INTRODUCTION:

Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop responding to
the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body. Symptoms
include frequent urination, lethargy, excessive thirst, and hunger. The treatment includes changes in diet, oral
medications, and in some cases, daily injections of insulin.
The most common form of diabetes is Type II, It is sometimes called age-onset or adult-onset diabetes, and this form
of diabetes occurs most often in people who are overweight and who do not exercise. Type II is considered a milder
form of diabetes because of its slow onset (sometimes developing over the course of several years) and because it
usually can be controlled with diet and oral medication. The consequences of uncontrolled and untreated Type II
diabetes, however, are the just as serious as those for Type I. This form is also called noninsulin-dependent diabetes,
a term that is somewhat misleading. Many people with Type II diabetes can control the condition with diet and oral
medications, however, insulin injections are sometimes necessary if treatment with diet and oral medication is not
working.
The causes of diabetes mellitus are unclear, however, there seem to be both hereditary (genetic factors passed on in
families) and environmental factors involved. Research has shown that some people who develop diabetes have
common genetic markers. In Type I diabetes, the immune system, the bodys defense system against infection, is
believed to be triggered by a virus or another microorganism that destroys cells in the pancreas that produce insulin.
In Type II diabetes, age, obesity, and family history of diabetes play a role.
In Type II diabetes, the pancreas may produce enough insulin, however, cells have become resistant to the insulin
produced and it may not work as effectively. Symptoms of Type II diabetes can begin so gradually that a person may
not know that he or she has it. Early signs are lethargy, extreme thirst, and frequent urination. Other symptoms may
include sudden weight loss, slow wound healing, urinary tract infections, gum disease, or blurred vision. It is not
unusual for Type II diabetes to be detected while a patient is seeing a doctor about another health concern that is
actually being caused by the yet undiagnosed diabetes.
Individuals who are at high risk of developing Type II diabetes mellitus include people who:
are obese (more than 20% above their ideal body weight)
have a relative with diabetes mellitus
belong to a high-risk ethnic population (African-American, Native American, Hispanic, or Native Hawaiian)
have been diagnosed with gestational diabetes or have delivered a baby weighing more than 9 lbs (4 kg)
have high blood pressure (140/90 mmHg or above)
have a high density lipoprotein cholesterol level less than or equal to 35 mg/dL and/or a triglyceride level greater
than or equal to 250 mg/dL
have had impaired glucose tolerance or impaired fasting glucose on previous testing
Diabetes mellitus is a common chronic disease requiring lifelong behavioral and lifestyle changes. It is best managed
with a team approach to empower the client to successfully manage the disease. As part of the team the, the nurse
plans, organizes, and coordinates care among the various health disciplines involved; provides care and education
and promotes the clients health and well being. Diabetes is a major public health worldwide. Its complications cause
many devastating health problems.
ANATOMY AND PHYSIOLOGY:
Every cell in the human body needs energy in order to function. The bodys primary energy source is glucose, a
simple sugar resulting from the digestion of foods containing carbohydrates (sugars and starches). Glucose from the
digested food circulates in the blood as a ready energy source for any cells that need it. Insulin is a hormone or
chemical produced by cells in the pancreas, an organ located behind the stomach. Insulin bonds to a receptor site on
the outside of cell and acts like a key to open a doorway into the cell through which glucose can enter. Some of the
glucose can be converted to concentrated energy sources like glycogen or fatty acids and saved for later use. When
there is not enough insulin produced or when the doorway no longer recognizes the insulin key, glucose stays in the
blood rather entering the cells.

