Diabetes mellitus is a metabolic disease characterized by dysregulation of carbohydrate, protein, and lipid metabolism.

The primary
feature of this disorder is elevation in blood glucose levels (hyperglycemia), resulting from either a defect in insulin secretion from the
pancreas, a change in insulin action, or both. 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.
1. Deficient FIuid VoIume
Glucose appears in the urine (glycosuria) because the kidney excretes the excess glucose to make the blood glucose level normal.
Glucose excreted in the urine acts as osmotic diuretic and causes excretion of increased amount of water, resulting in fluid volume deficit
or polyuria.
Assessment Nursing
Diagnosis
Planning Nursing
Interventions
Rationale Evaluation
Subjective:(none)
Objective:
elevated temperature
of 38.4C/axilla
increased urine output.
sweating of the skin
thirst
exhaustion
weight loss
dry skin or mucous
membrane
Deficient
Fluid Volume
r/t
intracellular
DHN 2 the
DM II
Short Term:After 3 of
NI, patient shall have
verbalized
understanding of
causative factors and
purpose of individual
therapeutic
interventions and
medications.Long
Term:After 2 days of
NI, the patient shall
have maintained fluid
volume at a functional
level as evidenced by
individual good skin
turgor, moist mucous
membrane and stable
vital signs.
Establish rapportTake
and record vital
signsMonitor the
temperature
Assess skin turgor
and mucous
membranes for signs
of dehydration
Encourage the
patient to increase
fluid intake
Administer IVF as
ordered by the
Doctor
Administer anti-
pyretic as prescribed
by the Doctor.
Friendly
relationship with
patient and to be
able to each
others concernTo
obtain baseline
dataTo monitor
changes in
temperature
Dry skin and
mucous
membranes are
signs of
dehydration
To replace fluid
loss and prevent
dehydration
To replace
electrolytes and
fluid loss
To decrease body
temperature and
will have less
occurrence of
dehydration.
Short Term:After
3 of NI, patient
will have verbalized
understanding of
causative factors
and purpose of
individual
therapeutic
interventions and
medications.Long
Term:After 2 days
of NI, the patient
will have
maintained fluid
volume at a
functional level as
evidenced by
individual good skin
turgor, moist
mucous membrane
and stable vital
signs
-~~~~~~~~~~~~-
. ImbaIanced Nutrition: Less Than
Body Requirements
Due to decrease of lack of insulin in the body, the glucose level continuously rises because glucose cant be utilized without the presence
of insulin. Glucose is the source of energy, while insulin is the vehicle to transport glucose to the body tissues. Because of decrease
insulin level in the blood stream, the cells starved, leading to alteration of metabolism. The body needs glucose for metabolism; there will
be a breakdown of energy reserved from adipose tissue, muscles and liver (glucagons). This will result to weight loss. But the energy
breaks down, the glucose level continuously increase because there is less amount of insulin. The body tissues need to be fed, this will
lead to polyphagia and polydipsia because the tissue are not being fed and need glucose for metabolism.
Assessment Nursing
Diagnosis
Planning Nursing
Interventions
Rationale Evaluation
Subjective:Objective:Pt
. maniIested:
- poor muscle tone
- generalized weakness
- increased thirst
- increased urination
-polyphagia
Pt. may maniIest:
- loss oI weight
Imbalanced
Nutrition:
less than
body
requiremen
t r/t insulin
deIiciency
Short
Term:AIter
3 oI NI,
patient shall
have
verbalized
understandin
g oI causative
Iactors when
known and
necessary
interventions
and identiIied
diabetic
client.Long
Term:
AIter 1-4
months oI NI,
the patient
shall have
demonstrated
weight gain
toward goal.
Establish rapportAscertain
understanding oI individual
nutritional needsDiscuss
eating habits and
encourage diabetic diet as
prescribed by the Doctor
Document actual weight,
do not estimate.
Note total daily intake
including patterns and time
oI eating.
Consult dietician/physicia
n Ior Iurther assessment
and recommend-dation
regarding Iood preIerences
and nutri-tional support
Friendly
relationship
with patient
and to be able
to each
other`s
concernTo
determine
what
inIormation
to be
provided to
client/SO- To
achieve
health needs
oI the patient
with the
proper Iood
diet Ior is/her
disease
- Patient may
be un aware
oI their actual
weight or
weight loss
due to
estimating
weight.
- To reveal
changes that
should be
made in
client`s
dietary intake
- For greater
understandin
g and Iurther
assessment oI
speciIic
Ioods.
