INTRODUCTION:

Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop responding to

the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body. Symptoms

include frequent urination, lethargy, excessive thirst, and hunger. The treatment includes changes in diet, oral

medications, and in some cases, daily injections of insulin.

The most common form of diabetes is Type II, It is sometimes called age-onset or adult-onset diabetes, and this form

of diabetes occurs most often in people who are overweight and who do not exercise. Type II is considered a milder

form of diabetes because of its slow onset (sometimes developing over the course of several years) and because it

usually can be controlled with diet and oral medication. The consequences of uncontrolled and untreated Type II

diabetes, however, are the just as serious as those for Type I. This form is also called noninsulin-dependent diabetes,

a term that is somewhat misleading. Many people with Type II diabetes can control the condition with diet and oral

medications, however, insulin injections are sometimes necessary if treatment with diet and oral medication is not

working.

The causes of diabetes mellitus are unclear, however, there seem to be both hereditary (genetic factors passed on in

families) and environmental factors involved. Research has shown that some people who develop diabetes have

common genetic markers. In Type I diabetes, the immune system, the body’s defense system against infection, is

believed to be triggered by a virus or another microorganism that destroys cells in the pancreas that produce insulin.

In Type II diabetes, age, obesity, and family history of diabetes play a role.

In Type II diabetes, the pancreas may produce enough insulin, however, cells have become resistant to the insulin

produced and it may not work as effectively. Symptoms of Type II diabetes can begin so gradually that a person may

not know that he or she has it. Early signs are lethargy, extreme thirst, and frequent urination. Other symptoms may

include sudden weight loss, slow wound healing, urinary tract infections, gum disease, or blurred vision. It is not

unusual for Type II diabetes to be detected while a patient is seeing a doctor about another health concern that is

actually being caused by the yet undiagnosed diabetes.

Individuals who are at high risk of developing Type II diabetes mellitus include people who:

are obese (more than 20% above their ideal body weight)

have a relative with diabetes mellitus

belong to a high-risk ethnic population (African-American, Native American, Hispanic, or Native Hawaiian)

have been diagnosed with gestational diabetes or have delivered a baby weighing more than 9 lbs (4 kg)

have high blood pressure (140/90 mmHg or above)

have a high density lipoprotein cholesterol level less than or equal to 35 mg/dL and/or a triglyceride level greater

than or equal to 250 mg/dL

have had impaired glucose tolerance or impaired fasting glucose on previous testing

Diabetes mellitus is a common chronic disease requiring lifelong behavioral and lifestyle changes. It is best managed

with a team approach to empower the client to successfully manage the disease. As part of the team the, the nurse

plans, organizes, and coordinates care among the various health disciplines involved; provides care and education

and promotes the client’s health and well being. Diabetes is a major public health worldwide. Its complications cause

many devastating health problems.

ANATOMY AND PHYSIOLOGY:

Every cell in the human body needs energy in order to function. The body’s primary energy source is glucose, a

simple sugar resulting from the digestion of foods containing carbohydrates (sugars and starches). Glucose from the

digested food circulates in the blood as a ready energy source for any cells that need it. Insulin is a hormone or

chemical produced by cells in the pancreas, an organ located behind the stomach. Insulin bonds to a receptor site on

the outside of cell and acts like a key to open a doorway into the cell through which glucose can enter. Some of the

glucose can be converted to concentrated energy sources like glycogen or fatty acids and saved for later use. When

there is not enough insulin produced or when the doorway no longer recognizes the insulin key, glucose stays in the

blood rather entering the cells.

PATHOPHYSIOLOGY:

Image Source: www.caninsulin.com/Pathophysiology-algorithm.htm

DIAGNOSTIC TEST:

Several blood tests are used to measure blood glucose levels, the primary test for diagnosing diabetes. Additional

tests can determine the type of diabetes and its severity.

Random blood glucose test — for a random blood glucose test, blood can be drawn at any time throughout the

day, regardless of when the person last ate. A random blood glucose level of 200 mg/dL (11.1 mmol/L) or higher

in persons who have symptoms of high blood glucose (see “Symptoms” above) suggests a diagnosis of diabetes.

