Nursing Diagnosis: Fatigue related to decreased muscular strength as manifested by presence of non-healing wound on both feet Nursing Inference:

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. Nursing Goal: After 2-3 hours of nursing interventions, the patient will be able to identify measures to conserve and increase body energy. Nursing Intervention: 1. Assess response to activity - Response to an activity can be evaluated to achieve desired level of tolerance. 2. Asses muscle strength of patient and functional level of activity. -To determine the level of activity 3. Discuss with patient the need for activity - Education may provide motivation to increase activity level even though patient may feel too weak initially 4. Alternate activity with periods of rest/ uninterrupted sleep. - Prevents excessive fatigue 5. Monitor pulse, respiration rate and blood pressure before/after activity - Indicates physiological levels of tolerance 6. Perform activity slowly with frequent rest periods -Tolerance develops by adjusting frequency, duration and intensity until desired activity level is achieved. 7. Promote energy conservation techniques by discussing ways of conserving energy while bathing, transferring and so on. -Interventions should be directed at delaying the onset of fatigue and optimizing muscle efficiency. Symptoms of fatigue are alleviated with rest. Also, patient will be able to accomplish more with a decreased expenditure of energy. 8. Provide comfort and safety

-To be free from injury 9. Instruct patient to perform deep breathing exercises -Promotes relaxation 10. Instruct client to increase Vitamins A, C and D and protein in her diet. - For muscle strength and tissue repair 11. Instruct also patient to increase iron in diet -To prevent weakness and paleness Nursing Evaluation After 2-3 hours of nursing interventions, the patient was able to identify measures to conserve and increase body energy