4 Type 1 Diabetes Mellitus Nursing Care Plans

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Type 1 diabetes mellitus (previously known as Insulin-dependent diabetes mellitus (IDDM) or juvenile DM) is a metabolic disorder caused by a lack of insulin. The deficiency is believed to happen in people who are genetically prone to the disease and who have experienced a precipitating event, commonly a viral infection or environmental change, that causes an autoimmune response affecting the insulin-producing cells (beta cells) of the pancreas.

It is treated by injection of insulin and regulation of diet and activity that maintain body functions. Complications that occur from improper coordination of these include hypoglycemia and hyperglycemia which, if untreated, lead to insulin shock or ketoacidosis. Long-term effects of the disease include neuropathy, nephropathy, retinopathy, atherosclerosis, and microangiopathy.

Nursing Care Plans

Nurses have an essential role and responsibilities when caring for a client with diabetes such as providing child and family with education about the management of hyperglycemia and hypoglycemia including insulin administration, dietary regimen, and exercise needs for the child, helping the family to adjust to having a chronic disease, and preventing short-term and long-term complications of diabetes.

Here are four (4) nursing care plans (NCP) and nursing diagnosis (NDx) for diabetes mellitus type 1:

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Deficient Knowledge

Nursing Diagnosis

Deficient Knowledge

May be related to

Lack of information about the disease condition

Possibly evidenced by

New diagnosis of IDDM
Request for information regarding the pathology, blood and urine testing, insulin therapy, activity/exercise needs, dietary regimen, personal hygiene and health promotion

Desired Outcomes

Client will verbalize understanding of IDDM.
Client and parents will demonstrate appropriate blood-glucose monitoring insulin administration, dietary management, and exercise plan.
Client and parents will identify signs and symptoms of hypoglycemia and hyperglycemia and correct response.

Nursing Interventions	Rationale
Assess parents and child understanding of disease and ability to perform procedures and care, for educational level and learning capacity, and for developmental level.	Provides information essential to develop a learning program; children ages 8 to 10 may be able to take responsibility for some of the care.
Provide a quiet, comfortable environment; allow time for teaching small amounts at a time and for reinforcement, demonstrations and return demonstration; start educating one day following diagnosis and limit sessions to 30 to 60 minutes.	Prevents distractions and facilitates learning.
Include as many family members in teaching sessions as possible.	Promotes understanding and support of family and feeling of security for the child.
Teach about the cause of disease, disease process and pathology; use pamphlets and other aids appropriate for the age of child and level of comprehension of parents.	Provides basic information that may be used as a rationale for treatments and care and allows for different teaching strategies.
Instruct parents and child in insulin administration including drawing up insulin into the syringe, rotating vial instead of shaking, drawing clear insulin first if mixing 2 types in the same syringe, injecting SC, storing insulin, rotating sites, adjusting dosages, reusing a syringe, and needle, and disposing of them.	Promotes proper technique of insulin administration to avoid complications.
Instruct in use of a syringe-loaded injector.	Provides an alternative method of insulin administration if the child is afraid of skin puncture.
Teach parents and child on how to operate a portable insulin pump to regulate insulin delivery.	Provides continuous subcutaneous insulin infusion.
Instruct parents and child to monitor blood glucose levels 4 times a day (before meals and before bed), with a lancet and blood-testing meter or a reagent strip compared to a color chart; collection and testing of urine with ketostix or Clinitest.	Monitors blood and urine for the presence of glucose and ketone.
Teach parents and child about dietary planning with an importance on proper meal times and adequate caloric intake according to age as ordered. Teach that food intake depends on activity, and describe methods to judge amounts of foods; provide a list of acceptable food items from “fast food” restaurants.	Provides information about an important aspect of the total care of the child with diabetes.
Teach parents and child about the role of exercise and changes needed in food and insulin intake with increased or decreased activity.	Provides information about common activity pattern and effect on dietary intake and insulin needs.
Teach parents and child about skin problems associated with diabetes, need for regular dental examinations, foot care, protection of and proper care of nails, prevention of infections and exposure to infections, eye examinations, immunizations.	Provides information about common complications as a result from chronic effects of the disease.
Instruct parents and child to keep a record of insulin administration, glucose monitoring, responses to diet and exercise, noncompliance in medical regimen and effects.	Provides a method to improve self-care and demonstrates the need to notify physician for treatment evaluation and possible modification.
Instruct the child to wear or carry identification and information about the disease, treatment, and physician name.	Provides information in case of an emergency.

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Next Compromised Family Coping

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses as reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of it’s evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions show how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
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Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

Nursing Care Plans

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Recommended Resources

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