Tyerman: Lewis's Medical-Surgical Nursing in Canada, 5th Edition

Chapter 52: Nursing Management: Diabetes Mellitus

Care Plans - Customizable

NCP 52-1: Nursing Care Plan: Patient With Diabetes Mellitus

NURSING DIAGNOSIS Ineffective health management related to insufficient

knowledge of therapeutic regimen as evidenced by
difficulty with prescribed regimen, failure to include
treatment regimen in daily living
Expected Patient Outcomes Nursing Interventions and Rationales
• Verbalizes key elements of the Teaching: Disease process
therapeutic regimen, including • Appraise the patient’s current level of
knowledge of the disease and knowledge related to the specific disease
treatment plan process to determine the scope and extent of
required teaching.
• Describe the disease process and therapy or
treatment recommendations to enable the
patient to better understand the rationale for
the treatment regimen and lifestyle changes.
• Instruct the patient on measures to prevent or
minimize symptoms to promote management of
the disease.
• Discuss lifestyle changes that may be required
to prevent future complications and control the
disease process to encourage the patient to
actively participate in determining changes that
will be acceptable.
• Describe possible chronic complications as
appropriate to increase awareness of the long-
term effects of inadequate control of the disease

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Care Plans - Customizable 52-2

process.
• Plan an individualized exercise program with
the patient because exercise is an integral part
of diabetes management.
• Review the steps to prevent hyperglycemia and
hypoglycemia because activity changes can
cause changes in insulin needs.
• Instruct the patient on which signs and
symptoms to report to the health care provider
to ensure prompt treatment.
• Review insulin administration (if used); have
the patient give a return demonstration of
insulin injection to ensure proper technique.
• Review the OHA regimen; have the patient
explain the timing and purpose of medication to
ensure understanding.
• Refer the patient to local community agencies
or support groups to provide continuing support
and education.

NURSING DIAGNOSIS Readiness for enhanced nutrition as evidenced by

expressed desire to enhance nutrition
Expected Patient Outcomes Nursing Interventions and Rationales
• Maintains a balance of nutrition, Teaching: Prescribed diet
activity, and insulin availability • Determine the patient’s or caregiver’s feelings
that results in normal blood and attitude toward the prescribed diet and the
glucose levels and optimum expected degree of dietary compliance to
weight determine the patient’s readiness to learn.
• Assist the patient to accommodate food
preferences in the prescribed diet to improve
adherence.

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Care Plans - Customizable 52-3

• Refer the patient and significant other to a

dietitian or nutritionist to provide continuing
diet education and evaluation.
Teaching: Prescribed activity and exercise
• Inform the patient of the purpose for, and the
benefits of, the prescribed activity and exercise
to improve his or her commitment to activity.
• Instruct the patient how to monitor tolerance of
the activity and exercise to prevent injury.
• Assist the patient to incorporate an activity and
exercise regimen into his or her daily routine or
lifestyle because it is an integral part of
diabetes control.
Hyperglycemia management
• Monitor for signs and symptoms of
hyperglycemia: polyuria, polydipsia,
polyphagia, weakness, lethargy, malaise,
blurring of vision, or headache to alert the
patient to a glucose–insulin imbalance and
need for treatment.
• Anticipate situations in which insulin
requirements will increase (e.g., illness) to
allow the patient to adjust the insulin dosage
appropriately and avoid undue fatigue.
• Facilitate adherence to the diet and exercise
regimen to promote diabetes control.
• Restrict exercise when blood glucose levels are
>14 mmol/L, especially when ketones are
present, to decrease the body’s requirement for
already unavailable glucose.

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Care Plans - Customizable 52-4

NURSING DIAGNOSIS Risk for injury as evidenced by compromised

nutritional source, physical barrier (decreased tactile
sensation)
Expected Patient Outcomes Nursing Interventions and Rationales
• Experiences no injury resulting Teaching: Foot care
from decreased sensation in feet • Perform a comprehensive foot assessment for
• Experiences no injury resulting neuropathy using a 10-g monofilament or 128-
from hypoglycemia Hz tuning fork to establish baseline findings.
• Provide information regarding the relationship
between neuropathy, injury, and vascular
disease and the risk for ulceration and lower
extremity amputation in people with diabetes to
promote commitment to care.
• Caution about potential sources of injury to the
feet (e.g., heat, cold, cutting corns or calluses,
chemicals, use of strong antiseptics or
astringents, use of adhesive tape, and going
barefoot or wearing thongs, open-toe shoes, or
ill-fitting shoes) to prevent injury to the feet.
• Instruct the individual to inspect the inside of
shoes daily for foreign objects, nail points, torn
linings, and rough areas to avoid injury by
factors that are not felt.
• Recommend specialist care for thick fungal or
ingrown toenails, corns, or calluses to ensure
the safe treatment of feet.
Hypoglycemia management
• Monitor for signs and symptoms of
hypoglycemia to alert the patient to a glucose–
insulin imbalance and the need for treatment.
• Determine the patient’s recognition of

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Care Plans - Customizable 52-5

hypoglycemia signs and symptoms to assess his

or her learning needs.
• Instruct the patient to have simple carbohydrate
available at all times to treat hypoglycemia.
• Instruct the patient to obtain and carry or wear
appropriate emergency identification to
facilitate treatment by others.

NURSING DIAGNOSIS Risk for peripheral neurovascular dysfunction

(related to the vascular effects of diabetes)
Expected Patient Outcomes Nursing Interventions and Rationales
• Verbalizes the effects of diabetes Circulatory care: arterial insufficiency
on peripheral artery circulation • Perform a comprehensive appraisal of
• Implements measures to increase peripheral circulation (e.g., check peripheral
peripheral circulatory status pulses, edema, capillary refill, colour, and
• Experiences no injury to feet temperature) to establish baseline findings.
from impaired circulation • Inspect the skin for arterial ulcers or tissue
breakdown to provide treatment and to prevent
infection and additional necrosis.
• Protect the extremity from injury (e.g.,
sheepskin under feet and lower legs in bed,
footboard or bed cradle at foot of bed; well-
fitted shoes) to prevent conditions that favour
skin breakdown.
• Maintain adequate hydration to decrease blood
viscosity.
• Encourage the patient to obtain exercise as
tolerated to increase peripheral circulation.
• Instruct the patient on factors that interfere with
circulation (e.g., smoking, restrictive clothing,
exposure to cold temperatures, crossing of legs

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Care Plans - Customizable 52-6

and feet) to prevent impairment of circulation.

• Instruct the patient on proper foot care,
including footwear, to prevent injury and
infection.

OHA, oral antihyperglycemic agent

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