PATHOPHYSIOLOGY:

Image Source: www.caninsulin.com/Pathophysiology-algorithm.htm
DIAGNOSTIC TEST:
Several blood tests are used to measure blood glucose levels, the primary test for diagnosing diabetes. Additional
tests can determine the type of diabetes and its severity.
Random blood glucose test for a random blood glucose test, blood can be drawn at any time throughout the
day, regardless of when the person last ate. A random blood glucose level of 200 mg/dL (11.1 mmol/L) or higher
in persons who have symptoms of high blood glucose (see Symptoms above) suggests a diagnosis of diabetes.
Fasting blood glucose test fasting blood glucose testing involves measuring blood glucose after not eating or
drinking for 8 to 12 hours (usually overnight). A normal fasting blood glucose level is less than 100 mg/dL. A
fasting blood glucose of 126 mg/dL (7.0 mmol/L) or higher indicates diabetes. The test is done by taking a small
sample of blood from a vein or fingertip. It must be repeated on another day to confirm that it remains abnormally
high (see Criteria for diagnosis below).
Hemoglobin A1C test (A1C) The A1C blood test measures the average blood glucose level during the past two
to three months. It is used to monitor blood glucose control in people with known diabetes, but is not normally
used to diagnose diabetes. Normal values for A1C are 4 to 6 percent (show figure 3). The test is done by taking a
small sample of blood from a vein or fingertip.
Oral glucose tolerance test Oral glucose tolerance testing (OGTT) is the most sensitive test for diagnosing
diabetes and pre-diabetes. However, the OGTT is not routinely recommended because it is inconvenient
compared to a fasting blood glucose test.
The standard OGTT includes a fasting blood glucose test. The person then drinks a 75 gram liquid glucose solution
(which tastes very sweet, and is usually cola or orange-flavored). Two hours later, a second blood glucose level is
measured.
Oral glucose tolerance testing is routinely performed at 24 to 28 weeks of pregnancy to screen for gestational
diabetes; this requires drinking a 50 gram glucose solution with a blood glucose level drawn one hour later. For
women who have an abnormally elevated blood glucose level, a second OGTT is performed on another day after
drinking a 100 gram glucose solution. The blood glucose level is measured before, and at one, two, and three hours
after drinking the solution.
MEDICATIONS:
When diet, exercise and maintaining a healthy weight arent enough, you may need the help of medication.
Medications used to treat diabetes include insulin. Everyone with type 1 diabetes and some people with type 2
diabetes must take insulin every day to replace what their pancreas is unable to produce. Unfortunately, insulin cant
be taken in pill form because enzymes in your stomach break it down so that it becomes ineffective. For that reason,
many people inject themselves with insulin using a syringe or an insulin pen injector,a device that looks like a pen,
except the cartridge is filled with insulin. Others may use an insulin pump, which provides a continuous supply of
insulin, eliminating the need for daily shots.
The most widely used form of insulin is synthetic human insulin, which is chemically identical to human insulin but
manufactured in a laboratory. Unfortunately, synthetic human insulin isnt perfect. One of its chief failings is that it
doesnt mimic the way natural insulin is secreted. But newer types of insulin, known as insulin analogs, more closely
resemble the way natural insulin acts in your body. Among these are lispro (Humalog), insulin aspart (NovoLog) and
glargine (Lantus).
A number of drug options exist for treating type 2 diabetes, including:
Sulfonylurea drugs. These medications stimulate your pancreas to produce and release more insulin. For them to
be effective, your pancreas must produce some insulin on its own. Second-generation sulfonylureas such as glipizide
(Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase PresTab, Micronase) and glimepiride (Amaryl) are prescribed
most often. The most common side effect of sulfonylureas is low blood sugar, especially during the first four months
of therapy. Youre at much greater risk of low blood sugar if you have impaired liver or kidney function.
