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 Deficient Fluid Volume
- Risk for Deficient Fluid Volume
- Osmotic diuresis (from hyperglycemia)
- Excessive gastric losses: diarrhea, vomiting
- Restricted intake: nausea, confusion
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.]
- Demonstrate adequate hydration as evidenced by stable vital signs, palpable peripheral pulses, good skin turgor and capillary refill, individually appropriate urinary output, and electrolyte levels within normal range.
|Assess patient’s history related to duration or intensity of symptoms such as vomiting, excessive urination.||Assists in the estimation of total volume depletion. Symptoms may have been present for varying amounts of time (hours to days). The presence of the infectious process results in fever and hypermetabolic state, increasing insensible fluid losses.|
|Monitor vital signs:|
||Hypovolemia may be manifested by hypotension and tachycardia. Estimates of severity of hypovolemia may be made when patient’s systolic BP drops more than 10 mmHg from a recumbent to a sitting then a standing position. Note: Cardiac neuropathy may block reflexes that normally increase heart rate.|
||Lungs remove carbonic acid through respirations, producing a compensatory respiratory alkalosis for ketoacidosis. Acetone breath is due to breakdown of acetoacetic acid and should diminish as ketosis is corrected. Correction of hyperglycemia and acidosis will cause the respiratory rate and pattern to approach normal.|
||In contrast, increased work of breathing, shallow, rapid respirations, and presence of cyanosis may indicate respiratory fatigue and/or that patient is losing ability to compensate for acidosis.|
||Although fever, chills, and diaphoresis are common with infectious process, fever with flushed, dry skin and decreased skin turgor may reflect dehydration.|
|Assess peripheral pulses, capillary refill, and mucous membranes.||Indicators of level of hydration, adequacy of circulating volume.|
|Monitor I&O and note urine specific gravity.||Provides ongoing estimate of volume replacement needs, kidney function, and effectiveness of therapy.|
|Weigh daily.||Provides the best assessment of current fluid status and adequacy of fluid replacement.|
|Maintain fluid intake of at least 2500 mL/day within cardiac tolerance when oral intake is resumed.||Maintains hydration and circulating volume.|
|Promote comfortable environment. Cover patient with light sheets.||Avoids overheating, which could promote further fluid loss.|
|Investigate changes in mentation and LOC.||Changes in mentation can be due to abnormally high or low glucose, electrolyte abnormalities, acidosis, decreased cerebral perfusion, or developing hypoxia. Regardless of the cause, impaired consciousness can predispose patient to aspiration.|
|Insert and maintain indwelling urinary catheter.||Provides for accurate ongoing measurement of urinary output, especially if autonomic neuropathies result in neurogenic bladder (urinary retention/overflow incontinence). May be removed when patient is stable to reduce risk of infection.|
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