Diabetes Mellitus(DM) Nursing Care Plan

Diabetes Mellitus 290x228 Diabetes Mellitus(DM) Nursing Care PlanDiabetes Mellitus (DM) 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 dieresis 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
  • Weakness
  • Thirst
  • Sudden weight loss
  • Poor skin turgor/ dry skin and mucous membranes
  • Hypotension
  • Increased pulse rate
  • Decreased pulse volume and pressure/ delayed capillary refill
  • Change in mental state

Goals/ Objectives:

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.

Outcome Criteria:

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(DM) Nursing Care Plan

Nursing Diagnosis

Objectives

Nursing Interventions

Rationale

Evaluation

Fluid Volume Deficient (Regulatory Failure)

Possible Etiologies: (Related to)

  • Uncontrolled diabetes mellitus

–       Osmotic dieresis 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
  • Weakness
  • Thirst
  • Sudden weight loss
  • Poor skin turgor/ dry skin and mucous membranes
  • Hypotension
  • 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.

 

1. Obtain history for intensity and duration of symptoms such as vomiting and excessive urination.

 

2. Monitor the vital signs like:

a. Orthostatic BP changes

b. Respiratory changes i.e. Kussmaul’s respiration, acetone breath

c. Respiratory rate and quality; use of accessory muscles, periods of apnea, and cyanosis

d. Temperature, skin turgor

3. Check peripheral pulses, capillary refill, and for skin turgor.

4. Strictly monitor the intake and the output.

5. Encourage client to take at least 2500ml/ day.

6. Weigh client daily or as indicated.

7. Investigate changes in mentation.

8. Administer fluid replacement measures are prescribed by the physician.

9. Insert and maintain a catheter as indicated.

10. Monitor laboratory results i.e. hematocrit, BUN/ creatinine, sodium, and potassium.

11. Administer medications like potassium intravenously or orally as indicated by the physician.(As soon as urinary flow is present)

12. Insert NGT as indicated.

 

- Helps in making approximation of total volume loss. Symptoms may be present for hours or days and presence of other diseases usually result, too, to increase in sensible fluid losses.

– Hypovolemia can be manifested by hypotension and tachycardia; Carbonic acid is removed in the lungs through respiration and producing respiratory alkalosis for ketoacidosis; Acetone breath is due to acetoacetic acid and should disappear when condition is corrected; Cyanosis, apnea and increase in respiratory effort may be due to compensation from acidosis; Fever with flushed skin reflects dehydration.

– These are indicators for the hydration status of a client and so as the circulating volume in the body.

– Gives baseline data of client’s hydration status and to know the approximation of fluid replacement; the function of kidney and the effectiveness of the fluid replacement therapy.

– It maintains hydration level in the functional state.

– It provides the current fluid status and adequacy of fluid replacement.

– Changes in mentation reflect abnormally high or low glucose level, acidosis, electrolyte imbalances and decreased cerebral perfusion.

– The type and amount of fluid depend on the degree of dehydration.

– It gives accurate assessment of urinary output.

– These parameters reflect fluid shifts and degree of dehydration of client. It may also pertain to how the body reacts to metabolic acidosis.

– To prevent hypokalemia.

– To decompress the stomach and to stop vomiting.

 

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.

 

Reference:
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.

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About Ira Hope

Writing is an integral part of my nursing career. It is my way to reach more people and empower them with the roles of nurses. Currently, I'm working as a nurse in a private hospital specifically in the Emergency Room. Emergency nursing is my forte.

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