NURSING CARE PLAN

NURSING DIAGNOSIS: Risk for fluid volume deficit related to frequent urination.

Goal: Provision of fluid balance. Demonstrate adequate hydration as evidenced by stable vital
signs, palpable peripheral pulses, good skin turgor and capillary refill, individuality appropriate
urinary output.

INTERVENTIONS

RATIONALE

1. Obtain history from patient related

1. Assists

to duration of intensity of symptoms

in

estimation of total

volume depletion.

like excessive urination.

2. Weight

daily

and

record

data

gathered.
2. Rapid losses or gains of 5%
more of total body weight indicate
moderate to severe fluid volume deficit or
3. Monitor vital signs:

excess.

a. Body temperature
3a. A decreased body temperature

may result from hypovolemia. Although

fever, chills, diaphoresis are common with
infection process, fever with flushed, dry
skin may reflect dehydration.

3b. An increased pulse rate and a

b. Pulse rate

weak, thread pulse may occur with fluid

volume deficit.

3c. Correction of hyperglycemia will

cause the rate and pattern to approach
c. Respiratory rate

normal. In contrast, increased work of

breathing, shallow, rapid respirations; and
presence

of

cyanosis

may

indicate

respiratory fatigue.

3d. Hypovolemia may be manifested

by hypotension and tachycardia. Estimates
the severity of hypovolemia may be made
when patients systolic blood pressure
d. Blood Pressure

drops

more

than

10mmhg

from

Recumbent to a sitting or standing

position.

4. Maintain fluid intake of at least 4. Adequate and increase in fluid intake

2500

ml/day

tolerance

when

within
oral

cardiac can maintain hydration or circulating

intake

is volume.

resumed.

NURSING DIAGNOSIS: Risk for infection related to insufficient knowledge on proper wound
care.

Goal: Have knowledge on proper wound care. Identify interventions to prevent or reduce risk of
infection. Demonstrate techniques, lifestyle changes to prevent development of infection.

INTERVENTIONS

RATIONALE

1. Observe for signs of infection and

inflammation,

like

fever,

flushed

appearance, wound drainage.

1. Proper assessment for signs of infection

can prevent any other complication and
can provide essential care.

2. Educate the patient on how to care

2. Prevention of infection is best achieved

properly the wounds on step by step

through following the guidelines of

process.

wound care obtained during educating

process.

3. Proper application and changing of

3. Change wound dressings if needed

wound dressing can facilitate the

using proper techniques of changing

prevention of progress or transfer of

and disposing contaminated materials.

infection.

4. Fruits rich in vitamin c can boost the

4. Encourage patient to eat foods rich in
vitamin

like

citrus,

oranges,

immunity of an individual which helps

him fight infection.

pineapple etc.

NURSING DIAGNOSIS: Imbalanced Nutrition: less than body requirements related to inability
to utilize nutrients.

GOAL: Maintain normal nutritional status. Demonstrate stabilized weight or gain toward
usual/desired range.

INTERVENTIONS
1. Weight daily or as indicated.

RATIONALE
1. Assesses adequate of nutritional
intake
By absorption and utilization of nutrients.

2. If patients food preferences can be

2. Identify food preferences, including
ethnic/cultural needs.

incorporated into the meal plan,

cooperation

with

dietary

requirements may be facilitated.

3. Proper intake and distribution of

meals can help an individual to
maintain, reduce, or gain the ideal
3. Discuss proper distribution of meals
that the client prefers but may
contribute in maintaining normal
body weight.

weight that he should achieve.

XII.
A. CONCLUSION
In making this care study, I really appreciate how vital our organs are, that we should be
very careful in doing things, in every action we take, because it may result to damage of such
organ. Diabetes Mellitus is a very complex disease process if not treated appropriately. Patients
with such condition should know how to control his lifestyle, diet, and avoid factors that could
worsen the condition. Through this case study we learned many things that are necessary and
have relevance to our future career.

B. RECOMMENDATION
This study aims to recommend a continued teaching to enhance skills and abilities of
concerned people, and to develop a good quality loaded with knowledge. This is also to eradicate
complications patients with Diabetes Mellitus

XIII. IMPLICATION OF THE STUDY TO

A. NURSING EDUCATION
The care study provides the academe of nursing education the opportunity to focus on
how to engage in care management of Diabetes Mellitus. And to renew the idea of dealing

patients easily, instead we must set much more effort in dealing with them because this is the
times when they need more support.

B. NURSING PRACTICE
The care study provides a wider venue for nursing students to develop and enrich their
skills and knowledge in rendering efficient and effective care. It sharpens our abilities in
performing nursing measures to be rendered to our respective clients. Thus, provides us
satisfactory exposure that cant be paid by any means.

C. NURSING RESEARCH
The care study helps in further investigation and research to optimize nursing care and
expand the scope of nursing practice. Thus, continued investigation is further encouraged on the
ultimate predisposing factor of having Diabetes Mellitus.