Diabetes Nursing Diagnosis and Nursing Care Plan

Diabetes Nursing Care Plans Diagnosis and Interventions

Diabetes NCLEX Review and Nursing Care Plans

Diabetes mellitus, simply known as diabetes, is a group of metabolic disorders that involve the abnormal production of insulin or response to it, affecting the absorption of glucose in the body.

Glucose (blood sugar) is the main source of energy for brain cells, body tissues, and muscles. There are different types of diabetes, but all of them lead to the buildup of excess glucose in the bloodstream.

This condition can cause serious complications if left uncontrolled. Diabetes cannot be cured, but is manageable through treatment and lifestyle changes.

Types of Diabetes

1. Prediabetes. This occurs when the blood glucose level is higher than normal, but not as high enough to diagnose as diabetes. People with prediabetes may eventually have type 2 diabetes if the condition is left untreated.
2. Type 1 Diabetes. Also known as insulin-dependent diabetes, type 1 diabetes is an autoimmune disorder that results from the antibodies’ attack to the pancreas. When the pancreas is damaged, it cannot make insulin. Type 1 diabetes was used to be called juvenile diabetes, as most cases begin during childhood.
3. Type 2 Diabetes. Also called non-insulin dependent diabetes, type 2 diabetes happens when the pancreas is able to create some insulin, but not enough to lower the amount of glucose in the blood. Insulin resistance is also evident in this type of diabetes. Most cases of diabetes mellitus are type 2, and most people who have type 2 diabetes are overweight or obese.
4. Gestational Diabetes. Pregnant women might experience insulin resistance, usually during the second or third trimester. Once the baby is delivered, gestational diabetes usually goes away. The baby is at a higher risk than the mother, as the glucose can travel via the placenta. This can make the baby overweight or have trouble breathing. Cesarean section might be necessary to deliver the baby.

Despite having a similar name, diabetes insipidus is not a type of diabetes mellitus. Both of them have polyuria (increased amount of urine) and polydipsia (excessive thirst).

However, diabetes insipidus involves the inability to retain hormone due to the dysfunction of the antidiuretic hormone vasopressin.

Signs and Symptoms

• Polydipsia – Increased / excessive thirst
• Polyuria – Frequent urination and increased amount of urine
• Polyphagia – Extreme hunger
• Fatigue
• Irritability
• Blurred vision
• Slow-healing wounds or sores
• Presence of ketones in the urine
• Unexplained weight loss – especially in type 1 diabetes
• Tingling and/or numbness of extremities

Causes

The pancreas is a gland located below the stomach and is responsible for producing and secreting the hormone insulin into the bloodstream. Insulin facilitates the entry of blood glucose into the cells of the body, which results to the lowering of its amount in the bloodstream.

Normally, when the blood glucose level goes down, the insulin production is also slowed down in the pancreas.

In Type 1 diabetes, the immune system produces antibodies that destroy the insulin-producing cells of the pancreas, leaving the organ to produce little or no insulin to help transport the glucose into the cells that need it. On the other hand, the cells of people with prediabetes and type 2 diabetes develop insulin resistance.

The pancreas is not able to create enough insulin to surpass this insulin resistance, resulting to the buildup of glucose in the blood. In gestational diabetes, the placenta secretes hormones that are vital for pregnancy but may form insulin resistance in the mother’s cells.

Complications

Untreated or poorly controlled diabetes may lead to the development of serious complications that may disabling or fatal to the patient. These include:

1. Heart diseases and stroke. The high glucose levels in the blood may damage the blood vessel walls, including the arteries of the heart. This increases the risk for angina, coronary artery disease, diabetic cardiomyopathy, myocardial infarction (heart attack), and stroke (brain attack).
2. Diabetic coma. This is a reversible form of coma resulting from either a severely high blood sugar level ( diabetic ketoacidosis in type 1 diabetes; hyperosmolar nonketotic coma in type 2 diabetes) or low blood sugar levels (hypoglycemia in type 1 diabetes with insulin replacement doses).
3. Neuropathy. Capillaries can be damaged by excess glucose in the blood. This deprives the nerves the nourishment they need. It eventually causes nerve damage or neuropathy, as evidenced by tingling and/or numbness of fingers and toes, spreading upward to the whole extremities.
4. Nephropathy. Kidneys can also be damaged due to poorly controlled diabetes.
5. Retinopathy. Excess glucose may damage the blood vessels located in the eye.
6. Foot infections. Poor blood flow and/or nerve damage in the feet increase the risk for blisters and cuts. If the wounds are infected, the diabetic patient may eventually require amputation due to poor wound healing.

Other complications may include skin problems, hearing impairment, depression, and Alzheimer’s disease.

Gestational diabetes may cause the baby to grow overly large, a condition known as macrosomia. The mother is also at high risk for pre-eclampsia, a fatal condition during pregnancy.

