NCP: Patient Diabetes Mellitus

Ineffective self health management related to insufficient knowledge as evidenced by continued hyperglikemia,
Nursing diagnosis inaccurate statements regarding diabetes and its management, and stated confusion regarding the pathophysiology of
diabetes
1. Verbalized key elements of therapheutic regiment, including knowlwdge of desease and treatment plan
Patient goal 2. Describe selfcare measures that may prevent to decrease progression of chronic complication
Intervention (NIC) Outcome (NOC)
Teaching: Disease process Knowledge : Diabetes management
 Appraise the patient's current level of knowledge related to  Cause and contributing factors.........
spesific disease process to detemine the scope and extent of  Role of diet in blood glucose control.......
required teaching  Prescribed meal plan.............
 Describe the disease process  Role of exercise in blood glucose control......
 Discuss rational behind management/therapy / treatment  Hyperglicemia and related symptom............
recommendations to enable patient to better understand rational  Hyperglicemia prevention...............
behind treatment regiment and lifestyle  Procedure to be followed in treating hyperglicemia..............
 Instruct patient on measures to prevent/minimize symptoms to
promote management of disease Measurement Scale
 Discuss lifestyle changes that may required to prevent future 1= No knowledge
complications and / or control desease process to encourage 2= Limited knowedge
patient to actively partipate in determining changes that will be 3= Moderate knowledge
acceptable 4= Subtanstial knowledge
 Describe possible chronic complications to increase awareness 5= Extensive knowledge
of long term effects of inadequate control disease process
 Describe possible chronic complications to increase awareness
of long term effects of disease process
 Instruct the patient on which signs and symptoms to report to
health care provider to ensure prompt treatment
 Refer the patient to local community agencies /support groups
to provide continuing support and education
 Imbalance nutrition: More than body requirements
Nursing diagnosis
Teaching: Prescribed diet
Patient goal

Intervention (NIC) Outcome (NOC)

Teaching: Prescribed diet
 Determine patient's / caregiver's feeling / attitude toward prescribed
diet and expected degree of dietery compliance to determine
readiness to learn
 Assist patient to accomodate food preferences into prescribed diet to
improve compliance
 Refer patient to dietitian / nutritionist to provide continuing diet
education and evaluation
Teaching: Prescribed activity/exercise
 Inform thepatient of the purpose for, and the benefits of, the
prescribed activity/exercise to improve commitment to activity
 Instruct the patient how to monitor tolerance of the activity/exercise
to prevent injury
 Assist patient to incorporate activity / exercise regiment into daily
routine/ lifestyle because it is an integral part of diabetes control
Hyperglikemia management
 Monitor for sign and symptoms of hyperglicemia: Polyuria,
polydipsia, poliphagia, weakness, lethargy, malaise, blurring of
vision, headache to alert patient to glucose/insulin imbalance and
need for tratment
 Antipate situation in which insulin requirements will increase (e.g.
Intercurrent illness) to allow patient to adjust insulin dosage
appropriately and avoid undue vatique
 Facilitate adherence to diet and exercise regimen to promote diabetes
control
 Restrict exercice when blood glucose level is > 250 mg/dl and
ketosne is present in persons with type 1 diabetes, to decrease the
body requirement for unavailable glucose
Diabetes self-management
 Uses diary to monitor blood glucose level over time....
 Treats symptoms of hyperglimia...........
 Follows recomended diet.....................
 Participates in recommended exercise program......
 Uses effective weight control strategies ...............
 Monitor body weight...........................................
 Maintains optimum weight...................................
 Seeks health care if blood glucose levels fluctuate outside
recommended parameters............
 Performs treatment regimen as prescribed
Measurement scale
1= Never demonstrated
2= Rarely demonstrated
3= Sometimes demonstrated
4= Often demonstrated
5= Consistently demonstrated
Nursing diagnosis Risk for injury

Patient goal Teaching: Prescribed diet

Intervention (NIC) Outcome (NOC)

Teaching: Foot Care
 Provide information regarding the relationship between neurophaty,
injury and vascular disease and the risk for ulceration and lower
extremity amputation in persons with diabetes to promote
commitment to care
 Coution about potential sources of injury to the feet (e.g heat, cold,
cutting corns or calluses, chemicals, use of adhesive tape and going
barefoot or wearing thong or open -toe soes)
 Instruct individual to inspect inside of shoes daily for foreign object,
nail points, torn linings and rough areas to avoid injury by factors
that are not left
 Recommend specialist care for thick fungal or ingrown toenails,
corn, or calluses to ensure safe treatment of feet
Hypoglicemia management
 Monitor for sign and symptoms of hypoglicemia to alert patient to
glucose / insulin imbalance and need for treatment
 Determine patient's recognition of hypoglicemia signs and symptoms
to assess learning needs
 Instruct patient to have simple carbohydrate available at all times to
treat hypoglicemia
 Instruct patient to obtain and carry / wear appropiate emergency
identification to facilitate treatment by others
 5= Consistently demonstrated
Risk control:
 Acknowledge risk factors.......................................
 Modifies lifestyle to reduce risk...............................
 Avoids exposure to health threats.............................
 Monitors health status changes.................
Diabetes self management
 Follows preventive foot care practice.................
 Uses preventive measures to reduce risk of complications.........
 Report nonhealing braeks in skin to primary care provider..
Measurement scale
1= Never demonstrated
2= Rarely demonstrated
3= Sometimes demonstrated
4= Often demonstrated
Nursing diagnosis Risk for peripheral neurovascular dysfunction

Patient goal

Intervention (NIC) Outcome (NOC)

Circulatory care: Arterial insufficiency Tissue perfussion: Peripheral
 Perform a comprehensive appraisal of peripheral circulation (e.g.  Capilary refil, toes..................................
Check peripheral pulses, edema, capillary refill, color and  Pedal pulse strenght (right).....................
temperature) to establish baseline finding  Pedal pulse strenght (left)........................
 Inspect skin for arterial ulcers or tissue breakdown to provide  Extemity skin temperature.......................
treatment to prevent infection and additional necrosis
 Protect the extremity form injury (e.g sheepskin under feet and lower Measurement scale
legs, footboard/bed cradle at foot of bed; well-fitted shoes) to prevent 1= Severe deviation from normal range
conditions that favor skin breakdown 2= Substantial deviation from normal range
 Maintain adequate hydration to decrease bloody viscocity 3= Moderate deviation from normal range
 Encourage the patient to exercise as tolerated to increase peripheral 4= Mild deviation from normal range
circulation 5= No deviation from normal range
 Instruct the patient on factors that interfere with circulation (e.g.
Smoking, restrictive clothing, exposure to cold temperatures,  Localized peripheral pain.......
crossing of legs and feet)  Necrosis..................................
 Instruct the patient on proper foor care  Numbness...............................
 Skin integrity..........................
 Tingling...................................
 Pallor........................................
Measurement scale
1= Severe
2= Substantial
3= Moderate
4= Mild
5= None