What Is The Care Plan For Diabetes?

What Is The Care Plan For Diabetes?

Diabetes is one of the most chronic diseases when the pancreas produces minimal insulin or the body cannot effectively utilize the insulin it produces. This increases glucose concentration in the blood (also known as hyperglycemia). The pancreas produces and secretes insulin hormones into the bloodstream. Insulin leads to the entry of glucose into body cells, causing lower amounts in the bloodstream. Low blood glucose levels align with slowed production of insulin by the pancreas. There are three types of Diabetes which are; Prediabetes, which occurs with higher than normal blood glucose levels in the body. When left untreated, it can lead to type 2 diabetes. Type 1 diabetes, whose main characteristic is the lack of production of insulin by the pancreas. It is also known as childhood-onset diabetes or insulin-dependent. Type 2 diabetes results from the ineffective use of insulin by the body. It can be caused by physical inactivity or excess body weight. It is also known as adult-onset diabetes or non-insulin-dependent. Gestational Diabetes mostly occurs during pregnancy, when women experience insulin resistance. This paper describes the for a care plan for diabetes.  

Signs and Symptoms

If untreated, people with diabetes will exhibit loss of weight, frequent urination (polyuria), increased urge to drink water (polydipsia), and increased hunger (polyphagia). The development of symptoms depends on the type of Diabetes; In type 1 diabetes may develop rapidly (weeks or months), while type 2 diabetes may be subtle or absent or develop much more slowly. Other symptoms include fatigue, slow-healing wounds or sores, irritability, presence of ketones in the urine, blurred vision, tingling, and/or numbness of extremities.

Diagnostic Procedures

Several blood tests are involved to diagnose and measure high or low blood glucose levels. They are; Random blood glucose test, Which shows the glucose levels in the blood, helping diagnose Diabetes. Hypoglycemia occurs when the blood sugar (glucose) level is lower than the standard range of 70 mg dl. Fasting blood glucose test; This involves blood glucose measurement before you eat or drink, usually overnight. Hemoglobin A1C test (A1C); This blood test is used in monitoring blood glucose control in known diabetics. The blood sample measures the average blood glucose level during the past two to three months. Oral glucose tolerance test(OGTT) is used for diagnosing Diabetes and pre-diabetes. It is also routinely performed during pregnancy at 24 to 28 weeks to screen for Gestational Diabetes.

If poorly controlled or left untreated, diabetes can lead to more developing complications that include; Stroke and heart disease caused by damage to blood vessel walls like arteries. Diabetic coma results from severe high blood sugar or low blood sugar levels. Damaged capillaries cause neuropathy due to excessive amounts of glucose in the blood. Nephropathy involves damaged kidneys. Retinopathy is caused by damaged eye blood vessels due to high glucose in the blood. Foot infections result from nerve damage or poor blood flow in the feet, increasing the risk of cuts. 

Diabetes Mellitus has no known cure. Management of the disease involves controlling the levels of serum glucose to prevent or delay the development of complications. Treatment of Diabetes includes; Changes in diet. Eating foods low in calories, fat and high in fiber is recommended for diabetic patients. Diabetic patients should avoid drinking fruit juice as it contains a large amount of sugar, raising blood sugar levels very quickly. The physician indicates a healthy meal plan to achieve perceived health goals. Increase in exercising and physical activity. Exercises lead to a decrease in the blood glucose level as the glucose (energy) demand in cells increases with physical activity. Oral medications like fast-acting glucose tablets can help those with diabetes to raise their blood sugar quickly when it drops dangerously low. For Type 2 diabetes patients, Metformin is prescribed to increase the body’s sensitivity to the effect of insulin. Insulin therapy is recommended for people with type 1 diabetes who require insulin injections to lower their blood sugar levels. Blood glucose monitoring is done to ensure that the patient does not experience high blood glucose levels (hyperglycemia ( or low blood glucose levels (hypoglycemia). Patients are educated on the importance of checking their blood sugar regularly, depending on their treatment plan.

Risk for Unstable Blood Glucose levels

The diagnosis results from inadequate monitoring of blood glucose levels and lacking adherence to the management plan for Diabetes. Other risk factors are lack of knowledge of managing Diabetes, lack of diagnosis acceptance, stress, sedentary activity level, and insulin deficiency or in excess. Desired goals; The patient will maintain a nutritional balance, activities, and availability of insulin, resulting in stable and normal blood glucose levels. Interventions are; The nurse will assess for signs of hyperglycemia which is the inadequacy of insulin to glucose amounts. High amounts of glucose in the blood create an osmotic effect that increases hunger, thirst, and urination; They can be accompanied by fatigue and blurred vision.

