What is Diabetes Mellitus?
Diabetes mellitus (DM) is a chronic disease characterized by insufficient production of insulin in the pancreas or when the body cannot efficiently use the insulin it produces. This leads to an increased concentration of glucose in the bloodstream (hyperglycemia). It is characterized by disturbances in carbohydrate, protein, and fat metabolism. 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.
Diabetes mellitus has a few types:
- Type 1 diabetes is characterized by destruction of the pancreatic beta cells.
- Types 2 diabetes involves insulin resistance and impaired insulin secretion.
- Gestational diabetes mellitus is when a pregnant woman experiences any degree of glucose intolerance with the onset of pregnancy.
Nursing Care Plans for Diabetes Mellitus
Nursing care planning goals for patients with diabetes include effective treatment to normalize blood glucose and decrease complications using insulin replacement, balanced diet, and exercise. The nurse should stress the importance of complying with the prescribed treatment program. Tailor your teaching to the patient’s needs, abilities, and developmental stage. Stress the effect of blood glucose control on long-term health.
Here are 13 nursing care plans (NCP) and nursing diagnoses for diabetes mellitus (DM):
- Risk for Unstable Blood Glucose
- Deficient Knowledge
- Risk for Infection
- Risk for Disturbed Sensory Perception
- Risk for Ineffective Therapeutic Regimen Management
- Risk for Injury
- Imbalanced Nutrition: Less Than Body Requirements
- Risk for Deficient Fluid Volume
- Risk for Impaired Skin Integrity
- Other Possible Nursing Care Plans
Risk for Infection
Risk factors may include
- High glucose levels, decreased leukocyte function, alterations in circulation
- Preexisting respiratory infection, or UTI
Possibly evidenced by
- [Not applicable for risk diagnosis. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.]
- Identify interventions to prevent/reduce risk of infection.
- Demonstrate techniques, lifestyle changes to prevent development of infection.
|Observe for the signs of infection and inflammation: fever, flushed appearance, wound drainage, purulent sputum, cloudy urine.||Patients with DM may be admitted with infection, which could have precipitated the ketoacidotic state. They may also develop nosocomial infection.|
|Teach and promote good hand hygiene.||Reduces risk of cross-contamination.|
|Maintain asepsis during IV insertion, administration of medications, and providing wound or site care. Rotate IV sites as indicated.||Increased glucose in the blood creates an excellent medium for bacteria to thrive.|
|Provide catheter or perineal care. Teach female patients to clean from front to back after elimination.||Minimizes the risk of UTI. A comatose patient may be at particular risk if urinary retention occurred before hospitalization. Note: Elderly female diabetic patients are especially prone to urinary tract and/or vaginal yeast infections.|
|Provide meticulous skin care: gently massage bony areas, keep skin dry. Keep linens dry and wrinkle-free.||Peripheral circulation may be ineffective or impaired, placing the patient at increased risk for skin breakdown and infection.|
|Auscultate breath sounds.||Rhonchi may indicate accumulation of secretions possibly related to pneumonia or bronchitis. Crackles may results from pulmonary congestion or edema from rapid fluid replacement or heart failure.|
|Place in semi-Fowler’s position.||Facilitates lung expansion; reduces risk of aspiration.|
|Reposition and encourage coughing or 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.||To minimizes spread of infection.|
|Encourage and assist with oral hygiene.||Reduces risk of oral/gum disease.|
|Encourage adequate dietary and fluid intake (approximately 3000 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.|
References and Sources
References and recommended sources for this care plan guide for Diabetes Mellitus:
- Ackley, B. J. (2008). Evidence-based nursing care guidelines: Medical-surgical interventions. Elsevier Health Sciences.
- Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier. [Link]
- Brunner, L. S., & Suddarth, D. S. (2004). Medical surgical nursing (Vol. 2123). Philadelphia: Lippincott Williams & Wilkins. [Link]
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. FA Davis. [Link]
- Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences. [Link]
- Rosenberg, C. S. (1990). Wound healing in the patient with diabetes mellitus. The Nursing clinics of North America, 25(1), 247-261. [Link]
- White, P. (1974). Diabetes mellitus in pregnancy. Clinics in perinatology, 1(2), 331-348.
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Endocrine and Metabolic Care Plans
Nursing care plans related to the endocrine system and metabolism:
- Acid-Base Balance
- - Respiratory Acidosis Nursing Care Plan
- - Respiratory Alkalosis Nursing Care Plan
- - Metabolic Acidosis Nursing Care Plan
- - Metabolic Alkalosis Nursing Care Plan
- Addison's Disease | 3 Care Plans
- Cushing’s Disease | 6 Care Plans
- Diabetes Mellitus Type 1 (Juvenile Diabetes) | 4 Care Plans
- Diabetes Mellitus Type 2 | 13+ Care Plans
- Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) | 4 Care Plans
- Eating Disorders: Anorexia & Bulimia Nervosa | 7 Care Plans
- Fluid and Electrolyte Imbalances | 10 Care Plans
- - Fluid Balance: Hypervolemia & Hypovolemia
- - Potassium (K) Imbalances: Hyperkalemia and Hypokalemia
- - Sodium (Na) Imbalances: Hypernatremia and Hyponatremia
- - Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia
- - Calcium (Ca) Imbalances: Hypercalcemia and Hypocalcemia
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperthyroidism | 7 Care Plans
- Hypothyroidism | 3 Care Plans
- Obesity | 4 Care Plans
- Thyroidectomy | 5 Care Plans