance. -To determine the level of activity -Education may provide motivation to increase activity level even though

Evaluatio n The patient shall have been able to identify measures to conserve and increase body energy The patient shall have been free

Subjective: (none) Objective:

y y y

y y y y y

generalized weakness increasedrespiratory rate of 25cpm presence of nonhealing wound on both feet body weakness wt. loss fatigue limited ROM inability to perform ADL

Short Term:After 2-3 of nursing intervention s, the patient will be able to identify measures to conserve and increase body energy. Long

y y

altered VS altered sensorium

-Alternate activity with periods of After 3-5 rest/ days of uninterrupte nursing intervention d sleep. s, the patient will -Monitor be free pulse, from signs respiration offatigue rate and blood pressure before/after activity Term:

patient may feel too weak initially -Prevents excessivefatig ue -Indicates physiological levels of tolerance

from signs of fatigue

-Tolerance develops by adjusting -Perform frequency, activity duration and slowly with intensity until frequent rest desired periods activity level is achieved. -Promote energy -Interventions conservation should be techniques directed at by delaying the discussing onset ways of of fatigueand conserving optimizing energy muscle while efficiency. bathing, Symptoms transferring offatigue are and so on. alleviated with rest. Also, -Provide patient will be adequate able to ventilation accomplish more with a decreased -Provide comfort and expenditure of energy. safety -Instruct -For proper

patient to perform deep breathing exercises -Instruct client to increase Vitamins A, C and D and protein in her diet. -Instruct also patient to increase iron in diet -Administer oxygen as ordered.

oxygenation -To be free from injury -Promotes relaxation -For muscle strength and tissue repair -To prevent weakness and paleness -To provide proper ventilation

Risk for Infection

Risks for infection is a increased probability of invasion of pathogenic organisms for a pt. with DM wound is possible in the furure.Clients with diabetes are susceptible to infections because of polymorphonuclear leukocyte function, diabetic neuropathies, and vascular insufficiency as a result is a poor glycemic control; thus making a wound to heal slowly because the damaged of the vascular system cannot carry sufficient oxygen, WBC, nutrients, and antibodies to the injured site. Thereby infections increase and enhance possibility of further complications.

Assessment Subjective: Objective:

Nursing Diagnosis

Planning Short Term: After 4 hours of NPI the risks factors of occurrence of infection will be reduce or control to a manageable

Nursing Interventions -Establish rapport -Take and record vital signs -Encourage expression of feelings and

Rationale - to obtain patients trust and cooperation - To obtain baseline data - facilitates grieving the

Evaluation Short Term: -The pt. shall have identified risks factors of occurrence of infection shall have

Risk for infectionrelated to disease Pt. manifested: condition. -purulent discharge

-hyperthermia Pt. may manifest: -altered circulation immunological deficit

level by a clean anxieties bed and maintain skin - Observe non intact. verbal cues Long Term: After 1-2 weeks of NPI, pt will be free of purulent drainage or erythema and be afebrile -Encourage client to look at/touch affected body part -Encourage verbalization of and role play anticipated conflicts -encourage to increase fluid intake -increase Vit. C in the diet -increase CHON intake -change dressing

loss

reduced or controlled to - non verbal a cues is more manageable accurate than level by a clean bed verbal cues and skin - to begin to intact. incorporate changes into Long Term: body image -The patient - to enhance shall be free of purulent handling of damage or potential erythema problems and be febrile -to prevent dehydration -to boost immune system and promote collagen formation -for tissue repair

-to promote -provide a safe healing and prevent and quiet contamination environment of the wound -Take Due meds on time -to promote pts comfort - To met the bodys requirements
Photo courtesy of: link

Related posts: