You may also want to check these updated NCPs for Diabetes Mellitus: 1. 2. 3. 4. 5.

Risk for Infection Risk for Disturbed Sensory Perception Fatigue Imbalanced Nutrition Less Than Body Requirements Deficient Fluid Volume

Deficient Fluid Volume Glucose appears in the urine (glycosuria) because the kidney excretes the excess glucose to make the blood glucose level normal. Glucose excreted in the urine acts as osmotic diuretic and causes excretion of increased amount of water, resulting in fluid volume deficit or polyuria. Nursing Diagnosis: Deficient Fluid Volume r/t intracellular DHN 2 the DM II Assessment Planning Nursing Interventions Rationale Evaluation

Short Term:After 3 of NI, patient shall have verbalized understanding of causative factors and purpose of Subjective: (none)Objective: individual therapeutic elevated temperature of interventions 38.4C/axilla and increased urine output. medications. sweating of the skin thirst Long Term: exhaustion weight loss After 2 days dry skin or mucous of NI, the membrane patient shall have maintained fluid volume at a functional level as evidenced by individual good skin turgor, moist

1. Establish rapport 2. Take and record vital signs 3. Monitor the temperature 4. Assess skin turgor and mucous membranes for signs of dehydration 5. Encourage the patient to increase fluid intake 6. Administer IVF as ordered by the Doctor 7. Administer anti-pyretic as prescribed by the Doctor.

1. Friendly Short relationship Term:After with patient 3 of NI, and to be patient will able to each have verbalized others understanding concern 2. To obtain of causative factors and baseline purpose of data 3. To monitor individual changes in therapeutic temperature interventions and 4. Dry skin and mucous medications. membranes are signs of Long Term: dehydration 5. To replace After 2 days fluid loss of NI, the and prevent patient will dehydration have 6. To replace maintained electrolytes fluid volume and fluid at a loss functional 7. To decrease level as body evidenced by temperature individual and will good skin have less turgor, moist

mucous membrane and stable vital signs.

occurrence mucous of membrane dehydration and stable . vital signs

Imbalanced Nutrition: Less Than Body Requirements Due to decrease of lack of insulin in the body, the glucose level continuously rises because glucose cannot be utilized without the presence of insulin. Glucose is the source of energy, while insulin is the vehicle to transport glucose to the body tissues. Because of decrease insulin level in the blood stream, the cells starved, leading to alteration of metabolism. The body needs glucose for metabolism; there will be a breakdown of energy reserved from adipose tissue, muscles and liver (glucagons). This will result to weight loss. But the energy breaks down, the glucose level continuously increase because there is less amount of insulin. The body tissues need to be fed, this will lead to polyphagia and polydipsia because the tissue are not being fed and need glucose for metabolism. NDx: Imbalanced Nutrition: less than body requirement r/t insulin deficiency Assessment Planning Nursing Interventions Rationale

Evaluation

Short Term:After 3 of NI, patient shall have verbalized understanding Subjective:Objective: of causative factors when poor muscle known and tone necessary generalized interventions weakness and identified increased thirst diabetic increased client. urination polyphagia Long Term: loss of weight After 1-4 months of NI, the patient shall have demonstrated weight gain toward goal.

1. Establish rapport 2. Ascertain understanding of individual nutritional needs 3. Discuss eating habits and encourage diabetic diet as prescribed by the Doctor 4. Document actual weight, do not estimate.Note total daily intake including patterns and time of eating. 5. Consult dietician/physician for further assessment and recommendation regarding food preferences and nutritional support

1. Friendly relationship Short with patient Term:After and to be 3 of NI, able to each patient will have others verbalized concern understandi 2. To determine of causative factors when what information known and necessary to be provided to intervention client/SO- and identifie 3. To achieve diabetic client. health needs of the patient with Long Term the proper food diet After 1-4 for is/her months of N diseasethe patient 4. Patient may will have be un aware demonstrate of their weight gain actual toward goal weight or

