Diabetes

eNURSING CARE PLAN 49-1

Patient With Diabetes Mellitus
NURSING DIAGNOSIS Ineffective self-health management related to deficient knowledge of diabetes management and lack of adherence to
diabetes management plan as evidenced by inaccurate statements regarding diabetes and its management and stated
confusion regarding the pathophysiology of diabetes
PATIENT GOALS 1. Verbalizes key elements of the therapeutic regimen, including knowledge of disease and treatment plan
2. Describes self-care measures that may prevent or decrease progression of chronic complications
Outcomes (NOC) Interventions (NIC) and Rationales
Knowledge: Diabetes Management Teaching: Disease Process
Cause and contributing factors _____ Appraise the patients current level of knowledge related to specific disease process to
Role of diet in blood glucose control _____ determine the scope and extent of required teaching.
Prescribed meal plan _____ Describe the disease process.
Strategies to increase diet adherence _____ Discuss rationale behind management/therapy/treatment recommendations to enable
Role of exercise in blood glucose control ____ patient to better understand rationale behind treatment regimen and lifestyle changes.
Role of sleep in blood glucose control _____ Instruct patient on measures to prevent/minimize symptoms to promote management
Correct use of insulin/prescribed medication/ of disease.
nonprescription medication _____ Discuss lifestyle changes that may be required to prevent future complications and/or
When to obtain assistance from a health control the disease process to encourage patient to actively participate in determining
professional _____ changes that will be acceptable.
Reputable sources of diabetes information _____ Describe possible chronic complications to increase awareness of the long-term effects
Benefits of disease management _____ of disease process.
Instruct the patient on which signs and symptoms to report to health care provider to
Measurement Scale ensure prompt treatment.
1 = No knowledge Refer the patient to local community agencies/support groups to provide continuing
2 = Limited knowledge support and education.
3 = Moderate knowledge
4 = Substantial knowledge
5 = Extensive knowledge

NURSING DIAGNOSIS Risk for unstable blood glucose levels related to inadequate blood glucose monitoring and lack of adherence to diabetes
management plan
PATIENT GOAL Maintains a balance of nutrition, activity, and insulin availability that results in stable, normal blood glucose levels
Outcomes (NOC) Interventions (NIC) and Rationales
Diabetes Self-Management Teaching: Prescribed Diet
Follows recommended diet _____ Teach patient to use a food diary to record dietary intake for at least 2 days.
Participates in recommended exercise program _____ Determine patients/caregivers feelings/attitude toward prescribed diet and expected
Uses glucose logs to monitor blood glucose level degree of dietary compliance to determine readiness to learn.
over time___ Assist patient to accommodate food preferences into prescribed diet to improve
Performs correct procedure for blood glucose compliance.
testing _____ Refer patient to dietitian/nutritionist to provide continuing diet education and evaluation.
Monitors blood glucose _____
Treats symptoms of hyperglycemia _____ Teaching: Prescribed Activity/Exercise
Treats symptoms of hypoglycemia _____ Inform the patient of the purpose for, and the benefits of, the prescribed activity/
Monitors frequency of hypoglycemic episodes _____ exercise to improve commitment to activity.
Uses diary to monitor blood glucose level over Instruct the patient how to monitor tolerance of the activity/exercise to prevent injury.
time _____ Assist the patient to incorporate activity/exercise regimen into daily routine/lifestyle
Obtains health care if blood glucose levels fluctuate because it is an integral part of diabetes control.
outside of recommended parameters _____
Performs treatment regimen as prescribed _____ Hypoglycemia Management
Instruct on interaction of diet, insulin/oral agents, and exercise to prevent hypoglycemia.
Measurement Scale Instruct patient and significant others of signs, symptoms, risk factors, and treatment of
1 = Never demonstrated _____ hypoglycemia to facilitate blood glucose balance
2 = Rarely demonstrated _____ Determine recognition of hypoglycemia signs and symptoms to alert patient to glucose/
3 = Sometimes demonstrated _____
insulin imbalance and need for treatment.
4 = Often demonstrated _____
5 = Consistently demonstrated _____ Provide complex carbohydrate and protein to treat a hypoglycemic event.
Instruct patient to have simple carbohydrate available at all times to treat hypoglycemia.
Provide feedback regarding appropriateness of self-management of hypoglycemia to
Blood Glucose Level
reinforce new learning.
Blood glucose _____
Instruct patient to obtain and carry/wear appropriate emergency identification.
Glycosylated hemoglobin _____
Urine glucose_____
Urine ketones _____
Hyperglycemia Management
Monitor for signs and symptoms of hyperglycemia: polyuria, polydipsia, polyphagia,
weakness, lethargy, malaise, blurring of vision, or headache to alert patient to glucose/
Measurement Scale
1 = Severe deviation from normal range insulin imbalance and need for treatment.
2 = Substantial deviation from normal range Anticipate situations in which insulin requirements will increase (e.g., intercurrent
3 = Moderate deviation from normal range illness) to allow patient to adjust insulin dosage appropriately and avoid undue fatigue.
4 = Mild deviation from normal range Facilitate adherence to diet and exercise regimen to promote diabetes control.
5 = No deviation from normal range Restrict exercise when blood glucose level is >250 mg/dL and ketone is present in
persons with type 1 diabetes, to decrease the bodys requirement for unavailable
glucose.

