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3 Nursing Care Plan Diabetes Mellitus

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  3 Nursing Care Plan Diabetes Mellitus - Diagnosis, Interventions and Rational Nursing Diagnosis for Diabetes Mellitus1. Nursing Diagnosis : Fluid Volue Defi!it  related to osmotic diuresis.Goal:Demonstrate adequate hydration evidenced by stable vital signs, palpable peripheral pulse, skinturgor and capillary refill well, individually appropriate urinary output, and electrolyte levels withinnormal limits. Nursing Intervention: 1.) onitor vital signs.!ational: hypovolemia can be manifested by hypotension and tachycardia. .) #ssess peripheral pulses, capillary refill, skin turgor, and mucous membranes.!ational: $his is an indicator of the level of dehydration, or an adequate circulating volume.%.) onitor input and output, record the specific gravity of urine.!ational: $o provide estimates of the need for fluid replacement, renal function, and effectiveness of the therapy given.&.) easure weight every day.!ational: $o provide the best assessment of fluid status of ongoing and further to provide a replacement fluid.'.) (rovide fluid therapy as indicated.!ational: $he type and amount of liquid depends on the degree of lack of fluids and the response of individual patients. . Nursing Diagnosis : Ibalan!ed Nutrition #ess t$an %od& Re'uirents related to insufficiency of insulin, decreased oral input.Goal:Digest the amount of calories  nutrients right*hows the energy level is usually*table or increasing weight. Nursing Intervention: 1.) Determine the patient+s diet and eating patterns and compared with food that can be spent by the patient.!ationale: dentify deficiencies and deviations from the therapeutic needs. .) -eigh weight per day or as indicated.!ational: #ssessing an adequate food intake including absorption and utili/ation).%.) dentification of preferred food  desired include the needs of ethnic  cultural.!ational: f the patient+s food preferences can be included in meal planning, this cooperation can be pursued after discharge.&.) nvolve patients in planning the family meal as indicated.!ationale: ncrease the sense of involvement0 provide information on the family to understand the patient+s nutrition.'.) Give regular insulin treatment as indicated.!ational: regular insulin has a rapid onset and quickly and therefore can help move glucose intocells.  c. Nursing Diagnosis : Ris( for Infe!tion  related to hyperglikemia.Goal:dentify interventions to prevent  reduce the risk of infection.Demonstrate techniques, lifestyle changes to prevent infection.ursing ntervention:1). 2bserved signs of infection and inflammation.!ationale: (atients may be entered with an infection that usually has sparked a state of ketoacidosis or may have nosocomial infections. ). mprove efforts to prevention by good hand washing for all people in contact with patients including the patients themselves.!ationale: (revents cross infection.%). aintain aseptic technique in invasive procedures.!ational: high glucose levels in blood would be the best medium for the growth of germs.&). Give your skin with regular care and earnest.!ational: the peripheral circulation may be disturbed that puts patients at increased risk of damage to the skin  skin irritation and infection.'). ake changes to the position, effective coughing and encourage deep breathing.!ational: memventilasi #ssist in all areas and mobili/e pulmonary secretions.   Diabetes Mellitus)DM* Nursing Care Plan Nursing Diagnosis+be!tivesNursingInterventionsRationalevaluation 3luid 4olume Deficient !egulatory 3ailure)(ossible 5tiologies: !elated to) ã 6ncontrolled diabetes mellitus7 2smotic dieresis fromhyperglycemia7 58cessive gastric loss diarrhea and vomiting)7 !estricted or low fluidintake due to nausea or confusionDefining characteristics: 5videnced by) ã *tatements of fatigue and nervousness ã ncreased urinary output ã 9oncentrated urine ã -eakness ã $hirst ã *udden weight *hort term goal: 9lient will maintain hydration at a functional level as evidenced by adequate urine output, stable vital signs, palpable peripheral pulses, good skin turgor and capillary refill, and electrolyte levels within normal range. ong term goal: 9lient will demonstrate behaviours to monitor and correct deficit as indicated. 1. 2btain history for intensity and duration of symptoms such as vomiting and e8cessive urination.  . onitor the vital signs like:a. 2rthostatic ;(changesb. !espiratory changes i.e. <ussmaul=s respiration, acetone breathc. !espiratory rate and quality0 use of accessorymuscles, periodsof apnea, and cyanosisd. $emperature, skin turgor %. 9heck peripheral pulses, capillary 7 >elps in making appro8imation of totalvolume loss. *ymptoms may be present for hours or days and presence of other diseases usually result, too, to increase in sensible fluid losses.7 >ypovolemia can bemanifested by hypotension and tachycardia0 9arbonicacid is removed in thelungs through respiration and producing respiratory alkalosis for ketoacidosis0 #cetonebreath is due to acetoacetic acid and should disappear when condition is corrected0 9yanosis, apnea and increase in respiratory effort may be due to compensation from acidosis0 3ever with flushed skin reflects dehydration.7 $hese are indicators9lient=s hydration status will resume to afunctional level through demonstrating a clear7 colored urine appro8imately 1?? cc in amount and reflecting the same appro8imate amount of intake0 less occurrence of posturalhypotension with ;( ranging from 1 ?@?mm>g to 11?A?mm>g0 palpable peripheral pulses in synchronouswith cardiac rate of @? B C' beats per minute0 good skin turgor and capillary refill of less than seconds0 and sodium and potassium levels within normal range after one week of nursing care. 9lient will be able to know and perform activities helpful in controlling diabetes  loss ã (oor skin turgor dry skin and mucous membranes ã >ypotension ã ncreased pulse rate ã Decreased pulse volume and pressure delayed capillary refill ã 9hange in mental state refill, and for skinturgor.&. *trictly monitor the intake and the output.'. 5ncourage client to take at least '??ml day.. -eigh client daily or as indicated.A. nvestigate changes in mentation.@. #dminister fluid replacement measures are prescribed by the physician.C. nsert and maintain a catheter as indicated.1?. onitor laboratory results i.e. hematocrit, ;6 creatinine, for the hydration status of a client and so as the circulating volume in the body.7 Gives baseline data of client=s hydration status and to know the appro8imation of fluid replacement0 thefunction of kidney andthe effectiveness of the fluid replacement therapy.7 t maintains hydration level in the functional state.7 t provides the current fluid status and adequacy of fluid replacement.7 9hanges in mentation reflect abnormally high or low glucose level, acidosis, electrolyte imbalances and decreased cerebral perfusion.7 $he type and amount of fluid depend on the degreeof dehydration.mellitus and maintaining adequate fluid volume like monitoring blood glucose periodically, administering own medications like insulin inEection, increasing fluid intake and monitoring urine for presence of ketones, and other activities like proper diet, e8ercise and lifestyle. 
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