Short
Term:AIter
3 oI NI,
patient will
have
verbalized
understandin
g oI causative
Iactors when
known and
necessary
interventions
and identiIied
diabetic
client.Long
Term:
AIter 1-4
months oI NI,
the patient
will have
demonstrated
weight gain
toward goal.
-~~~~~~~~~~~~-
. Fatigue
Diabetes Mellitus is a group of metabolic diseases characterized by increased levels of glucose in the blood resulting from defects in
insulin secretion, insulin action, or both. In type 2 diabetes, people have decreased sensitivity to insulin and impaired beta cell
functioning resulting in decreased insulin production. Glucose derived from food cannot be stored in the liver thereby remaining into the
bloodstream. The beta cells of the islets of Langerhans release glucagon which stimulates the liver to release the stored glucose. After 8 -
12 hours, the liver forms glucose from the breakdown of noncarboghydrate substances, including amino acids resulting to muscle wasting
which results to weakness.
Assessment Nursing Planning Nursing Rationale Evaluation
Diagnosis Interventions
Subjective:(none)Objective:
generalized weakness
increased respiratory
rate of 25cpm
presence of non-healing
wound on both feet
body weakness
wt. loss
fatigue
limited ROM
inability to perform ADL
altered VS
altered sensorium
Fatigue
related to
decreased
muscular
strength
Short Term:After 2-3
of nursing
interventions, the
patient will be able to
identify measures to
conserve and increase
body energy.Long
Term:After 3-5 days of
nursing interventions,
the patient will be free
from signs of fatigue
-Assess response to
activity-Asses muscle
strength of patient
and functional level
of activity.-Discuss
with patient the need
for activity
-Alternate activity
with periods of rest/
uninterrupted sleep.
-Monitor pulse,
respiration rate and
blood pressure
before/after activity
-Perform activity
slowly with frequent
rest periods
-Promote energy
conservation
techniques by
discussing ways of
conserving energy
while bathing,
transferring and so
on.
-Provide adequate
ventilation
-Provide comfort and
safety
-Instruct patient to
perform deep
breathing exercises
-Instruct client to
increase Vitamins A,
C and D and protein
in her diet.
-Instruct also patient
to increase iron in
diet
-Administer oxygen
as ordered.
-Response to an
activity can be
evaluated to
achieve desired
level of tolerance.-
To determine the
level of activity-
Education may
provide motivation
to increase activity
level even though
patient may feel
too weak initially
-Prevents
excessive fatigue
-Indicates
physiological
levels of tolerance
-Tolerance
develops by
adjusting
frequency, duration
and intensity until
desired activity
level is achieved.
-Interventions
should be directed
at delaying the
onset of fatigue
and optimizing
muscle efficiency.
Symptoms of
fatigue are
alleviated with
rest. Also, patient
will be able to
accomplish more
with a decreased
expenditure of
energy.
-For proper
oxygenation
-To be free from
injury
-Promotes
relaxation
-For muscle
strength and tissue
repair
-To prevent
weakness and
paleness
-To provide proper
The patient shall
have been able to
identify measures
to conserve and
increase body
energyThe patient
shall have been
free from signs of
fatigue
ventilation
-~~~~~~~~~~~~-
. Risk for Infection
Risks for infection is a increased probability of invasion of pathogenic organisms for a pt. with DM wound is possible in the
furure. Clients with diabetes are susceptible to infections because of polymorphonuclear leukocyte function, diabetic
neuropathies, and vascular insufficiency as a result is a poor glycemic control; thus making a wound to heal slowly because the
damaged of the vascular system cannot carry sufficient oxygen, WBC, nutrients, and antibodies to the injured site. Thereby
infections increase and enhance possibility of further complications.
Assessment Nursing
Diagnosis
Planning Nursing
Interventions
Rationale Evaluation
Subjective:Objective:Pt.
manifested:
-purulent discharge
-hyperthermia
Pt. may manifest:
-altered circulation
-immunological deficit
Risk for
infection
related to
disease
condition.
