No Nursing Diagnose Outcome Intervention Evaluation

1 Imbalanced Nutrition • Assess current timing and Maintains ideal

Nutrition: More balance content of meals. body weight with
than Body between • Advise patient on the importancebody mass index
Requirements needs and of an individualized meal plan in less than 25
related to intake intake meeting weight-loss goals.
in excess of Reducing intake of
activity carbohydrates may benefit some
expenditures patients; however, fad diets or
diet plans that stress one food
group and eliminate another are
generally not recommended.
• Discuss the goals of dietary
therapy for the patient. Setting a
goal of a 10% (of patient’s
actual body weight) weight loss
over several months is usually
achievable and effective in
reducing blood sugar and other
metabolic parameters.
• Assist patient to identify
problems that may have an
impact on dietary adherence and
possible solutions to these
problems. Emphasize that
lifestyle changes should be
maintainable for life.
• Explain the importance of
exercise in maintaining/reducing
body weight.
o Caloric expenditure for
energy in exercise
o Carryover of enhanced
metabolic rate and
efficient food utilization
• Assist patient to establish goals
for weekly weight loss and
incentives to assist in achieving
them.

• Strategize with patient to address

2 Fear related to Fear less or
insulin injection discrease
the potential social pitfalls of
weight reduction.
• Assist patient to reduce fear of Demonstrates
injection by encouraging self-injection of
verbalization of fears regarding insulin with

3 Risk for Injury Injury is not
(hypoglycemia) appears
related to effects
of insulin,
inability to eat
insulin injection, conveying a minimal fear
sense of empathy, and
identifying supportive coping
techniques.
• Demonstrate and explain
thoroughly the procedure for
insulin self-injection
• Help patient to master technique
by taking a step-by-step
approach.
o Allow patient time to
handle insulin and
syringe to become
familiar with the
equipment.
o Teach self-injection first
to alleviate fear of pain
from injection.
o Instruct patient in filling
syringe when he or she
expresses confidence in
self-injection procedure.
• Review dosage and time of
injections in relation to meals,
activity, and bedtime based on
patient’s individualized insulin
regimen.
• Closely monitor blood glucose Hypoglycemia
levels to detect hypoglycemia. identified and
• Instruct patient in the importancetreated
of accuracy in insulin appropriately
preparation and meal timing to
avoid hypoglycemia.
• Assess patient for the signs and
symptoms of hypoglycemia.
o Adrenergic (early
symptoms) sweating,
tremor, pallor,
tachycardia, palpitations,
nervousness from the
release of adrenalin when
blood glucose falls
rapidly
o Neurologic (later
symptoms) light-
 headedness, headache,
confusion, irritability,
slurred speech, lack of
coordination, staggering
gait from depression of
central nervous system as
glucose level
progressively falls
• Treat hypoglycemia promptly
with 15 to 20 g of fast-acting
carbohydrates.

• Encourage patient to carry a

portable treatment for
hypoglycemia at all times.
• Assess patient for cognitive or
physical impairments that may
interfere with ability to
accurately administer insulin.
• Between-meal snacks as well as
extra food taken before exercise
should be encouraged to prevent
hypoglycemia.
• Encourage patients to wear an
identification bracelet or card
that may assist in prompt
treatment in a hypoglycemic
emergency.

• Encourage patient to carry a

portable treatment for
hypoglycemia at all times.
• Assess patient for cognitive or
physical impairments that may
interfere with ability to
accurately administer insulin.
• Between-meal snacks as well as
extra food taken before exercise
should be encouraged to prevent
hypoglycemia.

• Encourage patients to wear an

identification bracelet or card
that may assist in prompt
treatment in a hypoglycemic
emergency.
4 Activity Normal • Advise patient to assess blood Exercises daily
Intolerance Activity is glucose level before and after
related to poor appears strenuous exercise.
glucose control • Instruct patient to plan exercises
on a regular basis each day.
• Encourage patient to eat a
carbohydrate snack before
exercising to avoid
hypoglycemia.
• Advise patient that prolonged
strenuous exercise may require
increased food at bedtime to
avoid nocturnal hypoglycemia.
• Instruct patient to avoid exercise
whenever blood glucose levels
exceed 250 mg/day and urine
ketones are present. Patient
should contact health care
provider if levels remain
elevated.