Fasting blood glucose test — fasting blood glucose testing involves measuring blood glucose after not eating or

drinking for 8 to 12 hours (usually overnight). A normal fasting blood glucose level is less than 100 mg/dL. A

fasting blood glucose of 126 mg/dL (7.0 mmol/L) or higher indicates diabetes. The test is done by taking a small

sample of blood from a vein or fingertip. It must be repeated on another day to confirm that it remains abnormally

high (see “Criteria for diagnosis” below).

Hemoglobin A1C test (A1C) — The A1C blood test measures the average blood glucose level during the past two

to three months. It is used to monitor blood glucose control in people with known diabetes, but is not normally

used to diagnose diabetes. Normal values for A1C are 4 to 6 percent (show figure 3). The test is done by taking a

small sample of blood from a vein or fingertip.

Oral glucose tolerance test — Oral glucose tolerance testing (OGTT) is the most sensitive test for diagnosing

diabetes and pre-diabetes. However, the OGTT is not routinely recommended because it is inconvenient

compared to a fasting blood glucose test.

The standard OGTT includes a fasting blood glucose test. The person then drinks a 75 gram liquid glucose solution

(which tastes very sweet, and is usually cola or orange-flavored). Two hours later, a second blood glucose level is

measured.

Oral glucose tolerance testing is routinely performed at 24 to 28 weeks of pregnancy to screen for gestational

diabetes; this requires drinking a 50 gram glucose solution with a blood glucose level drawn one hour later. For

women who have an abnormally elevated blood glucose level, a second OGTT is performed on another day after

drinking a 100 gram glucose solution. The blood glucose level is measured before, and at one, two, and three hours

after drinking the solution.

MEDICATIONS:

When diet, exercise and maintaining a healthy weight aren’t enough, you may need the help of medication.

Medications used to treat diabetes include insulin. Everyone with type 1 diabetes and some people with type 2

diabetes must take insulin every day to replace what their pancreas is unable to produce. Unfortunately, insulin can’t

be taken in pill form because enzymes in your stomach break it down so that it becomes ineffective. For that reason,

many people inject themselves with insulin using a syringe or an insulin pen injector,a device that looks like a pen,

except the cartridge is filled with insulin. Others may use an insulin pump, which provides a continuous supply of

insulin, eliminating the need for daily shots.

The most widely used form of insulin is synthetic human insulin, which is chemically identical to human insulin but

manufactured in a laboratory. Unfortunately, synthetic human insulin isn’t perfect. One of its chief failings is that it

doesn’t mimic the way natural insulin is secreted. But newer types of insulin, known as insulin analogs, more closely

resemble the way natural insulin acts in your body. Among these are lispro (Humalog), insulin aspart (NovoLog) and

glargine (Lantus).

A number of drug options exist for treating type 2 diabetes, including:

· Sulfonylurea drugs. These medications stimulate your pancreas to produce and release more insulin. For them to

be effective, your pancreas must produce some insulin on its own. Second-generation sulfonylureas such as glipizide

(Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase PresTab, Micronase) and glimepiride (Amaryl) are prescribed

most often. The most common side effect of sulfonylureas is low blood sugar, especially during the first four months

of therapy. You’re at much greater risk of low blood sugar if you have impaired liver or kidney function.

· Meglitinides. These medications, such as repaglinide (Prandin), have effects similar to sulfonylureas, but you’re not

as likely to develop low blood sugar. Meglitinides work quickly, and the results fade rapidly.

