Nursing Care Plan for Diabetes

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There are plenty of factors that should be considered when creating a nursing care plan for diabetes. Diabetes is one of the top causes of morbidity nowadays and in fact, up to 29.1 million people are affected in the United States according to the National Diabetes Statistics Report 2014.

In healthcare settings, diabetes is a common co-morbidity factor among admitted patients and it is vital to be adeptly knowledgeable about this disease.

diabetes

What is diabetes?

Diabetes, or medically termed as diabetes mellitus, is a metabolic disease where blood glucose levels are abnormally high. Symptoms of high blood glucose levels include polyuria, polydipsia, weight loss, fatigue and blurred vision. In general, there are three types of diabetes and each one varies in terms of treatment and management.

What are the different types of diabetes?

Diabetes mellitus comes in three forms – type 1, type 2 and gestational diabetes.

Type 1 Diabetes

Type 1 diabetes is also called insulin-dependent and juvenile-onset diabetes. This type of diabetes often begins early at childhood. It’s an autoimmune disorder where the body’s immune system attacks its own pancreas thereby inhibiting its capacity to produce insulin.

Type 2 Diabetes

Type 2 diabetes accounts for the 95% of diabetes cases in the US. Onset is usually late in adulthood when the pancreas is unable to produce adequate insulin to meet body’s needs or when the body’s cells become resistant to it. Type 2 diabetes can be managed with lifestyle and diet changes as well as intake of oral hypoglycemic agents (OHAs).

Gestational diabetes

Gestational diabetes is characterized by pregnancy-induced insulin resistance. It affects roughly 2% – 10% of pregnancies.

gestational diabetes

Diabetes Nursing Care Plans

Diabetic patients need complex nursing care. If you are planning your patient’s care, here are some of the most important NCPs for diabetes:

1. Deficient knowledge regarding disease process, treatment and individual care needs

patient education

 

May be related to
– unfamiliarity with information
– misinterpretation
– lack of recall

Possibly evidenced by
– verbal statements of concerns or misconceptions
– expressions of request for information
– improper or inadequate follow-through of instructions
– development of preventable complications

Desired Outcome
– participate in learning process.
– exhibit signs of taking responsibility for own learning by asking questions
– verbalize understanding of condition and treatment
– correlate signs and symptoms with disease process and identify corresponding management to do
– perform demonstrated procedures correctly and explain reasons for actions

Nursing Interventions Rationale
Priority 1: Assess readiness to learn and individual learning needs
Determine client’s readiness as well as his barriers to learning. Client may not be physically, emotionally or mentally capable at this time which will call for the need to reschedule diabetic health teaching plans.
Look for signs of avoidance to learn. Reflects the need to stress the consequences that may happen in lieu of lack of knowledge.
Identify client’s support person that may also need information about the planned diabetes regimen. Client’s support persons like parents, spouse and caregivers also need to be provided with right information as they also take part in the client’s treatment.
Priority 2: Establish priorities in learning
Provide information relevant only to the situation. To prevent information overload.
Provide positive reinforcement. This can encourage continuation of efforts. Avoid use of negative reinforcement like criticisms and threats.
Determine client’s most urgent learning need both from the client’s and nurse’s point of view. Client’s and nurse’s identified most urgent need may differ and require adjustments in teaching plan.
Priority 3: Develop client’s objectives for learning
Create objectives clearly in client’s terms. To meet the client’s needs and not the instructor’s needs.
Identify desired outcomes to be achieved. To stress the importance of the health teaching being done for the client.
Priority 4: Identify teaching methods fit for the client
Determine client’s preferred method of accessing information like visual, auditory and kinesthetic means. To personalize teaching plan and facilitate learning or recall of information provided.
Assist in mutual goal setting and learning contracts. Clarifies the expectations of the learner and the teacher.
Priority 5: Facilitate learning
Use short and simple concepts. Summarize as needed. Facilitates better information retention.
Discuss one topic at a time. Avoid jumping into different topics. Simplifies learning plan.
Provide written information or guidelines and self-learning modules, especially about the proper diet essential for diabetic patients. The written guidelines will be helpful for the client if he needs clarification or relearning in the future.
Provide feedback or positive reinforcement and evaluate learning of skills. To determine client’s extent of learning.
Priority 6: Promote wellness
Provide information on how to contact a healthcare provider after hospitalization. For concerns and clarifications post-discharge.
Educate about nearby community resources or support groups. For healthcare management resources post-discharge.
Educate about additional learning resources like diabetes care websites, videos, etc. To assist with further learning and promote client’s learning at own pace.

2. Risk for unstable blood glucose

blood glucose monitoring device

May be related to
– lack of adherence to diabetes management
– inadequate blood glucose monitoring practices
– fluctuating physical activity level
– stress

As evidenced by
– blood glucose levels below or above normal levels

Desired Outcome
– identify factors that may lead to unstable blood glucose levels.
– verbalize understanding of balancing body and energy needs.
– verbalize plan in modifying identified risk factors to prevent shifts in glucose level.
– maintain blood glucose levels within normal range.

