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Subjective: “Di na ako nakakapagexercise.. Madali akong exercise mapagod e. Di ko na rin maasikaso yung bakery namin.”
Fatigue related to decreased metabolic energy production from lack of insulin or insulin resistance secondary to Diabetes Mellitus Type 2
After 1 hour of Nursing Intervention, the client will be able to express desire to participate in activities.
Discuss with patient the need for activity. Plan schedule with patient and identify activities that lead to fatigue.
- Education may provide motivation to increase activity level even though patient may feel too weak initially.
Alternate activity with periods of rest/uninterrupted rest/uninterrupte d sleep.
- Prevents excessive fatigue.
Objective: Inability to maintain usual routines
Monitor pulse, respiratory rate, and BP before/after activity. Discuss ways of conserving energy while bathing, transferring, and so on.
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- Indicates physiological levels of tolerance.
- Patient will be able to accomplish more with a decreased expenditure of energy.
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Subjective: “Ano ba yung mga signs ng diabetes? Bigla nalang ako nagkaroon nun ng di ko namamalayan eh”
Knowledge deficit regarding disease, self-care and treatment related to unfamiliarity with information
After 2 hours of Nursing Intervention, the client will: a.
Objective:
Verbalize understanding of the disease process and its potential complications
Create an environment of trust by listening to concerns, and by being available.
- Rapport and respect need to be established before patient will be willing to take part in the learning process.
Discuss essential elements What the normal blood glucose range is and how it compares with patient’s level, the type of DM the patient has.
Acute and chronic complications of the disease, including visual disturbances, neurosensory and cardiovascular changes, renal impairment/hypertension.
b.
Initiate necessary lifestyle changes and participate in treatment regimen
Demonstrate fingerstick testing, or similar monitoring system, and have patient/SO return demonstration until proficient.
Discuss dietary plan, limiting intake of sugar, fat, salt, and alcohol; eating complex carbohydrates, especially those high in fiber (fruits, vegetables, whole grains); and ways to deal with meals outside the home.
-Provides knowledge base from which patient can make informed lifestyle choices.
-Awareness helps patient be more consistent with care and may prevent/delay onset of complications. - Self-monitoring of blood glucose four or more times a day allows flexibility in selfcare, promotes tighter control of serum levels (e.g., 60–150 mg/dL), and may prevent/delay development of longterm complications.
- Medical nutrition therapy for diabetes encourages patient to make meal choices based on individual unique needs and preferences. Awareness of importance of dietary control aids patient in planning meals/sticking to
Discuss factors that play a part in diabetic control, e.g., exercise (aerobic versus isometric), stress, surgery, and illness.
Identify the symptoms of hypoglycemia (e.g., weakness, dizziness, lethargy, hunger, irritability, diaphoresis, pallor, tachycardia, tremors, headache, changes in mentation) and explain causes. Instruct in importance of routine examination of the feet and proper foot care. Demonstrate ways to examine feet; inspect shoes for fit; and care for toenails, calluses, and corns.
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regimen. Fiber can slow glucose absorption, decreasing fluctuations in serum levels, but may cause GI discomfort, increase flatus, and affect vitamin/mineral absorption. - Aerobic exercise (e.g., walking, swimming) promotes effective use of insulin, lowering glucose levels, and strengthens the cardiovascular system -May promote early detection and treatment, preventing/limiting occurrence.
- Prevents/delays complications associated with peripheral neuropathies and/or circulatory impairment, especially cellulitis, gangrene, and amputation. R
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Subjective: “Nung una akala ko butlig lang sa paa tapos biglang namula at lumala kaya yan, di na pala gumagaling”
Impaired Skin Integrity related to altered metabolic state secondary to Diabetes Mellitus type 2
After 1 hour of Nursing Intervention, the client will be able to a.
Objective:
Report any altered sensation or pain at site of skin impairment
Assess site of skin impairment and determine etiology
- Prior assessment of wound etiology is critical for proper identification of nursing interventions
Monitor site of skin impairment at least once a day for color changes, redness, swelling, warmth, pain, or other signs of infection. Determine whether the client is experiencing changes in sensation or pain.
- Systematic inspection can identify impending problems early
Avoid massaging around the site of skin impairment and over bony prominences. b.
Describe measures to protect and heal the skin and to care for any skin lesion
Monitor the client's skin care practices, noting type of soap or other cleansing agents used, temperature of water, and frequency of skin cleansing Teach skin and wound assessment and ways to monitor for signs and symptoms of infection, complications, and healing.
- Research suggests that massage may lead to deep-tissue trauma - Avoid harsh cleansing agents, hot water, extreme friction or force, or cleansing too frequently -Early assessment and intervention help prevent serious problems from developing.