· Biguanides. Metformin (Glucophage, Glucophage XR) is the only drug in this class available in the United States. It

works by inhibiting the production and release of glucose from your liver, which means you need less insulin to

transport blood sugar into your cells. One advantage of metformin is that is tends to cause less weight gain than do

other diabetes medications. Possible side effects include a metallic taste in your mouth, loss of appetite, nausea or

vomiting, abdominal bloating, or pain, gas and diarrhea. These effects usually decrease over time and are less likely

to occur if you take the medication with food. A rare but serious side effect is lactic acidosis, which results when lactic

acid builds up in your body. Symptoms include tiredness, weakness, muscle aches, dizziness and drowsiness. Lactic

acidosis is especially likely to occur if you mix this medication with alcohol or have impaired kidney function.

· Alpha-glucosidase inhibitors. These drugs block the action of enzymes in your digestive tract that break down

carbohydrates. That means sugar is absorbed into your bloodstream more slowly, which helps prevent the rapid rise

in blood sugar that usually occurs right after a meal. Drugs in this class include acarbose (Precose) and miglitol

(Glyset). Although safe and effective, alpha-glucosidase inhibitors can cause abdominal bloating, gas and diarrhea. If

taken in high doses, they may also cause reversible liver damage.

· Thiazolidinediones. These drugs make your body tissues more sensitive to insulin and keep your liver from

overproducing glucose. Side effects of thiazolidinediones, such as rosiglitazone (Avandia) and pioglitazone

hydrochloride (Actos), include swelling, weight gain and fatigue. A far more serious potential side effect is liver

damage. The thiazolidinedione troglitzeone (Rezulin) was taken off the market in March 2000 because it caused liver

failure. If your doctor prescribes these drugs, it’s important to have your liver checked every two months during the

first year of therapy. Contact your doctor immediately if you experience any of the signs and symptoms of liver

damage, such as nausea and vomiting, abdominal pain, loss of appetite, dark urine, or yellowing of your skin and the

whites of your eyes (jaundice). These may not always be related to diabetes medications, but your doctor will need to

investigate all possible causes.

· Drug combinations. By combining drugs from different classes, you may be able to control your blood sugar in

several different ways. Each class of oral medication can be combined with drugs from any other class. Most doctors

prescribe two drugs in combination, although sometimes three drugs may be prescribed. Newer medications, such as

Glucovance, which contains both glyburide and metformin, combine different oral drugs in a single tablet.

NURSING INTERVENTIONS:

Advice patient about the importance of an individualized meal plan in meeting weekly weight loss goals and assist

with compliance.

Assess patients for cognitive or sensory impairments, which may interfere with the ability to accurately administer

insulin.

Demonstrate and explain thoroughly the procedure for insulin self-injection. Help patient to achieve mastery of

technique by taking step by step approach.

Review dosage and time of injections in relation to meals, activity, and bedtime based on patients individualized

insulin regimen.

Instruct patient in the importance of accuracy of insulin preparation and meal timing to avoid hypoglycemia.

Explain the importance of exercise in maintaining or reducing weight.

Advise patient to assess blood glucose level before strenuous activity and to eat carbohydrate snack before

exercising to avoid hypoglycemia.

Assess feet and legs for skin temperature, sensation, soft tissues injuries, corns, calluses, dryness, hair

distribution, pulses and deep tendon reflexes.

Maintain skin integrity by protecting feet from breakdown.

Advice patient who smokes to stop smoking or reduce if possible, to reduce vasoconstriction and enhance

peripheral flow

Pathophysiology of Diabetes Mellitus

Risk for Infection — Diabetes Mellitus

Nursing Diagnosis:  Risk for Infection

Risk factors may include:

High glucose levels, decreased leukocyte function, alterations in circulation Preexisting respiratory infection, or UTIDesired Outcomes:

Identify interventions to prevent/reduce risk of infection. Demonstrate techniques, lifestyle changes to prevent development of infection.

Nursing Interventions Rationale

Observe for signs of infection and inflammation, e.g., fever, flushed appearance, wound drainage, purulent sputum, cloudy urine.

Patient may be admitted with infection, which could have precipitated the ketoacidotic state, or may develop a nosocomial infection.

Promote good handwashing by staff and patient.

Reduces risk of cross-contamination.

Maintain aseptic technique for IV insertion procedure, administration of medications, and providing maintenance/site care. Rotate IV sites as indicated.

