‫‪Diabetes Mellitus‬‬

‫فريق االعداد ‪:‬‬

‫يوسف احمد علي‬ ‫مصطفى محمود لطفى‬

‫‪222605000093‬‬ ‫‪222605000074‬‬

‫محمد عبد الغني عبد الباسط‬

‫سيف محمد نبيل‬
‫‪222605000063‬‬
‫‪222605000041‬‬
‫احمد خالد حنفي محمد زاهر‬
‫‪212605000009‬‬
‫حمزة يوسف مجيد‬
‫‪222605000028‬‬
‫سالم محمد سالم‬
‫‪222605000039‬‬
‫عبدالوهاب مصطفى عبدالوهاب‬
‫‪222605000049‬‬
‫محمد صابر محمد‬
‫‪222605000062‬‬
‫إبراهيم محمد إبراهيم‬
‫‪222605000002‬‬

‫‪Supervision‬‬

‫‪Dr. Hana Abbas‬‬

‫‪Dr. Gehad‬‬
‫‪Dr. Alshaimaa‬‬
 Nursing Diagnosis Patient Goal
Deficient Fluid Volume -Patient will maintain
(Dehydration) normal fluid balance and
Demonstrate adequate
Related to: hydration.
(osmotic diuresis).
evidenced by:
Evidenced by: )Stable vital signs, palpable
peripheral pulses, good skin
-Increased urine output. turgor and capillary refill)
NG Intervention
•Monitor laboratory studies "HCT,
osmolality, sodium, potassium”.
•Assess patient's vital signs, weight,
respiratory pattern "such as acetone
breath" and I& O chart. Assess
temperature, skin Color, and moisture,
capillary refill, skin turgor, RBS, FBS and
Maintain fluid intake of at least 2500
ml/day.

-Weakness, thirst, •Environment, Cover client with light

sudden weight loss. sheets. which could promote further fluid
loss Avoids overheating.
-Dry skin and mucous
membranes, poor skin •Administer isotonic solutions "type and
turgor. amount of fluid depends on degree of deficit
and PT response".
-Decreased blood
pressure, increased pulse •if needed. Insert and maintain
rate. indwelling urinary catheter

•In case of DKA, replace fluid loss through

2-10 liter (at rate of 1 liter per hour)