Meglitinides. These medications, such as repaglinide (Prandin), have effects similar to sulfonylureas, but youre not
as likely to develop low blood sugar. Meglitinides work quickly, and the results fade rapidly.
Biguanides. Metformin (Glucophage, Glucophage XR) is the only drug in this class available in the United States. It
works by inhibiting the production and release of glucose from your liver, which means you need less insulin to
transport blood sugar into your cells. One advantage of metformin is that is tends to cause less weight gain than do
other diabetes medications. Possible side effects include a metallic taste in your mouth, loss of appetite, nausea or
vomiting, abdominal bloating, or pain, gas and diarrhea. These effects usually decrease over time and are less likely
to occur if you take the medication with food. A rare but serious side effect is lactic acidosis, which results when lactic
acid builds up in your body. Symptoms include tiredness, weakness, muscle aches, dizziness and drowsiness. Lactic
acidosis is especially likely to occur if you mix this medication with alcohol or have impaired kidney function.
Alpha-glucosidase inhibitors. These drugs block the action of enzymes in your digestive tract that break down
carbohydrates. That means sugar is absorbed into your bloodstream more slowly, which helps prevent the rapid rise
in blood sugar that usually occurs right after a meal. Drugs in this class include acarbose (Precose) and miglitol
(Glyset). Although safe and effective, alpha-glucosidase inhibitors can cause abdominal bloating, gas and diarrhea. If
taken in high doses, they may also cause reversible liver damage.
Thiazolidinediones. These drugs make your body tissues more sensitive to insulin and keep your liver from
overproducing glucose. Side effects of thiazolidinediones, such as rosiglitazone (Avandia) and pioglitazone
hydrochloride (Actos), include swelling, weight gain and fatigue. A far more serious potential side effect is liver
damage. The thiazolidinedione troglitzeone (Rezulin) was taken off the market in March 2000 because it caused liver
failure. If your doctor prescribes these drugs, its important to have your liver checked every two months during the
first year of therapy. Contact your doctor immediately if you experience any of the signs and symptoms of liver
damage, such as nausea and vomiting, abdominal pain, loss of appetite, dark urine, or yellowing of your skin and the
whites of your eyes (jaundice). These may not always be related to diabetes medications, but your doctor will need to
investigate all possible causes.
Drug combinations. By combining drugs from different classes, you may be able to control your blood sugar in
several different ways. Each class of oral medication can be combined with drugs from any other class. Most doctors
prescribe two drugs in combination, although sometimes three drugs may be prescribed. Newer medications, such as
Glucovance, which contains both glyburide and metformin, combine different oral drugs in a single tablet.
NURSING INTERVENTIONS:
Advice patient about the importance of an individualized meal plan in meeting weekly weight loss goals and assist
with compliance.
Assess patients for cognitive or sensory impairments, which may interfere with the ability to accurately administer
insulin.
Demonstrate and explain thoroughly the procedure for insulin self-injection. Help patient to achieve mastery of
technique by taking step by step approach.
Review dosage and time of injections in relation to meals, activity, and bedtime based on patients individualized
insulin regimen.
Instruct patient in the importance of accuracy of insulin preparation and meal timing to avoid hypoglycemia.
Explain the importance of exercise in maintaining or reducing weight.
Advise patient to assess blood glucose level before strenuous activity and to eat carbohydrate snack before
exercising to avoid hypoglycemia.
Assess feet and legs for skin temperature, sensation, soft tissues injuries, corns, calluses, dryness, hair
distribution, pulses and deep tendon reflexes.
Maintain skin integrity by protecting feet from breakdown.
Advice patient who smokes to stop smoking or reduce if possible, to reduce vasoconstriction and enhance
peripheral flow