High glucose in the blood creates an excellent medium for bacterial growth.

Provide catheter/perineal care. Teach the female patient to clean from front to back after elimination

Minimizes risk of UTI. Comatose patient may be at particular risk if urinary retention occurred before hospitalization. Note: Elderly female diabetic patients are especially prone to urinary tract/vaginal yeast infections.

Provide conscientious skin care; gently massage bony areas. Keep the skin dry, linens dry and wrinkle-free.

Peripheral circulation may be impaired, placing patient at increased risk for skin irritation/breakdown and infection.

Auscultate breath sounds. Rhonchi indicate accumulation of secretions possibly related to pneumonia/bronchitis (may have precipitated the DKA). Pulmonary congestion/edema (crackles) may result from rapid fluid replacement/HF.

Place in semi-Fowler’s position. Facilitates lung expansion; reduces risk of aspiration.

Reposition and encourage coughing/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.

Minimizes spread of infection.

Encourage/assist with oral hygiene. Reduces risk of oral/gum disease.

Encourage adequate dietary and fluid intake (approximately3000 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.

Risk for Disturbed Sensory Perception — Diabetes MellitusNursing Diagnosis: Sensory Perception, risk for disturbed (specify)

Risk factors may include

Endogenous chemical alteration: glucose/insulin and/or electrolyte imbalanceDesired Outcomes

Maintain usual level of mentation. Recognize and compensate for existing sensory impairments.

Nursing Interventions Rationale

 Monitor vital signs and mental

status.

 Provides a baseline from which to

compare abnormal findings, e.g.,

fever may affect mentation.

Address patient by name; reorient as

needed to place, person, and time.

Give short explanations, speaking

slowly and enunciating clearly.

 Decreases confusion and helps

maintain contact with reality.

 Schedule nursing time to provide for

uninterrupted rest periods.

 Promotes restful sleep, reduces

fatigue, and may improve cognition.

Keep patient’s routine as consistent

as possible. Encourage participation

in activities of daily living (ADLs) as

 Helps keep patient in touch with

reality and maintain orientation to

able. the environment.

 Protect patient from injury

(avoid/limit use of restraints as able)

when level of consciousness is

impaired. Place bed in low position.

Pad bed rails and provide soft airway

if patient is prone to seizures.

 Disoriented patient is prone to

injury, especially at night, and

precautions need to be taken as

indicated. Seizure precautions need

to be taken as appropriate to prevent

physical injury, aspiration.

 Evaluate visual acuity as indicated.  Retinal edema/detachment,

hemorrhage, presence of cataracts or

temporary paralysis of extraocular

muscles may impair vision, requiring

corrective therapy and/or supportive

care.

 Investigate reports of hyperesthesia,

pain, or sensory loss in the feet/legs.

Look for ulcers, reddened areas,

pressure points, loss of pedal pulses.

 Peripheral neuropathies may result

in severe discomfort, lack

of/distortion of tactile sensation,

potentiating risk of dermal injury and

impaired balance.

 Provide bed cradle. Keep hands/feet

warm, avoiding exposure to cool

drafts/hot water or use of heating

pad.

 Reduces discomfort and potential for

dermal injury.

 Assist with ambulation/position

changes.

 Promotes patient safety, especially

when sense of balance is affected.

 Monitor laboratory values, e.g.,

blood glucose, serum osmolality,

Hb/Hct, BUN/Cr.

 Imbalances can impair mentation.

Note: If fluid is replaced too quickly,

excess water may enter brain cells

and cause alteration in the level of

consciousness (water intoxication).

 Carry out prescribed regimen for

correcting DKA as indicated.

 Alteration in thought

processes/potential for seizure

activity is usually alleviated once

hyperosmolar state is corrected.

