Nursing Care Plan (NCP) for Diabetes Mellitus (DM)
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Outline
Overview of Nursing Care Plan for Diabetes Mellitus (DM)
- What is Diabetes Mellitus?
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- It’s a health condition that affects how your body turns food into energy.
- How Does the Body Normally Work?
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- Normally, when you eat, your body turns food, especially carbohydrates (like bread, pasta, and sugar), into a sugar called glucose.
- This glucose goes into your blood. Your body needs this sugar for energy.
- To use this sugar, your body needs a hormone called insulin, made by the pancreas. Insulin is like a key that opens your cells so they can use the sugar.
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- What Happens in Diabetes?
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- In diabetes, your body doesn’t make enough insulin or can’t use it well.
- So, the sugar stays in your blood and doesn’t get into your cells as well as it should. This is why people with diabetes have high blood sugar levels.
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- Types of Diabetes:
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- Type 1 Diabetes: The body doesn’t make insulin. People with Type 1 need to take insulin every day.
- Type 2 Diabetes: The body doesn’t make or use insulin well. It’s more common and can sometimes be managed with diet, exercise, and medication.
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- Why is Managing Diabetes Important?
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- Over time, high blood sugar can cause problems with your heart, eyes, kidneys, nerves, and other parts of your body.
- Managing diabetes by controlling blood sugar levels is crucial to prevent these complications.
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- Living with Diabetes:
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- People with diabetes need to monitor their blood sugar, eat healthily, exercise, and sometimes take medication or insulin.
- With proper management, people with diabetes can live a healthy life.
Pathophysiology of Diabetes Mellitus (DM):
Diabetes Mellitus is a chronic metabolic disorder characterized by dysregulation of blood glucose levels, resulting from inadequate insulin production or impaired cellular response to insulin.
Type 1 Diabetes is an autoimmune process that leads to the destruction of pancreatic beta cells, causing an absolute insulin deficiency.
Type 2 Diabetes involves insulin resistance, where cells fail to respond effectively to insulin, and a relative insulin deficiency due to reduced secretion. Insulin is a key hormone responsible for facilitating glucose uptake by cells, particularly in the liver, muscle, and adipose tissue.
In the absence of proper insulin action, elevated blood glucose levels occur, leading to hyperglycemia. Prolonged hyperglycemia contributes to microvascular and macrovascular complications, affecting organs such as the kidneys, eyes, nerves, and cardiovascular system. Understanding the complex interplay of insulin dysfunction, glucose dysregulation, and the resultant complications is crucial for formulating effective nursing interventions to manage and mitigate the impact of Diabetes Mellitus on overall health.
Etiology
The etiology of Diabetes Mellitus (DM) is multifactorial, involving both genetic and environmental factors.
In Type 1 Diabetes, a genetic predisposition combined with environmental triggers, like viral infections from enterovirus, prompt an autoimmune response. This response leads to the destruction of insulin-producing beta cells in the pancreas, resulting in a significant decrease or complete absence of insulin production.
Type 2 Diabetes, on the other hand, is strongly linked to genetic factors, family history, and ethnicity. Lifestyle factors such as sedentary behavior, unhealthy dietary patterns, and obesity contribute to insulin resistance and the subsequent inability of cells to effectively utilize insulin. Other risk factors for Type 2 Diabetes include aging, gestational diabetes during pregnancy, and certain medical conditions like polycystic ovary syndrome (PCOS). Understanding the diverse etiological factors aids in tailoring nursing interventions to manage and prevent the progression of Diabetes Mellitus.
Desired Outcome
- Main Goal for Diabetes Mellitus Care:
- To keep blood sugar levels just right and prevent health problems.
- Key Objectives:
- Blood Sugar Control: Keep blood sugar levels in a safe range set by the healthcare team.
- Prevent Complications: Avoid problems like kidney, eye, nerve issues, and heart disease.
- Healthy Lifestyle Focus:
- Exercise: Regular physical activity is important.
- Balanced Diet: Eat healthy to help the body use insulin better.
- Weight Management: Keeping a healthy weight helps with blood sugar control.
- Patient Education:
- Learn how to manage diabetes day-to-day.
- Understand medications and when to take them.
- Know the signs of low (hypo) or high (hyper) blood sugar.
