Nursing Care Plan (NCP) for Diabetes Mellitus (DM)

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Outline

Pathophysiology

Diabetes Mellitus is when blood glucose (sugar in the blood) is unable to move into the cells and helps in the making of ATP…AKA energy. The body makes insulin to assist with this process. Insulin is a hormone that allows the sugar in the blood to move across the cell wall so the body can use it to produce ATP. There are two types of diabetes. Type I and Type II.

Type I is an autoimmune disorder where the cells attack the insulin-producing cells in the pancreas. Thus, the body is producing very little or no insulin leaving the sugar in the blood and the cells starve.

Type II is when the cells don’t respond to the insulin trying to get sugar into them, called insulin resistance. Thus, the sugar stays in the blood and the cells starve.

Etiology

The cause for Type I diabetes is unknown but hypothesized to be potentially genetic or triggered by a virus. The cause for Type II diabetes is caused by a storm of events culminating such as weight gain, lack of activity, genetics, and stress levels.

Desired Outcome

Blood sugar control with minimal side effects.

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 Interventions and Rationales

Blood sugar monitoring: Normal range 70-180 mg/dL *patient may have a different target blood sugar level, make sure to know what each patient’s target is.

  • The physician will make a target blood glucose level. Teach the patient that they need to monitor their blood glucose. They need to call their primary care physician if they have blood glucose levels higher than their target for multiple days or if they have 2 readings of greater than 300 mg/dL.
  • Teach the patient how to use their glucometer and record their results.

Insulin administration -Rapid Acting: Humalog Novolog -Fast/short Acting: Regular -Intermediate Action: NPH -Long-Acting:’ Lantus Levemir

  • It is important to know which insulin to give and how they work. Each institution has guidelines and each insulin has guidelines. Following the guidelines, make sure you know the onset, peak, and duration of each type of insulin.
    • Rapid Acting
      Onset: 10-30 minutes
      Peak: 30 minutes- 3 hours
      Duration: 3-5 hours
    • Fast/short Acting
      Onset: 30 minutes-1 hour
      Peak: 2-5 hours
      Duration: Up to 12 hours
    • Intermediate Action
      Onset:1.5-4 hours
      Peak: 4-12 hours
      Duration: Up to 24 hours
    • Long-Acting
      Onset:1-4 hours
      Peak: minimal peak
      Duration: Up to 24 hours
  • To administer insulin, teach the patient to rotate injection sites and to clean the site with alcohol prior to inserting the needle.

Educate about nutritional changes and monitoring

  • This would be a good time to get the dietician involved. The patient needs to learn at a minimum, how to count carbs and which foods to avoid such as beer.
  • A patient’s glucose should be checked once when the patient wakes up, before meals, and before going to bed.
  • If the patient is hypoglycemic, and they are able to eat or drink, give them some OJ and graham crackers with peanut butter.
  • Increase water intake if the patient has hyperglycemia
Monitor feet and educate about monitoring feet
  • Both decreased blood flow to the feet, as well as neuropathy, occur to make the feet something the patient really needs to watch. Wounds are hard to heal so if they are having a hard time feeling their feet and they become injured, the wounds will be worse than with someone without diabetes.
  • Teach the patient to check their feet every day. Washing their feet, cutting their toenails straight across, and scrubbing off calluses gently are a couple of points to make with the patient.
  • The patient may have a podiatrist involved in their care as well.
  • As a nurse, you will need to be checking the patient’s feet as well and monitor any wounds.

Monitor Blood Pressure (BP) Normal Blood Pressure: 120/80 mmHg

  • It is vital to keep someone with diabetes within normal limits for their blood pressure.
  • Placing strain on the cardiovascular system wreaks havoc on other organ systems. Being diabetic makes the chances of that system having issues worse. A patient can lose their vision, kidney function, have a stroke, or heart attack.

Educate about maintaining a healthy weight and keeping active

  • With a healthy weight, the patient is likely also implementing a healthy diet as well as implementing more movement. These three things (weight, diet, exercise) can help to manage or even reverse diabetes.
  • Healthy weights are calculated based on the height and sex of the patient. Other ways to monitor the size of the patient is to use a BMI calculator or measure waist circumference.

Writing a Nursing Care Plan (NCP) for Diabetes Mellitus (DM)

A Nursing Care Plan (NCP) for Diabetes Mellitus (DM) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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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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