Assess blood glucose levels at night and before meals to maintain normal ranges (between 140 and 180 mg/dL). Weigh the patient daily to assess how adequate nutritional intake is. Assess the physical activity routine. Exercises lower blood glucose levels, and if done regularly, they reduce the risk of cardiovascular complications. Assess for signs of hypoglycemia, anxiety, tremors, and slurred speech to manage them earlier with 50% dextrose. Assess the feet for pulses, temperature, sensation, and color. This helps in monitoring peripheral perfusion and neuropathy. Auscultate for bowel sounds and note any complaints of bloating, abdominal pain, nausea, or vomiting. To diagnose hyperglycemia as it mostly disrupts gastric motility. Identify health beliefs the patient has regarding physical exercises. This helps the nurse educate on the importance of exercise and the need for a slow to gradual increase in the intensity of the exercise regimen. Educate the patient on the importance of controlling blood glucose to reduce the development and progression of complications.

Deficient knowledge related to dietary modifications, unfamiliarity with information and interpretation as evidenced by information requests, statements of concern, and inadequacy to follow instructions.

The desired outcome; Before discharge, the patient will demonstrate knowledge of diet, symptoms of low blood sugars, insulin injection, and treatment of hypoglycemia. Interventions are; The nurse will explain the number of times to inject insulin daily for the patient to understand clearly. Teach the patient insulin injection sites and how to rotate them to prevent lipodystrophy. Educate the patient to follow a simple diet low in sugars and fat and high in whole grains and fiber to control cholesterol and triglycerides in the body. Educate the patient to treat hypoglycemia with a snack or glucagon injection for better early management. Give the patient written information about the management of Diabetes for reference to reinforce learning and convey the maximum amount of information.

Risk for Infection

The diagnosis has various risk factors: inadequate glycemic control, diabetic microangiopathy, high glucose levels, decreased or impaired leukocyte function, circulation alterations, pre-existing infections in the respiratory system, and UTIs. Desired Outcomes; The patient will demonstrate lifestyle changes and techniques to prevent the development of complications. The patient will identify interventions to reduce or prevent the risk of infection. Interventions are; Monitoring for signs of infection and inflammation: wound drainage, fever, purulent sputum, and cloudy urine. Early detection controls the severity of the disease and decreases complications. Educate the patient on good hand hygiene to prevent the transmission of diseases. Maintain aseptic techniques during procedures to prevent infection risks. Provide skincare by keeping skin dry and linens dry without wrinkles to prevent the risk of infections and increased skin breakdown.

 Risk for Ineffective Therapeutic Regimen Management

Risk factors for the diagnosis are a new diabetes onset, lack of knowledge about Diabetes and its management, and a complex medical regimen. Desired Outcomes; Patient will verbalize a clear understanding of the condition and potential complications. Patients will demonstrate maximum knowledge of self-care measures for Diabetes. Patients will be involved and perform necessary procedures with explanations for the actions. Interventions are; Ask for a patient’s prior efforts in managing the diabetes care regimen to create a foundation for understanding any difficulties experienced in the diabetes management regimen. Evaluate the patient’s management skills, which include blood glucose monitoring, to determine the knowledge that needs to be provided. Identify factors affecting the regimen negatively to discover the reason for impaired abilities and correct it.

Imbalanced Nutrition: Less Than Body Requirements related to Insulin deficiency, decreased oral intake, and the hypermetabolic state as evidenced by increased urine output and inadequate food intake.

Desired Outcomes; Patient will record an adequate intake of calories/nutrients. The patient will display normal energy levels. The patient will demonstrate stabilized weight in the desired range. Nursing interventions are; Review the patient’s usual pattern and dietary program to identify deviations from therapeutic needs for positive feedback. Discuss the patient’s eating habits and encourage a balanced diabetic diet to achieve the health needs of the condition. Review the diet history to identify eating habits and lifestyles that could be introduced into the meal plan by considering food preferences, eating times, and special needs. Educate the patient on avoiding alcohol with the condition as it increases the risk for DKA due to conversion to fats. Alcohol may also lead to hyperglycemia, impairing the body’s glucose production. Consult a nutritionist to assess further and recommend food preferences and nutritional support to improve dietary changes and prevent complications as the for a care plan for diabetes.

References

  • American Diabetes Association. (2004). Physical activity/exercise and diabetes. Diabetes care, 27(suppl 1), s58-s62.
  • Björnsson, E. S., Urbanavicius, V., Eliasson, B., Attvall, S., Smith, U., & Abrahamsson, H. (1994). Effects of hyperglycemia on interdigestive gastrointestinal motility in humans. Scandinavian journal of gastroenterology, 29(12), 1096-1104.
  • Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier.
  • Brunner, L. S., & Suddarth, D. S. (2004). Medical-surgical nursing. Philadelphia: Lippincott Williams & Wilkins.