•Restoring electrolytes by - frequent

moimoitoring of sodium and potassium

-insulin administration -ECG every 4 hours

 Nursing Diagnosis Patient Goal
Risk for urinary tract Patent will be free from signs
Infection and symptoms of infection
related to (turbid urine -urinary frequency -
bad glucose control dysuria - cloudy urine flank pain-
fever) As evidenced by WB
5000-10000mm3 -normal body
temperature( 36.5 -37.2)
Risk for Chest infection Patient will be free from S&S of
related to chest infection (fever- cough-
bad glucose control chest pain - dyspnea) as
evidenced by -WBC (5000-
10000mm3) -body temperature
( 36.5-37.2)
NG Intervention
Encourage the patient to void frequently to
reduce stasis of urine.
• Drink cranberry juice and take probiotics
Teach patient perineal care (teach the
female to clean from front to back after
urination. Teach patient S&Sof UTI (urinary
frequency -dysuria - cloudy urine -
urgency) Teach patient (female) to avoid
irritating feminine products. Increase fluid
intake up to 2500 cc per day. Performing a
urine analysis for the patient. and urine
culture if indicated.
Teach patient S&S of chest Infection Signs:
coughing - green or yellow mucus
wheezing and shortness of breath chest
pain or discomfort, fever a headache
aching muscle. Tiredness -instruct patient
to avoid smoking. - to make sure that
hands are clean before eating or touching
face or mouth..-cover mouth during
coughing or sneezing - through away used
tissue immediately -wash hands regularly-
avoid overcrowding arcas
-teach patient deep breathing and Coghing
exercises. – increae fluid intake 2500 cc
per day -encourage sitting or semi setting
positions. -encourage periods of rest.-
encourage flu vaccine or pnumococcal
vaccine if indicated. -encourage dict with
vitamin C as lemon or orange encourage
daily exercises -make X-ray or sputum
culture if indicated.
Risk for diabetic Wound Patient will be free from S&S of
infection wound f infection (fever-
related to tenderness -purulent drainage)
diabetic foot ulcer and as evidenced by WBC (5000-
bad glucose control 10000mm3) Body temperature
(36.5-37.2)
Risk for urinary tract Patent will be free from signs
Infection and symptoms of infection
related to (turbid urine -urinary frequency -
bad glucose control dysuria - cloudy urine flank pain
-fever)
As evidenced by
-WBC 5000-10000mm3
- normal body temperature 36.5
-37.2
Risk for hospital acquired Patient will be free from S&S of
infection infection (fever - chills -Sweat -
increasing WBC)
Related to as evidenced by
Chronic disease -WBC (5000-10000)mm3
diabetes Mellitus; Normal body
leucopenia; invasive -temperature (36.5 - 37.2 )
procedure ,and in
effective aseptic
techniques
foot care
Daily examination and care of patients'
foot.
Dress wounds carefully and change at
regular intervals for faster wound healing.
Keeping the wound clean to avoid infection
Eating a healthy diet encourage medication
compliance
Exercising regularly as it stimulates blood
flow to the legs and eliminates numbness
and it is recommended to practice yoga or
walking.
Avoid smoking. Administer antibiotics as
prescribed
Encourage the patient to void frequently to
reduce stasis of urine.
Drink cranberry juice and take probiotics
Teach patient perineal care (teach the
female to clean from front to back after
urination.
Teach patient S&Sof UTI (urinary frequency
-dysuria - cloudy urine -urgency )
Teach patient (female ) to avoid irritating
feminine products.
Increase fluid intake up to 2500 cc per day .
Performing a urine analysis for the patient.
and urine culture if indicated
Observe for signs of infection and
inflammation—fever, flushed appearance,
wound drainage, purulent sputum, and cloudy
urine.
Promote good hand washing by staff and
patient.
Maintain aseptic technique for iv
insertion procedure, administration of
medications, and providing site care. Rotate
IV sites, as indicated.
Provide catheter and perianal care.
Avoidance of urinary catheterization is
recommended whenever possible. If it is not
clinically feasible to avoid catheterization,
intermittent catheterization is another
preferable option.

Provide conscientious skin care, gently

massage bony areas, keep the skin dry, and
keep linens dry and wrinkle-free.

Inspect client’s feet, noting presence of ulcers

or infected ingrown toenails, or other problems
requiring medical or nursing intervention.

Auscultate breath sounds.

Place in semi-fowler’s position.

Reposition and encourage coughing and deep

breathing if client is alert and cooperative.

Otherwise, suction airway, using sterile

technique, as needed

Provide tissues and trash bag in a convenient

location for sputum and other secretions.

Instruct client in proper handling of secretions.

Encourage and assist with oral hygiene.

Encourage adequate dietary and fluid intake (at

least 2500 ml/day if not contraindicated by
cardiac or renal dysfunction).

Obtain specimens for culture and sensitivities,

as indicated.

Administer antibiotics, as appropriate.

Nursing Diagnosis Patient Goal NG Intervention
About Medication Patient will list items Insulin administration:
of health teaching about -Subcutaneous (SQ) injection. The most
common (SQ) insulin injection sites are:
Medication )Insulin) abdomen, back of the upper arms, upper
buttocks, and the outer side of thighs.

Insulin storage considerations:

-Heat and freezing alter the insulin
molecule.

-Prolonged exposure to direct sun light

must be avoided.

-Insulin may be stored in refrigerator.

-The Prefilled syringe with cloudy solution

should be stored in a vertical position with
the needle pointed up.