Pathophysiology of Diabetes Mellitus

Risk for Infection Diabetes Mellitus

Nursing Diagnosis: Risk for Infection
Risk factors may include:
High glucose levels, decreased leukocyte function, alterations in
circulation
Preexisting respiratory infection, or UTI
Desired Outcomes:
Identify interventions to prevent/reduce risk of infection.
Demonstrate techniques, lifestyle changes to prevent development of
infection.
Nursing Interventions Rationale
Observe for signs of infection and
inflammation, e.g., fever, flushed appearance,
wound drainage, purulent sputum, cloudy
urine.
Patient may be admitted with infection,
which could have precipitated the
ketoacidotic state, or may develop a
nosocomial infection.
Promote good handwashing by staff and
patient.
Reduces risk of cross-contamination.
Maintain aseptic technique for IV insertion
procedure, administration of medications, and
providing maintenance/site care. Rotate IV
sites as indicated.
High glucose in the blood creates an excellent
medium for bacterial growth.
Provide catheter/perineal care. Teach the
female patient to clean from front to back
after elimination
Minimizes risk of UTI. Comatose patient may
be at particular risk if urinary retention
occurred before hospitalization. Note: Elderly
female diabetic patients are especially prone
to urinary tract/vaginal yeast infections.
Provide conscientious skin care; gently
massage bony areas. Keep the skin dry, linens
dry and wrinkle-free.
Peripheral circulation may be impaired,
placing patient at increased risk for skin
irritation/breakdown and infection.
Auscultate breath sounds. Rhonchi indicate accumulation of secretions
possibly related to pneumonia/bronchitis
(may have precipitated the DKA). Pulmonary
congestion/edema (crackles) may result from
rapid fluid replacement/HF.
Place in semi-Fowlers position. Facilitates lung expansion; reduces risk of
aspiration.
Reposition and encourage coughing/deep
breathing if patient is alert and cooperative.
Otherwise, suction airway, using sterile
technique, as needed.
Aids in ventilating all lung areas and
mobilizing secretions. Prevents stasis of
secretions with increased risk of infection.
Provide tissues and trash bag in a convenient
location for sputum and other secretions.
Instruct patient in proper handling of
secretions.
Minimizes spread of infection.
Encourage/assist with oral hygiene. Reduces risk of oral/gum disease.
Encourage adequate dietary and fluid intake
(approximately3000 mL/day if not
contraindicated by cardiac or renal
dysfunction), including 8 oz of cranberry juice
per day as appropriate.
Decreases susceptibility to infection.
Increased urinary flow prevents stasis and aids
in maintaining urine pH/acidity, reducing
bacteria growth and flushing organisms out of
system. Note: Use of cranberry juice can help
prevent bacteria from adhering to the bladder
wall, reducing the risk of recurrent UTI.
Administer antibiotics as appropriate. Early treatment may help prevent sepsis.


Risk for Disturbed Sensory Perception Diabetes Mellitus
Nursing Diagnosis: Sensory Perception, risk for disturbed (specify)
Risk factors may include
Endogenous chemical alteration: glucose/insulin and/or electrolyte
imbalance
Desired Outcomes
Maintain usual level of mentation.
Recognize and compensate for existing sensory impairments.
Nursing Interventions Rationale
Monitor vital signs and mental
status.
Provides a baseline from which to
compare abnormal findings, e.g.,
fever may affect mentation.
Address patient by name; reorient as
needed to place, person, and time.
Give short explanations, speaking
slowly and enunciating clearly.
Decreases confusion and helps
maintain contact with reality.
Schedule nursing time to provide for
uninterrupted rest periods.
Promotes restful sleep, reduces
fatigue, and may improve cognition.
Keep patients routine as consistent
as possible. Encourage participation
in activities of daily living (ADLs) as
able.
Helps keep patient in touch with
reality and maintain orientation to
the environment.
Protect patient from injury
(avoid/limit use of restraints as able)
when level of consciousness is
impaired. Place bed in low position.
Pad bed rails and provide soft airway
if patient is prone to seizures.
Disoriented patient is prone to
injury, especially at night, and
precautions need to be taken as
indicated. Seizure precautions need
to be taken as appropriate to prevent
physical injury, aspiration.
Evaluate visual acuity as indicated. Retinal edema/detachment,
hemorrhage, presence of cataracts or
temporary paralysis of extraocular
muscles may impair vision, requiring
corrective therapy and/or supportive
care.
Investigate reports of hyperesthesia,
pain, or sensory loss in the feet/legs.
Look for ulcers, reddened areas,
pressure points, loss of pedal pulses.
Peripheral neuropathies may result
in severe discomfort, lack
of/distortion of tactile sensation,
potentiating risk of dermal injury and
impaired balance.
Provide bed cradle. Keep hands/feet
warm, avoiding exposure to cool
drafts/hot water or use of heating
pad.
Reduces discomfort and potential for
dermal injury.
Assist with ambulation/position
changes.
Promotes patient safety, especially
when sense of balance is affected.
Monitor laboratory values, e.g.,
blood glucose, serum osmolality,
Hb/Hct, BUN/Cr.
Imbalances can impair mentation.
Note: If fluid is replaced too quickly,
excess water may enter brain cells
and cause alteration in the level of
consciousness (water intoxication).
Carry out prescribed regimen for
correcting DKA as indicated.
Alteration in thought
processes/potential for seizure
activity is usually alleviated once
hyperosmolar state is corrected.


