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 Injury
- Peripheral sensory neuropathy
- Autonomic neuropathy
- Immune system deficit
- Vascular insufficiency
- Patient is free of injury to feet.
|Assess the general appearance of the foot.||Foot lesions and associated wound infections are the most common reason for hospitalization of the patient with DM. The patient’s feet should be meticulously inspected at every visit. The patient may be unaware of injuries to the feet as a result of decreased sensation from peripheral neuropathy. Impaired vision from DM may decrease the ability to inspect the feet.|
|Assess the status of the nails.||Fungal infections in nails serve as a portal of entry for bacteria. The patient with diabetes has an increased risk for infection because of impaired immunity. Patients with thickened or deformed nails should be referred for treatment.|
|Assess the patient’s skin integrity.||Autonomic neuropathy leads to decreased perspiration, causing excessive dryness and fissuring of the skin. Skin breakdown predisposes the patient to infection.|
|Note the presence of callus formation or corns.||Pressure over bony prominences lead to callus formation; may lead to the development of skin breakdown.|
|Assess for evidence of infection.||Infection may be the initiating event for eventual amputation. Symptoms of pain and tenderness may be absent because of neuropathy. Look for redness, drainage, and swelling.|
|Assess for edema.||Edema is a major predisposing factor to ulceration. Autonomic neuropathy results in the loss of vasomotor reflexes and swelling in the foot.|
|Instruct the patient in the principle of hygiene: wash the feet daily in warm water using mild soap; avoid soaking the feet. Dry carefully and gently, especially between toes. Use moisturizing lotion at least once daily. Avoid the area between the toes.||Maceration between the toes predisposes the patient to infection. The use of lotion replaces the moisturizing effects lost by autonomic neuropathy. The patient should select a lotion with a low alcohol content to prevent drying.|
|Instruct the patient to inspect the feet daily for cuts, scratches, and blisters. A mirror may be necessary to assess the bottom of the foot. Instruct to use both visual inspection and touch.||All surfaces of the foot need to be examined, including the skin between toes. Touch will identify skin surface alterations that are not evident by sight.|
|Teach the patient to inspect the shoes daily by feeling the inside of the shoe for irregularities or sharp objects.||Reduces the risk of injury to the foot.|
|Instruct the patient to always wear protective footwear; never go barefoot.||Keeping the feet covered to prevent injuries to the foot.|
|Instruct the patient to trim nails straight across and to file sharp corners to match the contour of the toe.||Helps avoid injury to the toes when self-care cannot be provided.|
|Instruct the patient to wear clean, well-fitting stockings made from soft cotton, synthetic blend, or wool.||Soft cotton or wool absorbs moisture from perspiration and discourages an environment in which fungus can thrive.|
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