Short Term:After 4
hours of NPI the risks
factors of occurrence of
infection will be reduce
or control to a
manageable level by a
clean bed and maintain
skin intact.Long Term:
After 1-2 weeks of NPI,
pt will be free of
purulent drainage or
erythema and be
afebrile
-Establish rapport-
Take and record vital
signs-Encourage
expression of feelings
and anxieties
- Observe non -
verbal cues
-Encourage client to
look at/touch affected
body part
-Encourage
verbalization of and
role play anticipated
conflicts
-encourage to
increase fluid intake
-increase Vit. C in the
diet
-increase CHON
intake
-change dressing
-provide a safe and
quiet environment
-Take Due meds on
time
- to obtain
patients trust and
cooperation- To
obtain baseline
data- facilitates
grieving the loss
- non - verbal cues
is more accurate
than verbal cues
- to begin to
incorporate
changes into body
image
- to enhance
handling of
potential problems
-to prevent
dehydration
-to boost immune
system and
promote collagen
formation
-for tissue repair
-to promote
healing and
prevent
contamination of
the wound
-to promote pts
comfort
- To met the
bodys
requirements
Short Term:-The
pt. shall have
identified risks
factors of
occurrence of
infection shall have
reduced or
controlled to a
manageable level
by a clean bed and
skin intact.Long
Term:
-The patient shall
be free of purulent
damage or
erythema and be
febrile
Navigation
Diabetes Insipidus (DI) is a disorder in which there is an abnormal increase in urine output, fluid intake and often thirst.
It causes symptoms such as urinary frequency, nocturia (frequent awakening at night to urinate) or enuresis (involuntary urination
during sleep or "bedwetting).
Urine output is increased because it is not concentrated normally.
Consequently, instead of being a yellow color, the urine is pale, colorless or watery in appearance and the measured concentration
(osmolality or specific gravity) is low (1).

1. Deficient FIuid VoIume
Common ke|ated Iactors Def|n|ng Character|st|cs
Compromlsed endocrlne regulaLory
mechanlsmneurohypophyseal
dysfuncLlonPypoplLulLarlsmPypophysecLomynephrogenlc
ul
olyurlaCuLpuL exceeds lnLakeolydlpsla
(lncreased LhlrsL)Sudden welghL lossurlne
speclflc gravlLy less Lhan 1003urlne osmolallLy
less Lhan 300 mCsm/LPypernaLremla (sodlum
greaLer Lhan 143 mLq/L)
Altered mental status
Requests Ior cold or ice water
Common LxpecLed CuLcomeaLlenL experlences normal
fluld volume as evldenced by absence of LhlrsL normal
serum sodlum level and sLable welghL
-C tcomesluld 8alance LlecLrolyLe and
Acld8ase 8alance-C ntervent|onsluld
MonlLorlng luld ManagemenL LlecLrolyLe
ManagemenL
Ongoing Assessment
AcLlons/lnLervenLlons 8aLlonale
MonlLor lnLake and ouLpuL 8eporL urlne volume
greaLer Lhan 200 mL for each of 2 consecuLlve
WlLh ul Lhe paLlenL volds large urlne volumes
lndependenL of Lhe fluld lnLake urlne ouLpuL
ranges from 2 Lo 3 L/day wlLh renal ul Lo greaLer
hours or 300 mL ln a 2hour perlod Lhan 10 L/day wlLh cenLral ul
MonlLor for lncreased LhlrsL (polydlpsla) lf Lhe paLlenL ls consclous and Lhe LhlrsL cenLer ls
lnLacL LhlrsL can be a rellable lndlcaLor of fluld
balance olyurla and polydlpsla sLrongly suggesL
ul Also Lhe ul paLlenL prefers lce waLer
Welgh dally WelghL loss occurs wlLh excesslve fluld loss
MonlLor urlne speclflc gravlLy 1hls may be 1003 or less
MonlLor serum and urlne osmolallLy urlne osmolallLy wlll be decreased and serum
osmolallLy wlll lncrease
MonlLor urlne and serum sodlum levels 1he paLlenL wlLh ul has decreased urlne sodlum
levels and hypernaLremla
MonlLor serum poLasslum Pypokalemla may resulL from Lhe lncrease ln
urlnary ouLpuL of poLasslum
MonlLor for slgns of hypovolemlc shock (eg
Lachycardla Lachypnea hypoLenslon)
requenL assessmenL can deLecL changes early
for rapld lnLervenLlon olyurla causes decreased
