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Diabetes mellitus is a metabolic disease characterized by dysregulation of carbohydrate, protein,

and lipid metabolism. The primary feature of this disorder is elevation in blood glucose levels
(hyperglycemia), resulting from either a defect in insulin secretion from the pancreas, a change
in insulin action, or both. Sustained hyperglycemia has been shown to affect almost all tissues in
the body and is associated with significant complications of multiple organ systems, including
the eyes, nerves, kidneys, and blood vessels.

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.

Assessment Nursing Planning Nursing Rationale Evaluation


Diagnosis Interventio
ns
Subjective: (none) Objective: Deficient Short Establish Friendly Short
Fluid Term:After rapport Take relationshi Term:After
 elevated     temperature Volume r/t 3° of NI, and record p with 3° of NI,
of 38.4°C/axilla intracellul patient shall vital signs patient and patient will
 increased urine output. ar DHN 2° have to be able have
 sweating of the skin the DM II verbalized Monitor the to each verbalized
 thirst understandin temperature other’s understandin
 exhaustion g of concern To g of
 weight loss causative Assess skin obtain causative
factors and turgor and baseline factors and
 dry skin or  mucous
purpose of mucous data purpose of
membrane
individual membranes individual
therapeutic for signs of To monitor therapeutic
interventions dehydration changes in interventions
and temperatur and
medications. Encourage e medications.
Long Term: the patient to Long Term:
increase Dry skin
After 2 days fluid intake and After 2 days
of NI, the mucous of NI, the
patient shall Administer membranes patient will
have IVF as are signs of have
maintained ordered by dehydratio maintained
fluid volume the Doctor n fluid volume
at a at a
functional Administer To replace functional
level as anti-pyretic fluid loss level as
evidenced as prescribed and evidenced
by by the prevent by
individual Doctor. dehydratio individual
good skin n good skin
turgor, moist turgor, moist
mucous To replace mucous
membrane electrolytes membrane
and stable and fluid and stable
vital signs. loss vital signs

To
decrease
body
temperatur
e and will
have less
occurrence
of
dehydratio
n.

Imbalanced Nutrition: Less Than Body


Requirements
Due to decrease of lack of insulin in the body, the glucose level continuously rises because
glucose can’t 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.

Assessment Nursing Planning Nursing Rationale Evaluation


Diagnosis Interventions
Subjective:Æ Imbalance Short Term: Establish rapport Friendly Short Term:
Objective: d After 3° of Ascertain understanding relationship After 3° of
Nutrition: NI, patient of individual nutritional with patient NI, patient
Pt. manifested: less than shall have needs and to be will have
body verbalized able to each verbalized
- poor muscle requiremen understandin Discuss eating habits and other’s understandin
tone t r/t insulin g of encourage diabetic diet as concern To g of
deficiency causative prescribed by the Doctor determine causative
- generalized factors when what factors when
known and information known and
weakness necessary Document actual weight, to be necessary
interventions do not estimate. provided to interventions
- increased and client/SO and
thirst identified Note total daily intake identified
diabetic including patterns and - To achieve diabetic
- increased client. time of eating. health needs client.
urination of the patient
Long Term: Consult  with the Long Term:
-polyphagia dietician/physician for proper food
After 1-4 further assessment and diet for is/her After 1-4
Pt. may    months of recommend-dation disease months of
manifest: NI, the regarding food preferences NI, the
patient shall and nutri-tional support - Patient may patient will
- loss of weight have be un aware have
demonstrated of their demonstrated
weight gain actual weight weight gain
toward goal. or weight toward goal.
loss due to
estimating
weight.

- To reveal
changes that
should be
made in
client’s
dietary
intake

- For greater
understandin
g 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.

Assessment Nursing Planning Nursing Rationale Evaluation


Diagnosi Interventions
s
Subjective: (none) Fatigue Short -Assess -Response to The patient
Objective: related to Term:After 2-3º response to an activity can shall have
decreased of nursing activity -Asses be evaluated been able to
 generalized muscular interventions, muscle strength to achieve identify
weakness strength the patient will of patient and desired level measures to
 increased be able to functional levelof tolerance. conserve and
respiratory identify of activity. -To determine increase body
rate of 25cpm measures to the level of energy The
 presence of conserve and -Discuss with activity patient shall
non-healing increase body patient the need have been
wound on both energy. Long for activity -Education free from
feet Term: may provide signs of
 body -Alternate motivation to fatigue
weakness After 3-5 days of activity with increase
 wt. loss nursing periods of rest/ activity level
 fatigue interventions, uninterrupted even though
the patient will sleep. patient may
 limited ROM
be free from feel too weak
 inability to
signs of fatigue -Monitor pulse, initially
perform ADL
respiration rate
 altered VS -Prevents
and blood
 altered pressure excessive
sensorium before/after fatigue
activity
-Indicates
-Perform physiological
activity slowly levels of
with frequent tolerance
rest periods
-Tolerance
-Promote develops by
energy adjusting
conservation frequency,
techniques by duration and
discussing intensity until
ways of desired
conserving activity level
energy while is achieved.
bathing,
transferring and -Interventions
so on. should be
directed at
-Provide delaying the
adequate onset of
ventilation fatigue and
optimizing
-Provide muscle
comfort and efficiency.
safety Symptoms of
fatigue are
-Instruct patient alleviated
to perform deep with rest. 
breathing Also, patient
exercises will be able to
accomplish
-Instruct client more with a
to increase decreased
Vitamins A, C expenditure of
and D and energy.
protein in her
diet. -For proper
oxygenation
-Instruct also
patient to -To be free
increase iron in from injury
diet
-Promotes
-Administer relaxation
oxygen as
ordered. -For muscle
strength and
tissue repair

-To prevent
weakness and
paleness

-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.

Assessment Nursing Planning Nursing Rationale Evaluation


Diagnosis Interventions
Subjective:Æ Risk for Short Term: After -Establish - to obtain
Short Term:
Objective: infection 4 hours of NPI the rapport -Take patient’s trust
-The pt. shall
related to risks factors of and record vital and have identified
Pt. disease occurrence of signs cooperation -
risks factors of
manifested: condition. infection will be To obtainoccurrence of
reduce or control -Encourage baseline data
infection shall
-purulent to a manageable expression of have reduced
discharge level by a clean feelings and - facilitates or controlled to
bed and maintain anxieties grieving the a manageable
-hyperthermia skin intact. loss level by a
- Observe non – clean bed and
Pt. may Long Term: verbal cues - non – verbal skin intact.
manifest: cues is more
After 1-2 weeks -Encourage accurate than Long Term:
-altered of NPI, pt will be client to look verbal cues
circulation free of purulent at/touch affected -The patient
drainage or body part - to begin to shall be free of
- erythema and be incorporate purulent
immunologica afebrile -Encourage changes into damage or
l deficit verbalization of body image erythema and
and role play be febrile
anticipated - to enhance
conflicts handling of
potential
-encourage to problems
increase fluid
intake -to prevent
dehydration
-increase Vit. C
in the diet -to boost
immune
-increase CHON system and
intake promote
collagen
-change dressing formation

-provide a safe -for tissue


and quiet repair
environment
-Take Due meds -to promote
on time healing and
prevent
contamination
of the wound

-to promote
pt’s comfort

- To met the
body’s
requirements

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