Diabetes mellitus is a metabolic disease characterized by dysregulation of carbohydrate, protein, and lipid metabolism. The primary feature of this disorder is elevation in blood glucose level (hyperglycemia), resulting from either a defect in insulin secretion from the pancreas, a cha in insulin action, or both. Sustained hyperglycemia has been shown to affect almost all tissu the body and is associated with significant complications of multiple organ systems, includin the eyes, nerves, kidneys, and blood vessels.
Deficient Fluid Volume
Glucose appears in the urine (glycosuria) because the kidney excretes the excess glucose to the blood glucose level normal. Glucose excreted in the urine acts as osmotic diuretic and ca excretion of increased amount of water, resulting in fluid volume deficit or polyuria. Assessment
Nursing Planning Nursing Rationale Evaluation Diagnosis Interventions Subjective: (none) Deficient Short Establish Friendly Short Fluid Term: After 3° rapport Take relationshipTerm: After 3° Objective: Volume r/tof NI, patient and record vital with patientof NI, patient intracellular shall have signs and to be able will have elevated verbalized to each verbalized temperatureDHN 2° the DM II understandingMonitor the other¶s understanding of of causative temperature concern To of causative 38.4°C/axilla factors and obtain factors and increased purpose of purpose of urine output. Assess skin baseline data individual individual sweating of turgor and therapeutic mucous the skin To monitor therapeutic interventions membranes for thirst changes in interventions and exhaustion temperatureand signs of medications. dehydration medications. weight loss dry skin or Dry skin and Long Term: Long Term: mucous mucous Encourage the membrane After 2 days of patient to membranesAfter 2 days NI, the patientincrease fluidare signs of of NI, the shall have intake dehydrationpatient will maintained fluid have volume at a Administer IVF To replace maintained functional level fluid volume as ordered byfluid loss and as evidenced by at a functional the Doctor prevent individual good dehydrationlevel as skin turgor, Administer evidenced by moist mucousanti-pyretic as To replace individual membrane and prescribed byelectrolytesgood skin stable vital turgor, moist the Doctor. and fluid loss signs. mucous To decreasemembrane and y
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body stable vital temperaturesigns and will have less occurrence of dehydration.
Imbalanced Nutrition: Less Than Body Requirements
Due to decrease of lack of insulin in the body, the glucose level continuously rises beca glucose can¶t be utilized without the presence of insulin. Glucose is the source of energy, w insulin is the vehicle to transport glucose to the body tissues. Because of decrease insulin le the blood stream, the cells starved, leading to alteration of metabolism. The body needs glu for metabolism; there will be a breakdown of energy reserved from adipose tissue, muscles liver (glucagons). This will result to weight loss. But the energy breaks down, the glucose l continuously increase because there is less amount of insulin. The body tissues need to be this will lead to polyphagia and polydipsia because the tissue are not being fed and need gl for metabolism. Assessment NursingPlanning Nursing Rationale Evaluation Diagnosis Interventions Subjective:Æ Imbalanced Short Term: After Establish rapport Friendly Short Term: Objective: Nutrition: 3° of NI, patientAscertain relationship After 3° of NI, less than shall have understanding of with patient patient will body verbalized individual and to be able have Pt. understanding of nutritional needs to each other¶s verbalized manifested:requirement r/t insulin causative factors concern To understanding deficiencywhen known and Discuss eating determine of causative - poor necessary what factors when habits and muscle tone interventions and information to known and encourage diabetic identified diabetic be provided to necessary diet as prescribed - generalized client. interventions by the Doctor client/SO weakness and identified Long Term: - To achieve diabetic client. Document actual - increased weight, do not health needs of thirst the patient Long Term: After 1-4 months estimate. with the proper of NI, the patient - increased shall have Note total daily food diet for After 1-4 urination demonstrated intake includingis/her disease months of NI, weight gain the patient will patterns and time -polyphagia toward goal. - Patient mayhave of eating. be un aware demonstrated of Pt. may their actual weight gain Consult
manifest: - loss of weight
dietician/physician weight or toward goal. for further weight loss assessment and due to recommend-dation estimating regarding food weight. preferences and nutri-tional - To reveal support changes that should be made in client¶s dietary intake - For greater understanding and further assessment of specific foods.