Continued
Copyright 2014, 2011, 2007, 2004, 2000, 1996, 1992, 1987, 1983 by Mosby, an imprint of Elsevier Inc.
 eNURSING CARE PLAN 49-1cont'd
Patient With Diabetes Mellitus
NURSING DIAGNOSIS Risk for injury related to decreased tactile sensation, episodes of hypoglycemia
PATIENT GOALS 1. Experiences no injury resulting from decreased sensation in feet
2. Experiences no injury resulting from hypoglycemia
Outcomes (NOC) Interventions (NIC) and Rationales
Risk Control Teaching: Foot Care
Acknowledges risk factors _____ Provide information regarding the relationship between neuropathy, injury, and vascular
Modifies lifestyle to reduce risk _____ disease and the risk for ulceration and lower extremity amputation in persons with
Avoids exposure to health threats _____ diabetes to promote preventive measures.
Monitors health status changes _____ Caution about potential sources of injury to the feet (e.g., heat, cold, cutting corns or
calluses, chemicals, use of strong antiseptics or astringents, use of adhesive tape, and
Diabetes Self-Management going barefoot or wearing thongs or open-toe shoes).
Follows preventive foot care practices _____ Recommend daily foot inspection over all surfaces and between the toes looking for
Uses preventive measures to reduce risk of redness, swelling, warmth, dryness, maceration, tenderness, or open areas to identify
complications _____ and provide early treatment of foot lesions.
Reports nonhealing breaks in skin to primary care Instruct individual to inspect inside of shoes daily for foreign objects, nail points, torn
provider _____ linings, and rough areas to avoid injury by factors that are not felt.
Treats symptoms of hypoglycemia _____ Recommend daily washing of feet using warm water and mild soap to remove irritants.
Recommend specialist care for thick fungal or ingrown toenails, corns, or calluses to
Measurement Scale ensure safe treatment of feet.
1 = Never demonstrated
2 = Rarely demonstrated Hypoglycemia Management: As Per Prior Nursing Diagnosis
3 = Sometimes demonstrated As per prior nursing diagnosis.
4 = Often demonstrated
5 = Consistently demonstrated

NURSING DIAGNOSIS Risk for peripheral neurovascular dysfunction related to vascular effects of diabetes
PATIENT GOALS 1. Verbalizes effects of diabetes on peripheral artery circulation
2. Implements measures to increase peripheral circulation
Outcomes (NOC) Interventions (NIC) and Rationales
Tissue Perfusion: Peripheral Circulatory Care: Arterial Insufficiency
Capillary refill, toes _____ Perform a comprehensive appraisal of peripheral circulation (e.g., check peripheral
Pedal pulse strength (right) _____ pulses, edema, capillary refill, color, and temperature) to establish baseline findings.
Pedal pulse strength (left) _____ Inspect skin for arterial ulcers or tissue breakdown to provide treatment to prevent
Extremity skin temperature and color_____ infection and additional necrosis.
Protect the extremity from injury (e.g., sheepskin under feet and lower legs, footboard/
Measurement Scale bed cradle at foot of bed; well-fitted shoes) to prevent conditions that favor skin
1 = Severe deviation from normal range breakdown.
2 = Substantial deviation from normal range Maintain adequate hydration to decrease blood viscosity.
3 = Moderate deviation from normal range Encourage the patient to exercise as tolerated to increase peripheral circulation.
4 = Mild deviation from normal range
5 = No deviation from normal range Instruct the patient on factors that interfere with circulation (e.g., smoking, restrictive
clothing, exposure to cold temperatures, crossing of legs and feet).
Instruct the patient on proper foot care (see Table 49-21).
Localized peripheral pain ____
Necrosis _____
Numbness _____
Skin integrity _____
Tingling _____
Pallor _____

Measurement Scale
1 = Severe
2 = Substantial
3 = Moderate
4 = Mild
5 = None

Nursing diagnoses listed in order of priority.

Copyright 2014, 2011, 2007, 2004, 2000, 1996, 1992, 1987, 1983 by Mosby, an imprint of Elsevier Inc.