Insulin Pen:
A smart insulin pen is a reusable injector pen
with an intuitive smartphone app that can help
people with diabetes better manage insulin
delivery. This smart system calculates and
tracks doses and provides helpful reminders,
alerts, and reports. They can come in the form
of an add-on to your current insulin pen or a
reusable form which uses prefilled cartridges
instead of vials or disposable pens.
S.C injection steps:
While holding the swab between fingers of
non- dominant hand, pull cap from needle.

Pinch skin with non-dominant hand and

insert needle at 90 degrees for insulin
syringe & 45 degree for ordinary syringe 1
Aspirate if no blood appears.

slowly inject the medication (aspiration is

contraindicated with prepared medication)

Withdraw the needle while applying gentle

pressure Do not massage the site

Do not use Insulin if:

-Bottle is frosted Clear

- insulin that is cloudy or discolored Clear

-Cloudy insulin that is yellowish or lumpy

-Expiration date has already passed

How to use glucose checker:
1. Make sure the meter is clean and ready
to use.
2. After removing a test strip, immediately
close the test strip container tightly.
Test strips can be damaged if they are
exposed to moisture.
3. Wash your hands with soap and warm
water. Dry well. Massage your hand to
get blood into your finger. Don’t use
alcohol because it dries the skin too
much.
4. Use a lancet to prick your finger.
Squeezing from the base of the finger,
gently place a small amount of blood
onto the test strip. Place the strip in the
meter.
5. After a few seconds, the reading will
appear. Track and record your results.
Add notes about anything that might
 have made the reading out of your target
range, such as food, activity, etc.
6. Properly dispose the lancet and strip in a
trash container.
7. Do not share blood sugar monitoring
equipment, such as lancets, with
anyone, even other family members.
8. Store test strips in the container
provided. Do not expose them to
moisture, extreme heat, or cold
temperatures.
Nursing Diagnosis Patient Goal
About Foot Care Patient will list items of
health teaching about Foot
Care
NG Intervention
Washing Feet:
-Wash your feet with mild soap and
lukewarm water.
-Wash the areas between your toes
carefully.
-Use a soft towel to dry your feet.
Remember to keep the areas between your
toes dry.
-Otherwise, fungus may grow. Use a soft
towel to dry your feet.
-Otherwise, fungus may grow.
-Keep the skin of your feet supple by
applying a moisturizing cream or lotion.
Don’t do that
-soak for more than five minutes.
-soak your feet in hot water.
Protect Your Feet:
-Wear white cotton socks Choose light
color socks it is easy to inspect it for wound
discharge after removal.
-Choose light color socks it is easy to
inspect it for wound discharge after
removal.
-Choose shoes that are comfortable and of
the right size.
characteristics of shoes
increase width, reinforced support, a
removable sole, good arch support and a
protective lining on the inside.

-Soft leather shoes are recommended as

they have good ventilation.

-Check the inside of your shoes for rough

surfaces and small objects before wear it.

 Inspecting your feet:

Use mirror to inspect the planter surface of
foot

-Cuts and scratches in the skin.

-Calluses.

-Blisters.

-In growing toenails.

-Sores.

-Swelling or discoloration.

Cut nails
straight across, without rounding the
corners.
Make sure you cut them short enough that
they don't catch on shoes, socks, or
blankets, but not so short that they become
ingrown.
File nails to smooth any rough edges, but
only after nails are completely dry, and file
in one direction.
Nursing Diagnosis Patient Goal NG Intervention
About Diabetic Diet Patient will list items 1gram Carb or Protein = 4 cal.
1gram Fat = 9cal.
of health teaching about
Complex carbohydrates: (Starch).
Diet Encourage small frequent meals.
Encourage complex carbohydrates
(45% -65%)
Example
- Breads, cereals, grains
- (vitamins/mineral/ fiber) almost all of
the calories provided by fruits and
vegetables represent an important
source of energy.