Powerlessness — Diabetes Mellitus

Nursing Diagnosis: Powerlessness

May be related to

Long-term/progressive illness that is not curable Dependence on othersPossibly evidenced by

Reluctance to express true feelings; expressions of having no control/influence over situation Apathy, withdrawal, anger Does not monitor progress, nonparticipation in care/decision making Depression over physical deterioration/complications despite patient cooperation with regimenDesired Outcomes: 

Acknowledge feelings of helplessness. Identify healthy ways to deal with feelings. Assist in planning own care and independently take responsibility for self-care activities.

Nursing Interventions Rationale

 Encourage patient/SO to express

feelings about hospitalization and

disease in general.

Identifies concerns and facilitates

problem solving.

Acknowledge normality of feelings.  Recognition that reactions are

normal can help patient problem-

solve and seek help as needed.

Diabetic control is a full-time job that

serves as a constant reminder of

both presence of disease and threat

to patient’s health/life.

 Assess how patient has handled  Knowledge of individual’s style helps

problems in the past. Identify locus of

control.

determine needs for treatment goals.

Patient whose locus of control is

internal usually looks at ways to gain

control over own treatment program.

Patient who operates with an

external locus of control wants to be

cared for by others and may project

blame for circumstances onto

external factors.

 Provide opportunity for SO to

express concerns and discuss ways

in which he or she can be helpful to

patient.

 Enhances sense of being involved

and gives SO a chance to problem-

solve solutions to help patient

prevent recurrence.

 Ascertain expectations/goals of

patient and SO.

 Unrealistic expectations/pressure

from others or self may result in

feelings of frustration/loss of control

and may impair coping abilities.

 Determine whether a change in

relationship with SO has occurred.

 Constant energy and thought

required for diabetic control often

shifts the focus of a relationship.

Development of psychological

concerns/visceral neuropathies

affecting self-concept (especially

sexual role function) may add further

stress.

 Encourage patient to make decisions

related to care, e.g., ambulation,

time for activities, and so forth.

 Communicates to patient that some

control can be exercised over care.

 Support participation in self-care and

give positive feedback for efforts.

 Promotes feeling of control over

situation.

Imbalanced Nutrition Less Than Body Requirements — Diabetes Mellitus

Nursing Diagnosis: Imbalanced Nutrition Less Than Body Requirements

May be related to:

Insulin deficiency (decreased uptake and utilization of glucose by the tissues, resulting in increased protein/fat metabolism) Decreased oral intake: anorexia, nausea, gastric fullness, abdominal pain; altered consciousness Hypermetabolic state: release of stress hormones (e.g., epinephrine, cortisol, and growth hormone), infectious processPossibly evidenced by:

Increased urinary output, dilute urine Reported inadequate food intake, lack of interest in food Recent weight loss; weakness, fatigue, poor muscle tone Diarrhea Increased ketones (end product of fat metabolism)Desired Outcomes: 

Ingest appropriate amounts of calories/nutrients. Display usual energy level. Demonstrate stabilized weight or gain toward usual/desired range with normal laboratory values.

Nursing Interventions Rationale

Weigh daily or as indicated. Assesses adequacy of nutritional

intake (absorption and utilization).

Ascertain patient’s dietary program

and usual pattern; compare with

recent intake.

Identifies deficits and deviations from

therapeutic needs.

Auscultate bowel sounds. Note

reports of abdominal pain/bloating,

nausea, vomiting of undigested food.

Maintain nothing by mouth (NPO)

status as indicated.

Hyperglycemia and fluid and

electrolyte disturbances can

decrease gastric motility/function

(distension or ileus), affecting choice

of interventions. Note: Long-term

difficulties with decreased gastric

emptying and poor intestinal motility

suggest autonomic neuropathies

affecting the GI tract and requiring

symptomatic treatment.

Provide liquids containing nutrients

and electrolytes as soon as patient

can tolerate oral fluids; progress to

more solid food as tolerated.

Oral route is preferred when patient

is alert and bowel function is

restored.

Identify food preferences, including

ethnic/cultural needs.

If patient’s food preferences can be

incorporated into the meal plan,

cooperation with dietary

requirements may be facilitated after

discharge.

Include SO in meal planning as

indicated.