Nursing Interventions Rationale
Priority 1: Assess risks and contributing factors to unstable blood glucose levels 
Determine the client’s factors that may contribute to unstable blood glucose levels. Certain risk factors like family history of diabetes, history of poor glucose control, poor exercise habits, eating disorders and failure to recognize changes in glucose needs can result in blood glucose stability problems.
Determine influence of client’s cultural and religious factors affecting dietary practices, taking responsibility for own care and expectations of healthcare outcome. These factors may need to be addressed in creating client’s healthcare plan.
Determine client’s awareness or ability to be responsible for own healthcare plans. Age, developmental stage, maturity level and current health status affect client’s ability to adhere to treatment plans.
Priority 2: Assist client in creating preventive strategies for unstable blood glucose levels
Ensure client is knowledgeable about using his own blood glucose monitoring device. The blood glucose monitoring device is a handy and accurate way of assessing blood glucose levels. Proper usage of this device is essential in detecting unstable blood glucose levels.
Educate about balancing food intake with physical activities. Vital in preventing sudden increase or decrease in blood glucose levels.
Educate about adjusting home glucose monitoring frequency depending on client’s risk factors like stress and poor diet. To quickly identify fluctuating blood glucose levels for immediate correction.
Review and discuss client’s carbohydrate intake. Blood glucose levels greatly depend on carbohydrate intake. It should be monitored and controlled closely when stabilizing high blood glucose levels.
Discuss how the client’s anti-diabetic medications work. Essential in ensuring client’s understanding of his treatment regimen to ensure his compliance and adherence.
Priority 3: Ensure effective and safe treatment for clients on insulin therapy
Emphasize importance of inspecting client’s own insulin medication. It is important to regularly check for the insulin’s expiration date, cloudiness/clearness and storage to ensure drug efficacy.
Discuss the different types of insulin as well as each type’s administration method. Different types of insulin have different administration methods as well. Knowing and following proper administration method is important in ensuring drug’s efficiency.
Check injection sites. Insulin absorption is affected by the integrity of injection sites. Insulin is less absorbed in hypohypertropic or lumpy tissues.
Priority 4: Promote wellness
Review client’s risk factors and provide information on how to avoid complications. Ensures prevention of unstable blood glucose levels in the future.
Refer client to a dietitian to plan specific dietary needs based on complicated situations like pregnancy, growth spurt and change in activity level following an injury. To balance dietary intake with complicated body needs.
Provide information about community resources, support groups and diabetic educators. For client’s access to additional resources for diabetes management.

3. Risk for infection

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May be related to
– decreased leukocyte function
– circulatory changes due to high blood glucose levels

As evidenced by
– delayed wound healing

Desired Outcome
– verbalize understanding of identified risk factors.
– identify important interventions in reducing risks for infection.
– ensure timely wound healing free from purulent discharges and necrosis.

Nursing Interventions Rationale
Priority 1: Assess client’s risk factors 
Determine blood glucose stability. Unstable blood glucose levels contribute to delayed wound healing. Persistent high blood glucose levels may warrant modification in diabetic treatment like adjusting insulin doses or changing oral hypoglyemic agents as prescribed by the physician.
Assess for necrotic tissues around client’s wound. Necrotic tissues around a diabetic person’s wound signify poor blood flow. In severe cases, amputation may be needed.
Assess and document skin condition around the wound. To monitor for impending infection or progressing necrosis.
Priority 2: Reduce and correct client’s risk factors
Educate patient about the importance of adhering to prescribed diabetic treatment. Efforts in controlling blood glucose levels is essential in ensuring good blood flow around the wound. High blood glucose levels result in poor blood circulation which further leads to delayed wound healing.
Clean and change wound dressings as indicated. To prevent development of infections that may be associated with poor wound care and hygiene.
Administer and monitor medication regimen. Proper administration of prescribed diabetic medications is important in stabilizing blood glucose levels. Normal blood glucose levels ensure good circulation especially around the affected wound area. Antibiotic therapy is also important in preventing development of infection in site of wound.
Priority 3: Promote wellness
Review client’s current diet and nutritional needs. Proper diabetic diet balanced with nutritional needs is important in maintaining normal blood glucose levels. Stabilized blood glucose levels ensure good blood flow especially around wound site.
Educate client about proper wound care. Persons with delayed wound healing are at highest risk for developing infection. Proper wound care contributes in the prevention of wound infection.
Educate about the importance of following diabetic treatment consistently. Adherence to prescribed diabetic treatment ensures good blood flow and reduced risk for delayed wound healing.

These nursing care plans are just some of the most important ones for the management of diabetes. When creating a nursing care plan for diabetes, keep in mind that the focus should be directed to the prevention of diabetes-related problems and complications. Priority should also be given for the promotion of good behaviors and practices to ensure wellness despite existing diabetic condition.

Resources:

Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014.

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis.

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