Diagnosis

1. Diabetes Screening – blood sugar screening
2. Age 45 and above
3. Body mass index of greater than 23 (regardless of age)
4. Women who has experienced gestational diabetes – screening every 3 years
5. Prediabetes patients – screening every year
6. Blood tests
7. Glycated hemoglobin (A1C) test – to check the average blood glucose level in the last 2-3 months; non-fasting

– A1C below 5.7 – normal

– A1C between 5.7 and 6.4 – prediabetes

-A1C greater than 6.5 – diabetes

• Random blood sugar test – blood sugar level of 200 mg/dL or 11.1 mmol/L suggests diabetes
• Fasting blood sugar test – fasting overnight; blood sugar level of greater than 7mmol/L in 2 different test days suggests diabetes
• Oral glucose test – fasting overnight; patient is asked to drink a sugary liquid, then the nurse tests the blood sugar level for the next 2 hours; a level of more than 200 mg/dL or 11.1 mmol/L suggests diabetes

Treatment

1. Dietary changes. Low fat, low calories, and high fiber foods are ideal for diabetic patients. The patient is usually referred to a dietitian to ensure that a meal plan that suits the patient’s health goals and preferences is created.
2. Increase in physical activity. Exercise decreases the blood glucose level as the demand for glucose (energy) in the cells increases with physical activity. It is recommended to have at least 30 minutes of aerobic exercise.
3. Oral medications. Metformin is prescribed for Type 2 diabetes patients to increase the body’s sensitivity to the effect of insulin.
4. Insulin therapy. Type 1 diabetes patients require insulin injections to lower the blood sugar levels.
5. Blood glucose monitoring. To ensure that the patient does not experience hyperglycemia (high blood glucose level) or hypoglycemia (low blood glucose level), patients are educated to check their blood sugar about 3 to 4 times a day, or more depending on their treatment plan.
6. Transplant of Pancreas. Type 1 diabetes patients may be eligible for a pancreas transplantation.

Nursing Diagnosis for Diabetes

Nursing Care Plan for Diabetes 1

Nursing Diagnosis: Risk for Unstable Blood Glucose

Desired Outcome: The patient will maintain a blood glucose level of less than 180 mg/dL and an A1C level below 5.7

Nursing Care Plan for Diabetes 2

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to insulin deficiency, as evidenced by unexplained weight loss, increased urinary output, dilute urine, high blood glucose levels, fatigue, and weakness

Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

Nursing Care Plan for Diabetes 3

Nursing Diagnosis: Deficient Knowledge related to new diagnosis of Type 2 diabetes as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of Type 2 diabetes and its management.

Nursing Care Plan for Diabetes 4

Nursing Diagnosis: Fatigue related to decreased metabolic energy production as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized weakness, blood sugar level of 210 mg/dL, and shortness of breath upon exertion

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

Nursing Care Plan for Diabetes 5

Nursing Diagnosis: Risk for Fluid Volume Deficit due to osmotic diuresis

Desired Outcome: The patient will demonstrate adequate hydration and balanced fluid volume

Nursing Care Plan for Diabetes 6

Nursing Diagnosis: Risk for Disturbed Sensory Perception

Desired Outcome: The patient will recognize any changes in sensory perception and effectively cope with them.

Nursing Care Plan for Diabetes 7

Nursing Diagnosis: Risk for Infection

Desired Outcome: The patient will be able to avoid the development of an infection.

Nursing Care Plan for Diabetes 8

Powerlessness

Nursing Diagnosis: Powerlessness related to a long-term and progressive illness and probable dependence on significant others secondary to diabetes mellitus as evidenced by expressions of having little control over circumstances, reluctance to convey actual feelings, apathy, disengagement, not participating in treatment and decision-making, and depression about bodily deterioration or complications.

• The patient will be able to recognize feelings of powerlessness.
• The patient will be able to find healthy strategies to deal with emotions.
• The patient will be able to assist in the planning of own care, and assume ownership for self-care tasks.

Nursing Care Plan for Diabetes 9

Risk for Impaired Skin Integrity

Nursing Diagnosis: Risk for Impaired Skin Integrity related to neuropathy and decreased sensation and circulation caused by peripheral neuropathy and arterial obstruction secondary to diabetes mellitus.

Desired Outcome: The patient will demonstrate ways to properly care for the feet and the patient will maintain an intact skin on the legs and feet while still admitted to the hospital.

Nursing Care Plan for Diabetes 10

Risk for Ineffective Therapeutic Regimen Management

Nursing Diagnosis: Risk for Ineffective Therapeutic Regimen Management related to new-onset illness, treatment management that is not well understood, and a difficult medical management secondary to diabetes mellitus.

Desired Outcome: The patient will demonstrate awareness of diabetic self-care techniques,

will express verbally the comprehension of the diabetes disease process and its possible complications, and the patient will be able to perform all necessary procedures accurately and give discuss reasons for the actions.

Nursing Care Plan for Diabetes 11

Ineffective Coping

Nursing Diagnosis: Ineffective Coping related to poor ability in understanding the disease process, inadequate social support, inadequate perception of control and insufficient resources secondary to diabetes mellitus as evidenced by negative self-image, grief, a lack of problem-solving abilities, and fatigue.

• The patient will be able to declare the ability to cope and when necessary, seeks assistance.
• The patient will show problem-solving abilities and engage in society at a normal level.
• The patient will be free of self-destructive actions and the patient will be able to address needs, communicate them and negotiate with others.

Nursing Care Plan for Diabetes 12

Risk for Risk-Prone Behavior

Nursing Diagnosis: Risk for Risk-Prone Behavior related to negative self, poor comprehension several stress factors, lack of social support and negative perceptions about healthcare secondary to diabetes mellitus.

• The patient will be able to demonstrate an increase in self-care interest and participation.
• The patient will develop the ability to take responsibility for his/her own needs.
• The patient will be able to identify stressors that cause difficulty adapting to changes in health status and take particular steps to address them.
• The patient will be able to begin making lifestyle modifications that will allow adaptation to current circumstances.

With proper use of the nursing process, a patient can benefit from various nursing interventions to assess, monitor, and manage diabetes and promote client safety and wellbeing.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.