Diabetes Mellitus is a metabolic disorder characterized by glucose intolerance or inadequate insulin production of the pancreas. It has two types, namely: Type 1 or Insulin dependent DM (IDDM) and Type 2 or Non- insulin dependent DM (NIDDM).
The metabolic effects of diabetes mellitus include the decrease in utilization of glucose because insufficiency in insulin supply in the body, an increased fat metabolism, when the body breaks down fat for energy since glucose is not available, and increased protein utilization, referring to an increase in catabolism and protein wasting.
The complications of DM consist of neuropathy, retinopathy, nephropathy, cataracts, glaucoma, pyelonephritis, peripheral vascular lesions, coronary artery disease, stroke and hypertension. With its complications, diabetes mellitus is considered the third leading cause of death by disease and risk factors involve mainly of genetics and obesity.
Nursing Diagnosis: Fluid Volume Deficient (Regulatory Failure)
Possible Etiologies:(Related to)
- Uncontrolled diabetes mellitus
- Osmotic diuresis from hyperglycemia
- Excessive gastric loss (diarrhea and vomiting)
- Restricted or low fluid intake due to nausea or confusion
Defining characteristics: (Evidenced by)
- Statements of fatigue and nervousness
- Increased urinary output
- Concentrated urine
- Sudden weight loss
- Poor skin turgor/ dry skin and mucous membranes
- Increased pulse rate
- Decreased pulse volume and pressure/ delayed capillary refill
- Change in mental state
Short term goal:
Client will maintain hydration at a functional level as evidenced by adequate urine output, stable vital signs, palpable peripheral pulses, good skin turgor and capillary refill, and electrolyte levels within normal range.
Long term goal:
Client will demonstrate behaviours to monitor and correct deficit as indicated.
Client’s hydration status will resume to a functional level through demonstrating a clear- colored urine approximately 100 cc in amount and reflecting the same approximate amount of intake; less occurrence of postural hypotension with BP ranging from 120/80mmHg to 110/70mmHg; palpable peripheral pulses in synchronous with cardiac rate of 80 – 95 beats per minute; good skin turgor and capillary refill of less than 2 seconds; and sodium and potassium levels within normal range after one week of nursing care.
Client will be able to know and perform activities helpful in controlling diabetes mellitus and maintaining adequate fluid volume like monitoring blood glucose periodically, administering own medications like insulin injection, increasing fluid intake and monitoring urine for presence of ketones, and other activities like proper diet, exercise and lifestyle.
Diabetes Mellitus Nursing Care Plan
Palandri, M.K. and Sorrentino, C.R. (1993). Black and Matassarin – Jacobs, Pocket Companion for Luckmann and Sorensen’s Medical – Surgical Nursing: A Psychophysiologic Approach. 4th Edition. W.B. Saunders.