Simple carbohydrates(Sugary foods):

-Should be limited in favor of nutrientdense

complex carbohydrate foods

-Sugary beverages should be limited

or avoided.

Fibers:
Types of Fibers
 Soluble fibers
Soluble fibers prolong stomach emptying time
so that sugar is released and absorbed more
slowly bind with fatty acids so lower total
cholesterol and LDL
Example
Vegetables as carrots -- Apples -- some fruits -
- in legumes
Insoluble Fiber
Insoluble absorb water so make bulk to food ,
promote regular bowel movement and prevent
constipation
Example
Whole-wheat products -- Cauliflowers --
green beans
Nursing Diagnosis Patient Goal NG Intervention
consumption of dietary fiber is encouraged.
About Danger signs Patient will list items of Assess for signs of hyperglycemia,
health teaching about And hypoglycemia.
Current recommendations are to consume
Danger signs. approximately:
management of hypoglycemia.
-25 g/day for women
-38
(If g/day forpatient)
conscious men.
-give 15-20 grams of fast acting
Protein:
carbohydrate as 1/2 cup of fruit juice
tablespoon
-Should limitofprotein
honey intake
or sugar.
to 10% of daily
-check
caloriesglucose level after 15 minutes

management of hyperglycemia.
-Patients with normal renal function should
-betreat
ablethe
to adequately meet their
underlying cause protein
as infection
needs on diets that supply the usual amount
stress
-ofincrease
kilocalories
fluidas protein.
intake up to 3 liter per day
unless contra indicated.
- Administer insulin as doctor order
-administer oral hypoglycemic agents as
doctor
Fat:order.
--Increase
instruct patient to follow guide
foods containing lines of
omega-3. Two
diabetic diet.
or more servings of fish /week (with
exception of fried fish) provide omega-3
-instruct patient to
polyunsaturated do acids
fatty daily exercises
are and
adjust the medication dose with level of
recommended.
activity
-Less than 30% of daily calories from
-saturated
advice patent
fat. with hyperglycemia to take
adequate rest to prevent the need to
glucose for tissue.
-Cholesterol intake should be less than 300
mg/day from fat amount.
If you skipped a dose of medication
-and
Choose
havefat-free or low-fat
symptoms milk and milk
of mild
products (skimmed milk or dairy).
hyperglycemia taking your insulin or
oral hypoglycemia
- Limiting canconsumption
trans-fatty acid help stabilize
by
your blood sugar level.
avoid hydrogenated oils.
Sodium:
Reassess for signs
-Recommended sodium intake is less than
2400 mg/dl.
hypo/hyperglycemia.
Nursing Diagnosis Patient Goal
About Follow up Patient will list items of
health teaching about
Follow up.
Nursing Diagnosis Patient Goal
About Exercise Patient will list items of
health teaching about
Exercise.
NG Intervention
Protect client from injury-avoid or limit use
of restraints as able, place bed In low
position-when cognition is impaired. Pad
bed rails If client is .Prone to seizures.
Evaluate visual acuity, as Indicated
Investigate reports of Hyperesthesia, pain,
or sensory loss in the feet and legs. Look
for ulcers, reddened areas, pressure
points, and loss of Pedal pulses. Provide
bed cradle.
Keep hands and feet warm, avoiding
exposure to cool drafts, hot .Water, or
heating pad .
Schedule nursing time to provide for
uninterrupted rest periods Assist with
ambulation or position changes carry out
prescribed regimen for .
Correcting DKA, as Indicated
NG Intervention
- Schedule exercise one hour after meal.
- Never take chocolate or candy
- Avoid exercise in extreme heat and cold.
- Use proper foot wear and Inspect foot
daily after exercise.
- Self monitoring of blood glucose before,
during, and after exercise.
- Remember that strenuous activity can be
perceived by the body as a stress.
- Never swim alone
- Best time for exercise is 2 hours after
breakfast
- Always carry a fast acting carbohydrate source as
glucose tablets to take if hypoglycemia occur