Powerlessness Diabetes Mellitus

Nursing Diagnosis: Powerlessness
May be related to
Long-term/progressive illness that is not curable
Dependence on others
Possibly evidenced by
Reluctance to express true feelings; expressions of having no
control/influence over situation
Apathy, withdrawal, anger
Does not monitor progress, nonparticipation in care/decision making
Depression over physical deterioration/complications despite patient
cooperation with regimen
Desired Outcomes:
Acknowledge feelings of helplessness.
Identify healthy ways to deal with feelings.
Assist in planning own care and independently take responsibility for self-
care activities.
Nursing Interventions Rationale
Encourage patient/SO to express
feelings about hospitalization and
disease in general.
Identifies concerns and facilitates
problem solving.
Acknowledge normality of feelings. Recognition that reactions are
normal can help patient problem-
solve and seek help as needed.
Diabetic control is a full-time job that
serves as a constant reminder of
both presence of disease and threat
to patients health/life.
Assess how patient has handled
problems in the past. Identify locus
of control.
Knowledge of individuals style helps
determine needs for treatment goals.
Patient whose locus of control is
internal usually looks at ways to gain
control over own treatment program.
Patient who operates with an
external locus of control wants to be
cared for by others and may project
blame for circumstances onto
external factors.
Provide opportunity for SO to
express concerns and discuss ways in
which he or she can be helpful to
patient.
Enhances sense of being involved
and gives SO a chance to problem-
solve solutions to help patient
prevent recurrence.
Ascertain expectations/goals of
patient and SO.
Unrealistic expectations/pressure
from others or self may result in
feelings of frustration/loss of control
and may impair coping abilities.
Determine whether a change in
relationship with SO has occurred.
Constant energy and thought
required for diabetic control often
shifts the focus of a relationship.
Development of psychological
concerns/visceral neuropathies
affecting self-concept (especially
sexual role function) may add further
stress.
Encourage patient to make decisions
related to care, e.g., ambulation,
time for activities, and so forth.
Communicates to patient that some
control can be exercised over care.
Support participation in self-care
and give positive feedback for
efforts.
Promotes feeling of control over
situation.