Fatigue
Diabetes Mellitus is a group of metabolic diseases characterized by increased levels of glucose in the blood resulting from defects in insulin secretion, insulin action, or both. In type 2 diab people have decreased sensitivity to insulin and impaired beta cell functioning resultin decreased insulin production. Glucose derived from food cannot be stored in the liver the remaining into the bloodstream. The beta cells of the islets of Langerhans release gluca which stimulates the liver to release the stored glucose. After 8 ± 12 hours, the liver glucose from the breakdown of noncarboghydrate substances, including amino acids resulti muscle wasting which results to weakness. Assessment
Nursing Planning Nursing Rationale Evaluation Diagnosis Interventions -Assess -Response toThe patient Subjective: (none) Fatigue Short related to response to an activity can shall have Term: After 2-3º Objective: decreased of nursing activity -Assesbe evaluatedbeen able to to achieve identify generalized muscularinterventions, muscle strength strength the patient will of patient anddesired levelmeasures to weakness be able to functional level of tolerance.conserve and increased identify of activity. To determine increase body respiratory rate measures to the level of energy The of 25cpm conserve and -Discuss withactivity patient shall presence of increase body patient the need have been non-healing energy. Long for activity -Education free from wound on both feet may providesigns of Term: fatigue body weakness motivation to -Alternate y
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wt. loss fatigue limited ROM inability to perform ADL altered VS altered sensorium
After 3-5 days activity of with increase nursing periods of rest/ activity level interventions, uninterruptedeven though the patient will sleep. patient may be free from feel too weak signs of fatigue -Monitor pulse, initially respiration rate and blood -Prevents pressure excessive before/after fatigue activity -Indicates -Perform physiological activity slowlylevels of with frequenttolerance rest periods -Tolerance -Promote develops by energy adjusting conservation frequency, techniques byduration and discussing ways intensity until of conservingdesired energy while activity level bathing, is achieved. transferring and so on. -Interventions should be -Provide directed at adequate delaying the ventilation onset of fatigue and optimizing -Provide comfort and muscle efficiency. safety Symptoms of fatigue are -Instruct patient alleviated to perform deep with rest. breathing Also, patient exercises will be able to accomplish -Instruct client to increase more with a Vitamins A, Cdecreased expenditure of and D and protein in her
diet.
energy.
-Instruct also -For proper patient to oxygenation increase iron in diet -To be free from injury -Administer oxygen as -Promotes ordered. relaxation -For muscle strength and tissue repair -To prevent weakness and paleness -To provide proper ventilation
Risk for Infection
Risks for infection is a increased probability of invasion of pathogenic organisms for a pt. with DM wou possible in the furure.Clients with diabetes are susceptible to infections because of polymorphonuclear leukocyte function, diabetic neuropathies, and vascular insufficiency as a result is a poor glycemic control; thus ma wound to heal slowly because the damaged of the vascular system cannot carry sufficient oxygen, WBC, nutr and antibodies to the injured site. Thereby infections increase and enhance possibility of further complications.
Assessment
Nursing Planning Nursing Rationale Evaluation Diagnosis Interventions Subjective:ÆRisk for Short Term: After -Establish - to obtain Short Term: Objective: infection4 hours of NPI the rapport -Take patient¶s trust The pt. shall related to risks factors of and record vital and have identified disease occurrence of signs cooperation -risks factors of Pt. manifested: condition. infection will be To obtain occurrence of reduce or control -Encourage baseline datainfection shall -purulent to a manageable have reduced expression of discharge level by a clean feelings and - facilitates or controlled to bed and maintain anxieties grieving the a manageable -hyperthermia skin intact. level by a clean loss bed and skin - Observe non ± Pt. may intact. Long Term: verbal cues - non ± verbal manifest: cues is more
-altered circulation immunological deficit
After 1-2 weeks-Encourage o accurate than Long Term: NPI, pt will be client to look verbal cues free of purulentat/touch affected -The patient drainage or body part - to begin to shall be free of erythema and be incorporate purulent afebrile -Encourage changes intodamage or verbalization of body image erythema and and role play be febrile anticipated - to enhance conflicts handling of potential -encourage to problems increase fluid intake -to prevent dehydration -increase Vit. C in the diet -to boost immune -increase CHON system and intake promote collagen formation -change dressing -provide a safe-for tissue repair and quiet environment -to promote -Take Due meds healing and prevent on time contamination of the wound -to promote pt¶s comfort - To met the body¶s requirements
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