Promotes sense of involvement;

provides information for SO to

understand nutritional needs of

patient. Note:Various methods

available or dietary planning include

exchange list, point system, glycemic

index, or preselected menus.

Observe for signs of hypoglycemia,

e.g., changes in level of

consciousness, cool/clammy skin,

rapid pulse, hunger, irritability,

anxiety, headache, lightheadedness,

shakiness.

Once carbohydrate metabolism

resumes (blood glucose level

reduced) and as insulin is being

given, hypoglycemia can occur. If

patient is comatose, hypoglycemia

may occur without notable change in

level of consciousness (LOC). This

potentially life-threatening

emergency should be assessed and

treated quickly per protocol. Note:

Type 1 diabetics of long standing

may not display usual signs of

hypoglycemia because normal

response to low blood sugar may be

diminished.

Perform fingerstick glucose testing. Bedside analysis of serum glucose is

more accurate (displays current

levels) than monitoring urine sugar,

which is not sensitive enough to

detect fluctuations in serum levels

and can be affected by patient’s

individual renal threshold or the

presence of urinary retention/renal

failure. Note: Some studies have

found that a urine glucose of 20%

may be correlated to a blood glucose

of 140–360 mg/dL.

Administer regular insulin by

intermittent or continuous IV method,

e.g., IV bolus followed by a

continuous drip via pump of

approximately 5–10 U/hr so that

glucose is reduced by 50 mg/dL/hr.

Regular insulin has a rapid onset and

thus quickly helps move glucose into

cells. The IV route is the initial route

of choice because absorption from

subcutaneous tissues may be erratic.

Many believe the continuous method

is the optimal way to facilitate

transition to carbohydrate

metabolism and reduce incidence of

hypoglycemia.

Administer glucose solutions, e.g.,

dextrose and half-normal saline.

Glucose solutions may be added after

insulin and fluids have brought the

blood glucose to approximately 400

mg/dL. As carbohydrate metabolism

approaches normal, care must be

taken to avoid hypoglycemia.

Provide diet of approximately 60%

carbohydrates, 20% proteins, 20%

fats in designated number of

meals/snacks.

Complex carbohydrates (e.g., corn,

peas, carrots, broccoli, dried beans,

oats, apples) decrease glucose

levels/insulin needs, reduce serum

cholesterol levels, and promote

satiation. Food intake is scheduled

according to specific insulin

characteristics (e.g., peak effect) and

individual patient response. Note:A

snack at bedtime (hs) of complex

carbohydrates is especially important

(if insulin is given in divided doses) to

prevent hypoglycemia during sleep

and potential Somogyi response. <

Administer other medications as

indicated, e.g., metoclopramide

(Reglan); tetracycline.

May be useful in treating symptoms

related to autonomic neuropathies

affecting GI tract, thus enhancing

oral intake and absorption of

nutrients.

Fatigue — Diabetes Mellitus

Nursing Diagnosis:  Fatigue

May be related to

Decreased metabolic energy production Altered body chemistry: insufficient insulin Increased energy demands: hypermetabolic state/infectionPossibly evidenced by

Overwhelming lack of energy, inability to maintain usual routines, decreased performance, accident-prone Impaired ability to concentrate, listlessness, disinterest in surroundingsDesired Outcomes

Verbalize increase in energy level. Display improved ability to participate in desired activities.

Nursing Interventions Rationale

 Discuss with patient the need for

activity. Plan schedule with patient

and identify activities that lead to

 Education may provide motivation to

increase activity level even though

fatigue. patient may feel too weak initially.

Alternate activity with periods of

rest/uninterrupted sleep.

 Prevents excessive fatigue.

Monitor pulse, respiratory rate, and

BP before/after activity.

 Indicates physiological levels of

tolerance.

 Discuss ways of conserving energy

while bathing, transferring, and so

on.

 Patient will be able to accomplish

more with a decreased expenditure

of energy.

 Increase patient participation in

ADLs as tolerated.

 Increases confidence level/self-

esteem and tolerance level.