• Counsel patient to inject insulin

into the abdominal site on days
when arms or legs are exercised.
5 Deficient Knowledge is • Assess level of knowledge of Verbalizes
Knowledge sufficient disease and ability to care for appropriate use
related to use of self and action of oral
oral • Assess adherence to diet hypoglycemic
hypoglycemic therapy, monitoring procedures, agents
agents medication treatment, and
exercise regimen
• Assess for signs of
hyperglycemia: polyuria,
polydipsia, polyphagia, weight
loss, fatigue, blurred vision
• Assess for signs of
hypoglycemia: sweating, tremor,
nervousness, tachycardia, light-
headedness, confusion
• Perform thorough skin and
extremity assessment for
peripheral neuropathy or
peripheral vascular disease and
any injury to the feet or lower
extremities
• Assess for trends in blood
 glucose and other laboratory
results
• Make sure that appropriate
insulin dosage is given at the
right time and in relation to
meals and exercise
• Make sure patient has adequate
knowledge of diet, exercise, and
medication treatment
• Immediately report to health
care provider any signs of skin
or soft tissue infection (redness,
swelling, warmth, tenderness,
drainage)
• Get help immediately for signs
of hypoglycemia that do not
respond to usual glucose
replacement

• Get help immediately for patient

presenting with signs of either
ketoacidosis (nausea and
vomiting, Kussmaul respirations,
fruity breath odor, hypotension,
and altered level of
consciousness) or hyperosmolar
hyperglycemic nonketotic
syndrome (nausea and vomiting,
hypothermia, muscle weakness,
seizures, stupor, coma).
6 Risk for Impaired Impaired Skin • Assess feet and legs for skin No skin
Skin Integrity Integrity is temperature, sensation, soft breakdown
related to not appears tissue injuries, corns, calluses,
decreased dryness, hammer toe or bunion
sensation and deformation, hair distribution,
circulation to pulses, deep tendon reflexes.
lower extremities
• Maintain skin integrity by
protecting feet from breakdown.
o Use heel protectors,
special mattresses, foot
cradles for patients on
bed rest.
o Avoid applying drying
agents to skin (eg,
alcohol).
 o Apply skin moisturizers
to maintain suppleness
and prevent cracking and
fissures.
• Instruct patient in foot care
guidelines

• Advise the patient who smokes

to stop smoking or reduce if
possible, to reduce
vasoconstriction and enhance
peripheral blood flow. Help
patient to establish behavior
modification techniques to
eliminate smoking in the
hospital and to continue them at
home for smoking-cessation
program.
7 Ineffective Effective • Discuss with the patient the Verbalizes initial
Coping related to coping perceived effect of diabetes on strategies for
chronic disease lifestyle, finances, family life, coping with
and complex self- occupation. diabetes
care regimen • Explore previous coping
strategies and skills that have
had positive effects.

• Encourage patient and family

participation in diabetes self-
care regimen to foster
confidence.
• Identify available support groups
to assist in lifestyle adaptation.

• Assist family in providing

emotional support.

Related posts:

1. Nursing diagnosis Diabetes mellitus

2. Diabetes Mellitus, Patient Teaching Discharge and Home Healthcare Guide
3. Nursing Care Plans for Myocardial Infarction (MI)

8 Comments
 1. Karen Kern says:

April 6, 2010 at 9:42 pm

there is a rising incidence of Diabetes these days and you can blame high sugar diet and a
lifestyle that is low on physical activities.

Reply

o lifenurses says:

April 9, 2010 at 8:56 am

It would be the Risk Factors For Diabetes Mellitus, since The cause of both type 1
and type 2 diabetes remains unknown, although genetic factors may play a role.
Diabetes mellitus results from insulin deficiency or resistance. Insulin transports
glucose into the cell for use as energy and storage as glycogen. It also stimulates
protein synthesis and free fatty acid storage. Insulin deficiency or resistance
compromises the body tissues’ access to essential nutrients for fuel and storage.
The resulting hyperglycemia can damage many of the body’s organs and tissues

Reply

2. Zeruin says:

August 18, 2010 at 1:58 pm

What are the rationale of your interventions?

Reply

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