Imbalanced Nutrition Less Than Body Requirements Diabetes
Mellitus

Nursing Diagnosis: Imbalanced Nutrition Less Than Body Requirements
May be related to:
Insulin deficiency (decreased uptake and utilization of glucose by the
tissues, resulting in increased protein/fat metabolism)
Decreased oral intake: anorexia, nausea, gastric fullness, abdominal pain;
altered consciousness
Hypermetabolic state: release of stress hormones (e.g., epinephrine,
cortisol, and growth hormone), infectious process
Possibly evidenced by:
Increased urinary output, dilute urine
Reported inadequate food intake, lack of interest in food
Recent weight loss; weakness, fatigue, poor muscle tone
Diarrhea
Increased ketones (end product of fat metabolism)
Desired Outcomes:
Ingest appropriate amounts of calories/nutrients.
Display usual energy level.
Demonstrate stabilized weight or gain toward usual/desired range with
normal laboratory values.
Nursing Interventions Rationale
Weigh daily or as indicated. Assesses adequacy of nutritional
intake (absorption and utilization).
Ascertain patients dietary program
and usual pattern; compare with
recent intake.
Identifies deficits and deviations from
therapeutic needs.
Auscultate bowel sounds. Note
reports of abdominal pain/bloating,
nausea, vomiting of undigested food.
Maintain nothing by mouth (NPO)
status as indicated.
Hyperglycemia and fluid and
electrolyte disturbances can decrease
gastric motility/function (distension
or ileus), affecting choice of
interventions. Note: Long-term
difficulties with decreased gastric
emptying and poor intestinal motility
suggest autonomic neuropathies
affecting the GI tract and requiring
symptomatic treatment.
Provide liquids containing nutrients
and electrolytes as soon as patient
can tolerate oral fluids; progress to
more solid food as tolerated.
Oral route is preferred when patient
is alert and bowel function is
restored.
Identify food preferences, including
ethnic/cultural needs.
If patients food preferences can be
incorporated into the meal plan,
cooperation with dietary
requirements may be facilitated after
discharge.
Include SO in meal planning as
indicated.
Promotes sense of involvement;
provides information for SO to
understand nutritional needs of
patient. Note:Various methods
available or dietary planning include
exchange list, point system, glycemic
index, or preselected menus.
Observe for signs of hypoglycemia,
e.g., changes in level of
consciousness, cool/clammy skin,
rapid pulse, hunger, irritability,
anxiety, headache, lightheadedness,
shakiness.
Once carbohydrate metabolism
resumes (blood glucose level
reduced) and as insulin is being
given, hypoglycemia can occur. If
patient is comatose, hypoglycemia
may occur without notable change in
level of consciousness (LOC). This
potentially life-threatening
emergency should be assessed and
treated quickly per protocol. Note:
Type 1 diabetics of long standing
may not display usual signs of
hypoglycemia because normal
response to low blood sugar may be
diminished.
Perform fingerstick glucose testing. Bedside analysis of serum glucose is
more accurate (displays current
levels) than monitoring urine sugar,
which is not sensitive enough to
detect fluctuations in serum levels
and can be affected by patients
individual renal threshold or the
presence of urinary retention/renal
failure. Note: Some studies have
found that a urine glucose of 20%
may be correlated to a blood glucose
of 140360 mg/dL.
Administer regular insulin by
intermittent or continuous IV
method, e.g., IV bolus followed by a
continuous drip via pump of
approximately 510 U/hr so that
glucose is reduced by 50 mg/dL/hr.
Regular insulin has a rapid onset and
thus quickly helps move glucose into
cells. The IV route is the initial route
of choice because absorption from
subcutaneous tissues may be erratic.
Many believe the continuous method
is the optimal way to facilitate
transition to carbohydrate
metabolism and reduce incidence of
hypoglycemia.
Administer glucose solutions, e.g.,
dextrose and half-normal saline.
Glucose solutions may be added after
insulin and fluids have brought the
blood glucose to approximately 400
mg/dL. As carbohydrate metabolism
approaches normal, care must be
taken to avoid hypoglycemia.
Provide diet of approximately 60%
carbohydrates, 20% proteins, 20%
fats in designated number of
meals/snacks.
Complex carbohydrates (e.g., corn,
peas, carrots, broccoli, dried beans,
oats, apples) decrease glucose
levels/insulin needs, reduce serum
cholesterol levels, and promote
satiation. Food intake is scheduled
according to specific insulin
characteristics (e.g., peak effect) and
individual patient response. Note:A
snack at bedtime (hs) of complex
carbohydrates is especially important
(if insulin is given in divided doses)
to prevent hypoglycemia during sleep
and potential Somogyi response. <
Administer other medications as
indicated, e.g., metoclopramide
(Reglan); tetracycline.
May be useful in treating symptoms
related to autonomic neuropathies
affecting GI tract, thus enhancing
oral intake and absorption of
nutrients.


Fatigue Diabetes Mellitus

Nursing Diagnosis: Fatigue
May be related to
Decreased metabolic energy production
Altered body chemistry: insufficient insulin
Increased energy demands: hypermetabolic state/infection
Possibly evidenced by
Overwhelming lack of energy, inability to maintain usual routines,
decreased performance, accident-prone
Impaired ability to concentrate, listlessness, disinterest in surroundings
Desired Outcomes
Verbalize increase in energy level.
Display improved ability to participate in desired activities.
Nursing Interventions Rationale
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 sleep.
Prevents excessive fatigue.
Monitor pulse, respiratory rate, and Indicates physiological levels of
BP before/after activity. tolerance.
Discuss ways of conserving energy
while bathing, transferring, and so
on.
Patient will be able to accomplish
more with a decreased expenditure
of energy.
Increase patient participation in
ADLs as tolerated.
Increases confidence level/self-
esteem and tolerance level.



Nursing Diagnosis and Nursing Intervention


Fluid volume deficient related to osmotic diuresis from hyperglycemia

Planning

After 8 hours of nursing interventions, the patient will demonstrate adequate hydration.