Nursing Diagnosis and Nursing Intervention

Fluid volume deficient related to osmotic diuresis from hyperglycemia

Planning

After 8 hours of nursing interventions, the patient will demonstrate adequate hydration.

Intervention

Monitor orthostatic blood pressure changes.Rational : Hypovolemia may be manifested by hypotension and tachycardia.

Assess peripheral pulses, capillary refill, skin turgor, and mucous membrane.Rational : Indicators of level of dehydration, adequacy of circulating volume.

Monitor respiratory pattern like Kussmaul’s respirations and acetone breath.Rational : Lungs remove carbonic acid through respirations, producing a compensatory respiratory alkalosis for ketoacidosis.

Monitor input and output. Note urine specific gravity.Rational : Provides ongoing estimate of volume replacement needs, kidney function, and effectiveness of therapy.

Promote comfortable environment. Cover patient with light sheets.Rational : Avoids overheating, which could promote further fluid loss.

Monitor temperature, skin color and moisture.Rational : Fever, chills, and diaphoresis are common with infectious process; fever with flushed, dry skin may reflect dehydration.

3 Nursing Care Plan Diabetes Mellitus - Diagnosis, Interventions and RationalNursing Diagnosis for Diabetes Mellitus

1. Nursing Diagnosis : Fluid Volume Deficit related to osmotic diuresis.

Goal:Demonstrate adequate hydration evidenced by stable vital signs, palpable peripheral pulse, skin turgor and capillary refill well, individually appropriate urinary output, and electrolyte levels within normal limits.

Nursing Intervention:1.) Monitor vital signs.Rational: hypovolemia can be manifested by hypotension and tachycardia.2.) Assess peripheral pulses, capillary refill, skin turgor, and mucous membranes.Rational: This is an indicator of the level of dehydration, or an adequate circulating volume.3.) Monitor input and output, record the specific gravity of urine.Rational: To provide estimates of the need for fluid replacement, renal function, and effectiveness of the therapy given.4.) Measure weight every day.Rational: To provide the best assessment of fluid status of ongoing and further to provide a replacement fluid.5.) Provide fluid therapy as indicated.Rational: The type and amount of liquid depends on the degree of lack of fluids and the response of individual patients.

2. Nursing Diagnosis : Imbalanced Nutrition Less than Body Requirmentsrelated to insufficiency of insulin, decreased oral input.

Goal:Digest the amount of calories / nutrients rightShows the energy level is usuallyStable 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.Rationale: Identify deficiencies and deviations from the therapeutic needs.2.) Weigh weight per day or as indicated.Rational: Assessing an adequate food intake (including absorption and utilization).3.) Identification of preferred food / desired include the needs of ethnic / cultural.Rational: If the patient's food preferences can be included in meal planning, this cooperation can be pursued after discharge.4.) Involve patients in planning the family meal as indicated.Rationale: Increase the sense of involvement; provide information on the family to understand the patient's nutrition.5.) Give regular insulin treatment as indicated.Rational: regular insulin has a rapid onset and quickly and therefore can help move glucose into cells.

c. Nursing Diagnosis : Risk for Infection related to hyperglikemia.

Goal:Identify interventions to prevent / reduce the risk of infection.Demonstrate techniques, lifestyle changes to prevent infection.

Nursing Intervention:1). Observed signs of infection and inflammation.Rationale: Patients may be entered with an infection that usually has sparked a state of ketoacidosis or may have nosocomial infections.2). Improve efforts to prevention by good hand washing for all people in contact with patients including the patients themselves.Rationale: Prevents cross infection.3). Maintain aseptic technique in invasive procedures.Rational: high glucose levels in blood would be the best medium for the growth of germs.4). Give your skin with regular care and earnest.Rational: the peripheral circulation may be disturbed that puts patients at increased risk of damage to the skin / skin irritation and infection.5). Make changes to the position, effective coughing and encourage deep breathing.Rational: memventilasi Assist in all areas and mobilize pulmonary secretions.