- Regular Check-Ups:
- Keep track of blood sugar, cholesterol, and other important health numbers.
- Overall Aim:
- Help people with Diabetes Mellitus live well, manage their condition effectively, and reduce the risk of health problems related to diabetes.
Diabetes Mellitus Nursing Care Plan
Subjective Data:
- Hyperglycemia: BG >180 mg/dL
- Polydipsia
- Polyphagia
- Polyuria
- Blurred vision
- Dry mouth
- Increased tiredness
- Leg pain
- Nausea/Vomiting
Hypoglycemia: <70 mg/dL
- Confusion
- Weakness
- Numbness around the mouth
- Nervousness/Anxiety
- Hungry
- Headaches
- Nightmares
- Groggy
Objective Data:
Hyperglycemia:
- -Hot and Dry, Sugar High.
Hypoglycemia:
- -Cold and clammy give them some candy!
- Sweaty
- Tachycardia
- Irritability
- Slurring words
Nursing Assessment for Diabetes Mellitus (DM):
Regular and thorough assessment is crucial for tailoring the nursing care plan to the individual needs of the patient with Diabetes Mellitus. Ongoing monitoring and collaboration with the healthcare team contribute to the effective management and prevention of complications associated with diabetes.
- Medical History:
- Obtain a comprehensive medical history, including the type and duration of diabetes, previous treatments, and any history of diabetic complications. Explore family history to assess genetic predisposition.
- Symptom Assessment:
- Evaluate the presence and severity of diabetes-related symptoms such as polyuria, polydipsia, polyphagia, weight loss, fatigue, neuropathy, and vision changes.
- Blood Glucose Monitoring:
- Monitor blood glucose levels regularly. Consider monitoring while the patient is fasting, postprandial (after meals), and tracking HbA1c values. Assess trends and patterns to guide adjustments to the treatment plan.
- Medication Review:
- Review the patient’s current medications, including insulin or oral antidiabetic agents. Evaluate adherence, potential side effects, and any difficulties with medication administration.
- Lifestyle Factors:
- Assess the patient’s lifestyle, including dietary habits, physical activity, and stress levels. Identify factors that may contribute to blood glucose fluctuations.
- Nutritional Assessment:
- Collaborate with a dietitian to assess the patient’s dietary intake, preferences, and adherence to prescribed nutritional guidelines. Address any challenges in maintaining a balanced diet.
- Weight and BMI:
- Measure the patient’s weight and calculate body mass index (BMI). Discuss weight management goals and strategies to achieve or maintain a healthy weight.
- Blood Pressure and Lipid Profile:
- Monitor blood pressure regularly to assess cardiovascular risk. Evaluate lipid profiles to identify dyslipidemia, a common comorbidity in individuals with diabetes.
- Foot Assessment:
- Perform a foot assessment to identify any signs of neuropathy, vascular compromise, or foot ulcers. Emphasize the importance of foot and nail care and regular podiatric evaluations.
- Eye Examination:
- Schedule regular eye examinations to assess for diabetic retinopathy. Collaborate with ophthalmologists to address any vision-related concerns.
- Renal Function:
- Monitor renal function through regular assessments of serum creatinine, estimated glomerular filtration rate (eGFR), and urine microalbumin levels to detect early signs of diabetic nephropathy.
- Psychosocial Assessment:
- Evaluate the patient’s psychosocial well-being, addressing potential stressors, mental health concerns, and the impact of diabetes on the individual’s quality of life.
- Patient Education Needs:
- Identify gaps in the patient’s knowledge about diabetes self-management, including insulin administration, blood glucose monitoring, dietary choices, and the recognition of hypo- or hyperglycemic symptoms.
Nursing Interventions and Rationales
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Blood sugar monitoring: Normal range 70-100 mg/dL *The patient may have a different target blood sugar level, make sure to know what each patient’s target is. |
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Insulin administration
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Educate about nutritional changes and monitoring |
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| Monitor feet and educate about monitoring feet |
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Educate about maintaining a healthy weight and keeping active |
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Implementation for Diabetes Mellitus (DM):
Implementation involves translating the diabetes care plan into actionable steps tailored to each patient’s needs. Through continuous education, monitoring, and collaboration, the implementation plan aims to empower individuals with Diabetes Mellitus to actively manage their condition and enhance their overall well-being.
