NURSING CARE PLAN no.

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective Data: Risk for Within 4 hours of Independent: Independent: After 4 hours of
“Napapansin ko na unstable blood nursing -Establish rapport with the -To develop successful nurse- nursing intervention
ang lakas ko kumai glucose related intervention, the patient. patient relationship. the patient was able
n at lagi akong nau to lack of patient will: to:
uhaw kaya adherence to -Assist the patient in identifying -This information provides the
palagi rin akong naii diabetes -Maintain eating patterns that need to be basis for individualized dietary -Maintain glucose in
hi.Lumalabo din management glucose in modified. instruction related to the clinical satisfactory range of
ang paningin ko” as satisfactory condition that contributes to less than 140
verbalized by the Scientific range; and fluctuation in blood glucose mg/dL;
patient. Rationale: levels.
Studies have -Acknowledge -Acknowledge
Objective Data: reported key factors that -Explain the importance of -Weight loss is an important factors that may lead
-Increased thirst that strict may contribute weight loss to obese patients factor in the treatment of to unstable glucose
-Frequent urination metabolic to unstable with diabetes. diabetes. level such as
-Increased hunger control can glucose levels. overeating and
-Fatigue; Weakness delay or -Weight daily -To help assess the adequacy inconsistent
-Blurry Vision prevent the of nutritional intake. administration of
-Sudden weight progression of medication; and
loss: 82 kg complications -Educate the patient about the -A prescribed meal plan will
(November 10, associated with importance of following a help the patient maintain stable -Verbalize
2021) to 78 kg diabetes prescribed meal plan. blood glucose levels. understanding of the
(Shirivastava, disease process.
et al., 2013). -Educate the patient on -A consistent amount of food
However, maintaining consistency in and time interval between GOAL MET
people who do food and the approximate time meals helps prevent
not manage intervals between meals. hypoglycemic reactions and
their diabetes maintain overall blood glucose
are at risk of control.
dangerously
high blood -Educate the patient about the -Exercise plays a role in
glucose health benefits and importance lowering blood glucose and
(Villines, of exercise in the management reducing cardiovascular risk
2019). of diabetes. factors for patients with
 diabetes.

-Teach the patient when and -Blood glucose is monitored

how to use self-monitoring before meals and at bedtime to
blood glucose monitor the effectiveness of
exercise, diet, and oral anti-
diabetic agents.

-Instruct the patient -Eating a rapidly absorbed

experiencing hypoglycemia source of glucose is appropriate
about appropriate actions to for patients with diabetes.
raise blood glucose.

-Advise to watch out for signs -Excess glucose in the blood

of hyperglycemia. creates an osmotic effect that
increases thirst, hunger, and
increased urination.

-Educate patient and her -Systematic rotation of injection

companion to rotate insulin sites is recommended to
injection sites. prevent lipodystrophy.

-Provide written information -Reinforces learning and

about diabetes management conveys the maximum amount
for the patient to refer to. of information.

-Instruct patient to carry -The medical team needs to be

medical alert information. able to identify the patient as
having a clinical condition linked
with unstable blood glucose.

Dependent: Dependent:
-Administer insulin medication -Insulin is required to lower
as prescribed. blood glucose levels in diabetic
patients.
 -Administer hypertensive -Hypertension is commonly
medication as prescribed. associated with diabetes.

Collaborative: Collaborative:
-Refer to the physician if -To ensure that proper
patient’s condition worsened. treatments are met.

-Refer the patient to support -To help the patient incorporate

groups, diet and nutrition weight management and learn
education, and counseling. new dietary habits.

NURSING CARE PLAN no. 2

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective Imbalanced After 8 hours of Independent: Independent: After 8 hours of
“Bakit nutrition: less nursing -Weigh daily or as ordered. -Weighing serves as an nursing intervention,
kaya bumababa an than body intervention, the assessment tool to determine the patient was able
g timbang ko kahit requirements patient will be the adequacy of nutritional to:
palagi related to able to: intake.
naman akong kuma insulin -Ingest appropriate
kain at umiinom ng deficiency as -Ingest -Review the patient’s diet -To help identify the patient’s amounts of
tubig?” as evidenced by appropriate history. eating habits and lifestyle that calories/nutrients;
verbalized by the sudden weight amounts of could be incorporated into the
patient. loss calories/ meal plan. -Display usual
nutrients; energy level;
Objective Scientific -Discuss eating habits and -To achieve the health needs of
-Increased thirst Rationale: -Display usual encourage a diabetic diet the patient with the proper food -Demonstrate
-Frequent urination Diabetes is an energy level; and (balanced diet) as prescribed diet for his condition. stabilized weight or
-Increased hunger endocrine by the doctor. gain toward
-Fatigue; Weakness disorder; -Demonstrate usual/desired range
-Blurry Vision insulin stabilized weight -Identify food preferences, -If the patient’s food with normal
-Sudden weight deficiency or gain toward including ethnic and cultural preferences can be laboratory values.
loss: 82 kg happens either usual/desired needs. incorporated into the meal plan,
(November 10, because the range with cooperation with dietary GOAL MET.
2021) to 78 kg pancreas normal requirements may be facilitated
produces laboratory after discharge.
insufficient values.
insulin, or the -Provide a diet of -Complex carbohydrates
body tissues approximately 60% (apples, broccoli, peas, dried
become carbohydrates, 20% proteins, beans, carrots, peas, oats)
resistant to 20% fats in the designated decrease glucose levels/insulin
insulin. When number of meals and snacks. needs, reduce serum
that happens, cholesterol levels, and promote
there will be a satiation.
decrease in
uptake and -Explain the importance of -The recommendation is three
utilization of having consistent meal content meals of equal size, evenly
glucose by the or timing. spaced mealtimes (5-6 hours
tissues, apart), with one or two snacks.
resulting in Pacing food intake throughout
increased the day places more
protein/fat manageable demands on the
metabolism. pancreas.
This then
results in a -Include SO in meal planning -To promote a sense of
sudden weight as indicated. involvement and provide
loss. (Hameed information to the SO
& Verge, 2015) to understand the patient’s
nutritional needs.

-Instruct to have adequate rest -If a person is tired, the body

periods. will crave sugar and other quick
energy fixes. This can easily
lead to overeating, rising, and
falling blood sugar levels, and
mood swings.

-Educate the patient about the -Exercise plays a role in

health benefits and importance lowering blood glucose and
of exercise in the management reducing cardiovascular risk
of diabetes. factors for patients with

Dependent:
-Administer insulin (Lantus) as
prescribed.
Collaborative:
-Refer to a dietician for further
assessment and
recommendation regarding
food preferences and
nutritional support.
diabetes. Exercise lowers blood
glucose levels by increasing the
uptake of glucose and
improving the utilization of
insulin.
Dependent:
-Long-acting insulins have an
onset of one hour after
administration, and have no
peak action because insulin is
released into the bloodstream
at a relatively constant rate.
Collaborative:
-To reveal changes that should
be made in the patient’s dietary
intake. For greater
understanding and further
assessment of specific foods.