Intervention

Monitor orthostatic blood pressure changes.
Rational : Hypovolemia may be manifested by hypotension and tachycardia.
Assess peripheral pulses, capillary refill, skin turgor, and mucous membrane.
Rational : Indicators of level of dehydration, adequacy of circulating volume.
Monitor respiratory pattern like Kussmauls respirations and acetone breath.
Rational : Lungs remove carbonic acid through respirations, producing a compensatory respiratory alkalosis for
ketoacidosis.
Monitor input and output. Note urine specific gravity.
Rational : Provides ongoing estimate of volume replacement needs, kidney function, and effectiveness of therapy.
Promote comfortable environment. Cover patient with light sheets.
Rational : Avoids overheating, which could promote further fluid loss.
Monitor temperature, skin color and moisture.
Rational : Fever, chills, and diaphoresis are common with infectious process; fever with flushed, dry skin may reflect
dehydration.

3 Nursing Care Plan Diabetes Mellitus - Diagnosis, Interventions
and Rational
Nursing Diagnosis for Diabetes Mellitus

1. Nursing Diagnosis : Fluid Volume Deficit related to osmotic diuresis.

Goal:
Demonstrate adequate hydration evidenced by stable vital signs, palpable peripheral pulse, skin turgor
and capillary refill well, individually appropriate urinary output, and electrolyte levels within normal limits.

Nursing Intervention:
1.) Monitor vital signs.
Rational: hypovolemia can be manifested by hypotension and tachycardia.
2.) Assess peripheral pulses, capillary refill, skin turgor, and mucous membranes.
Rational: This is an indicator of the level of dehydration, or an adequate circulating volume.
3.) Monitor input and output, record the specific gravity of urine.
Rational: To provide estimates of the need for fluid replacement, renal function, and effectiveness of the
therapy given.
4.) Measure weight every day.
Rational: To provide the best assessment of fluid status of ongoing and further to provide a replacement
fluid.
5.) Provide fluid therapy as indicated.
Rational: The type and amount of liquid depends on the degree of lack of fluids and the response of
individual patients.

2. Nursing Diagnosis : Imbalanced Nutrition Less than Body Requirmentsrelated to insufficiency of
insulin, decreased oral input.

Goal:
Digest the amount of calories / nutrients right
Shows the energy level is usually
Stable or increasing weight.

Nursing Intervention:
1.) Determine the patient's diet and eating patterns and compared with food that can be spent by the
patient.
Rationale: Identify deficiencies and deviations from the therapeutic needs.
2.) Weigh weight per day or as indicated.
Rational: Assessing an adequate food intake (including absorption and utilization).
3.) Identification of preferred food / desired include the needs of ethnic / cultural.
Rational: If the patient's food preferences can be included in meal planning, this cooperation can be
pursued after discharge.
4.) Involve patients in planning the family meal as indicated.
Rationale: Increase the sense of involvement; provide information on the family to understand the
patient's nutrition.
5.) Give regular insulin treatment as indicated.
Rational: regular insulin has a rapid onset and quickly and therefore can help move glucose into cells.

c. Nursing Diagnosis : Risk for Infection related to hyperglikemia.

Goal:
Identify interventions to prevent / reduce the risk of infection.
Demonstrate techniques, lifestyle changes to prevent infection.

Nursing Intervention:
1). Observed signs of infection and inflammation.
Rationale: Patients may be entered with an infection that usually has sparked a state of ketoacidosis or
may have nosocomial infections.
2). Improve efforts to prevention by good hand washing for all people in contact with patients including the
patients themselves.
Rationale: Prevents cross infection.
3). Maintain aseptic technique in invasive procedures.
Rational: high glucose levels in blood would be the best medium for the growth of germs.
4). Give your skin with regular care and earnest.
Rational: the peripheral circulation may be disturbed that puts patients at increased risk of damage to the
skin / skin irritation and infection.
5). Make changes to the position, effective coughing and encourage deep breathing.
Rational: memventilasi Assist in all areas and mobilize pulmonary secretions.