- Blood Sugar Monitoring:
- Implement regular blood glucose monitoring, considering individualized target levels for each patient. Utilize a glucometer to assess fasting, postprandial, and blood glucose levels before bed. HbA1c values should be drawn at regular intervals along with recommendations from the patient’s physician and require a blood draw. Educate patients on the importance of consistent monitoring and understanding their unique and personal target blood glucose range.
- Insulin Administration:
- Administer insulin as prescribed, recognizing the various types and actions:
- Rapid-Acting: Insulin lispro (Humalog), Insulin aspart (Novolog)
- Fast/Short-Acting: Regular (Humulin R and Novolin R)
- Intermediate Action: NPH (Humulin N and Novolin N)
- Long-Acting: Glargine (Lantus), Detemir (Levemir)
- Ensure patients comprehend proper injection techniques like rotating injection sites, skin prep, and timing.
- Administer insulin as prescribed, recognizing the various types and actions:
- Nutritional Education:
- Provide individualized nutritional education, emphasizing dietary changes tailored to the patient’s preferences, cultural background, and lifestyle. Discuss portion control, carbohydrate counting, and the impact of food choices on blood glucose levels.
- Foot Monitoring:
- Instruct patients on the importance of regular foot monitoring to identify early signs of neuropathy or circulatory issues, and checking for wounds or infection. Emphasize proper foot care practices, including daily inspections, wearing comfortable shoes, and seeking prompt medical attention for any foot or toenail abnormalities.
- Blood Pressure Management:
- Monitor blood pressure regularly, aiming for a target of 120/80 mmHg or as per individualized recommendations. Educate patients on lifestyle modifications, such as maintaining a heart-healthy diet, engaging in regular physical activity, and stress management to support blood pressure control.
- Weight Management and Physical Activity:
- Educate patients on the significance of maintaining a healthy weight through balanced nutrition and regular physical activity. Collaborate with dietitians and fitness professionals to tailor plans based on individual preferences and capabilities.
Evaluation for Diabetes Mellitus (DM):
- Why Evaluate Diabetes Care?
- To check if the treatment for Diabetes Mellitus (DM) is working and to keep improving it.
- Checking Blood Sugar Levels:
- Regularly review blood sugar tests to see how well the treatment is controlling it.
- Use this information to adjust insulin doses and meal plans.
- Insulin Use Review:
- Look at how insulin is given and if it’s being used correctly.
- Find ways to improve or change the technique if needed.
- Other Health Checks:
- Keep an eye on foot health to prevent sores or infections.
- Monitor blood pressure and weight, as they’re important in diabetes management.
- Learning from Education:
- See how well the patient applies what they’ve learned about diabetes care in their daily life.
- Make sure they know how to spot and handle low or high blood sugar.
- Working Together:
- Collaborate with doctors, nurses, and other healthcare workers.
- Keep talking to the patient to understand their needs and adjust the care plan.
- Goal:
- To make sure the care plan for Diabetes Mellitus is as effective as possible and meets the changing needs of the patient.
References
- http://www.diabetes.co.uk/diabetes-symptoms.html
- https://www.ucsfhealth.org/conditions/diabetes_mellitus/signs_and_symptoms.html
- http://www.mayoclinic.org/diseases-conditions/type-1-diabetes/basics/causes/con-20019573
- http://www.joslin.org/info/insulin_a_to_z_a_guide_on_different_types_of_insulin.html
- https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems
- http://www.diabetes.org/are-you-at-risk/lower-your-risk/bloodpressure.html?referrer=https://www.google.com/
- https://www.cdc.gov/healthyweight/assessing/
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Example Nursing Diagnosis For Nursing Care Plan (NCP) for Diabetes Mellitus (DM)
- Imbalanced Nutrition: More than Body Requirements: Diabetes may result in overeating or poor dietary choices. This diagnosis addresses nutritional excess.
- Risk for Unstable Blood Glucose: Patients with diabetes are at risk for unstable blood glucose levels. This diagnosis emphasizes blood glucose management.
- Deficient Knowledge: Some patients may lack knowledge about diabetes management. This diagnosis focuses on patient education and self-care.