weight loss due to estimating weight. 5. To reveal changes that should be made in clients dietary intake- For greater understandi ng 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 diabetes, people have decreased sensitivity to insulin and impaired beta cell functioning resulting in decreased insulin production. Glucose derived from food cannot be stored in the liver thereby remaining into the bloodstream. The beta cells of the islets of Langerhans release glucagon which stimulates the liver to release the stored glucose. After 8 12 hours, the liver forms glucose from the breakdown of noncarboghydrate substances, including amino acids resulting to muscle wasting which results to weakness. Nursing Diagnosis: Fatigue RT decreased muscular strength Nursing Rationale Interventions Subjective:(none)Objective: 1. Assess 1. Response to an response to activity can be Short activity evaluated to generalized weakness Term:After 2. Assess muscle achieve desired increased respiratory 2-3 of nursing strength of level of rate of 25cpm interventions, patient and tolerance. presence of nonthe patient functional 2. To determine healing wound on will be able level of the level of both feet to identify activity. activity body weakness measures to 3. Discuss with 3. Education may wt. loss conserve and patient the provide fatigue increase need for motivation to limited ROM activity increase activity inability to perform body energy. 4. Alternate level even ADL Assessment Planning Evaluation The patient shall have been able to identify measures to conserve and increase body energyThe patient shall have been free from signs

altered VS altered sensorium

Long Term: After 3-5 days of nursing interventions, the patient will be free from signs of fatigue

activity with periods of rest/ uninterrupted sleep. 5. Monitor pulse, respiration rate and blood pressure before/after activity 6. Perform activity slowly with frequent rest periods 7. Promote energy conservation techniques by discussing ways of conserving energy while bathing, transferring and so on. 8. Provide adequate ventilation 9. Provide comfort and safety 10. Instruct patient to perform deep breathing exercises 11. Instruct client to increase Vitamins A, C and D and protein in her diet. 12. Instruct also patient to increase iron in diet 13. Administer oxygen as ordered.

though patient of fatigue may feel too weak initially 4. Prevents excessive fatigue-Indicates physiological levels of tolerance 5. Tolerance develops by adjusting frequency, duration and intensity until desired activity level is achieved. 6. Interventions should be directed at delaying the onset of fatigue and optimizing muscle efficiency. 7. Symptoms of fatigue are alleviated with rest. Also, patient will be able to accomplish more with a decreased expenditure of energy. 8. For proper oxygenation 9. To be free from injury 10. Promotes relaxation 11. For muscle strength and tissue repair 12. To prevent weakness and paleness 13. To provide

proper ventilation

Risk for Infection

Risks for infection is a increased probability of invasion of pathogenic organisms for a pt. with DM wound is 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 making a wound to heal slowly because the damaged of the vascular system cannot carry sufficient oxygen, WBC, nutrients, and antibodies to the injured site. Thereby infections increase and enhance possibility of further complications.

Nursing Diagnosis: Risk for Infection Nursing Rationale Evaluation Interventions 1. Establish 1. to obtain rapport patients Short 2. Take and trust and Short Term:After record vital cooperation Term:The 4 hours of pt. shall signs 2. To obtain NPI the 3. Encourage baseline data have risks factors identified expression of 3. facilitates of feelings and grieving the risks occurrence factors of anxieties loss of infection 4. Observe non 4. non verbal occurrence will be verbal cues cues is more of infection reduce or 5. Encourage accurate than shall have control to a Subjective: client to look verbal cues- reduced or manageable (none)Objective: at/touch to begin to controlled level by a affected body incorporate to a clean bed 1. purulent discharge part changes into manageable and 2. hyperthermia 6. Encourage body image level by a maintain 3. altered circulation verbalization 5. to enhance clean bed skin intact 4. immunological of and role handling of and skin intact. deficit play potential Long anticipated problems Term: conflicts 6. to prevent Long 7. Encourage to dehydration Term: After 1-2 increase fluid 7. to boost weeks of intakeimmune The patient NPI, pt will increase Vit. system and shall be be free of C in the dietpromote free of purulent increase collagen purulent drainage or CHON intake formation- damage or erythema 8. Change for tissue erythema and be dressing repair and be febri afebrile 9. Provide a safe 8. to promote and quiet healing and Assessment Planning

environment 10. Take Due meds on time

prevent contaminatio n of the wound 9. To promote pts comfort 10. To met the bodys requirements