Transcript
Let’s create a care plan for Diabetes Mellitus. Diabetes is when the blood glucose aka the sugar and the blood is unable to move into the cells. It helps make ATP or energy, and the body makes insulin to assist with this process. Insulin is just the hormone that allows the sugar in the blood to move across the cell so the body can use it to create energy. Or there are two types of diabetes: type one and type two. What we want to consider as nurses is we want to make sure that we check the blood glucose levels and treat as needed. And we want to assess for signs of hyper or hypoglycemia. And we want to educate the patient on insulin administration. It’s very important to teach them how to use the glucometer. The desired outcome is to have blood sugar control with minimum side effects.
When the patient comes in, they are going to feel a certain way, depending on whether their blood sugar is high or whether it’s low. Some of the things that they are going to tell us if they are hyperglycemic or they have high blood sugar, is they are going to complain of what we call the three P’s. So these are the three P’s and that is polydipsia, polyphagia,and polyuria. And pretty much what those mean is polydipsia is thirsty. They’re going to have excessive thirst. Polyphagia; they’re going to be hungry. They’re always eating. If you notice, and they’re going to have polyuria, they’re going to always be urinating. They’re going to sometimes dump out a liter to two liters per day. They’re going to have blurred vision, dry mouth, increased tiredness, leg pain, and nausea and vomiting. If a patient comes in with hypoglycemia or their blood sugar is less than 70 it’s a low BG.
They’re going to have some lethargy or weakness. They may be confused. They’re going to have some numbness around the mouth and be nervous. They’re going to be hungry. They’re going to have headaches, nightmares, and they may also be groggy. Some things that we want to observe as nurses, we just want to keep these little mnemonics, okay. Let’s do hyperglycemia. We always say, if they’re hot and dry, then the sugar is high. If they’re cold and clammy, then give them some candy. So they’re going to be sweaty. Okay. They’re going to have tachycardia. They’re going to be irritable. The words are going to slur when they are hypoglycemic. Okay? Here’s some things that we want to be considered and that education is very important. So we want to teach patients that they need to monitor their blood glucose levels by using a glucometer. They want to call their primary care physician. If they have blood glucose levels that are higher than their targets. So hyperglycemia is technically anything over a 180. We want to teach the patient how to use the glucometer and how to record the results for the next doctor’s appointment. We also want to educate about nutritional changes. A lot of things with diabetes can be managed diet wise. We can collaborate with the dietician. The patient does need to learn how to count carbs and which foods to avoid. Patient’s sugars should be checked. Once the patient wakes up before meals and before going to bed, we want to teach the patient about monitoring their feet because the patient has decreased blood flow due to the diabetes, neuropathy could occur and make the feet something that the patient really needs to watch. Wounds are very hard to heal. So if they are having a hard time with their feet or they can’t feel their feet, their wounds will be worse than with someone without diabetes.
We want to monitor their blood pressure. We want to make sure that they are administering antihypertensives and diuretics to keep their blood pressure within normal limits. We want to keep it around 120/80. Hypertension can lead to end organ damage and renal disease. We’re just going to touch on some of the different insulins that a patient could use if they are prescribed by their physician. So just keep in mind the different types and action times rapid-acting. This is usually something that we use just for quick coverage. We call it a sliding scale, a fast-acting. We also have intermediate acting and then long acting such as Lantus and Levemir. We also have a Humalog NovoLog. Those are the rapid acting NPH. Okay. These are some of the key points that you want to keep in mind when developing this care plan.
So the pathophysiology: diabetes is when the blood sugar in the blood is unable to move it to the cells. It helps make energy. Some of the things the patient’s going to tell us: polydipsia polyuria polyphagia, the three P’s. They would also complain of weakness. If their sugar is low, they’re going to be clammy. Some objective things that they’re going to show on the monitor. And they’re going to show an increased heart rate. You’re going to look at them. They’re going to be clammy sweaty. They’re also going to have weakness. Glucose management is very important. The patient needs to learn how to manage their blood glucose at home. They may be prescribed insulin coverage if needed. Also, they want to be put on warm precautions. They’re very prone to wounds, so they want to check their feet daily. They need to report any new neuropathy and they want to avoid tight-fitting shoes. We love you guys; go out and be your best selves today. And, as always, happy nursing.
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