clrculaLory blood volume
%eropeutic 1nteroentions
AcLlons/lnLervenLlons 8aLlonale
Allow Lhe paLlenL Lo drlnk waLer aL wlll aLlenLs wlLh lnLacL LhlrsL mechanlsms may
malnLaln fluld balance by drlnklng huge
quanLlLles of waLer Lo compensaLe for Lhe
amounL Lhey urlnaLe aLlenLs prefer cold or lce
waLer
rovlde easlly accesslble fluld source keeplng
adequaLe flulds aL bedslde
1hls encourages fluld lnLake
AdmlnlsLer lnLravenous (lv) flulds lv flulds are lndlcaLed lf Lhe paLlenL cannoL Lake
ln sufflclenL flulds orally
3 dexLrose ln waLer or 043 sodlum
chlorlde
PypoLonlc lv flulds provlde free waLer and help
lower serum sodlum levels gradually
09 sodlum chlorlde lsoLonlc flulds may be lndlcaLed for Lhe paLlenL
who has susLalned slgnlflcanL fluld loss and ls
hemodynamlcally unsLable Cnce clrculaLory
volume has been resLored hypoLonlc lv flulds
can be glven
AdmlnlsLer medlcaLlon as prescrlbed Aqueous vasopressln ls usually used for ul of
shorL duraLlon (eg posLoperaLlve neurosurgery
or head Lrauma) lLressln LannaLe (vasopressln)
ln oll (Lhe longeracLlng vasopressln) ls used for
longerLerm ul aLlenLs wlLh mllder forms of ul
may use chlorpropamlde (ulablnese) cloflbraLe
(ALromld) or carbamazeplne (1egreLol) Lo
sLlmulaLe release of AuP from Lhe posLerlor
plLulLary and enhance lLs acLlon on Lhe renal
Lubules PydrochloroLhlazlde (Pydroulu8lL) may
also be used for nephrogenlc ul
lf vasopressln ls glven monlLor for waLer
lnLoxlcaLlon or rebound hyponaLremla
CvermedlcaLlon can resulL ln volume excess
. Risk for Impaired Skin Integrity
Common 8lsk acLor
urlnary frequency wlLh hlgh volume ouLpuL and
Lhe poLenLlal for lnconLlnence

Common LxpecLed CuLcomeaLlenL's skln
remalns lnLacL
-C tcomes1lssue lnLegrlLy Skln and Mucous
Membranes 8lsk ConLrol 8lsk ueLecLlon-C
ntervent|onsSkln SurvelllanceSkln Care 1oplcal
1reaLmenLs
Ongoing Assessment
AcLlons/lnLervenLlons 8aLlonale
lnspecL skln documenL condlLlon and changes ln
sLaLus
Larly deLecLlon and lnLervenLlon may prevenL
occurrence or progresslon of lmpalred skln
lnLegrlLy luld loss from polyurla conLrlbuLes Lo
decreased skln Lurgor and dryness
Assess for conLlnence or lnconLlnence LvaluaLe
need for an lndwelllng urlnary caLheLer
Lxcesslve molsLure on Lhe skln lncreases Lhe rlsk
of skln breakdown
Assess oLher facLors LhaL may rlsk Lhe paLlenL's
skln lnLegrlLy (eg lmmoblllLy nuLrlLlonal sLaLus
alLered menLal sLaLus)
Lxcesslve molsLure from urlnary lnconLlnencecan
add Lo Lhe rlsk for skln breakdown from oLher
sources
%eropeutic 1nteroentions
AcLlons/lnLervenLlons 8aLlonale
rovlde easy access Lo Lhe baLhroom urlnal or
bedpan
8oLh polyurla and polydlpsla dlsrupL Lhe
paLlenL's normal acLlvlLles (lncludlng sleep) Lasy
access Lo vold wlll decrease lnconvenlence and
frusLraLlon
use skln barrlers as needed 1hese prevenL redness or excorlaLlon
fromurlnary frequency
eep bed llnen clean dry and wrlnklefree 1hls prevenLs shearlng forces
. Deficient KnowIedge
Common 8elaLed acLors ueflnlng CharacLerlsLlcs
new condlLlonunfamlllarlLy wlLh dlsease and
LreaLmenL
CuesLlons8equesLs for more
lnformaLlonverballzed mlsconcepLlons or
mlslnLerpreLaLlon
Common LxpecLed CuLcomeaLlenL verballzes
correcL undersLandlng of ul and Lhe medlcaLlons
used ln LreaLmenL
-C tcomesnowledge ulsease rocess
nowledge MedlcaLlon-C
ntervent|ons1eachlng ulsease rocess
1eachlng rescrlbed MedlcaLlon
Ongoing Assessment
AcLlons/lnLervenLlons 8aLlonale
Assess level of knowledge of ul cause and
LreaLmenL
An lndlvlduallzed Leachlng plan ls based on Lhe
paLlenL's currenL knowledge and deslre for
addlLlonal lnformaLlon
Assess readlness Lo learn 8apld fluld loss from polyurla can lead Lo
lmpalred cognlLlve funcLlon 1hls change ln
menLal sLaLus can llmlL Lhe paLlenL's ablllLy Lo
learn new lnformaLlon
%eropeutic 1nteroentions
ct|ons]ntervent|ons kat|ona|e
Clve wrlLLen lnformaLlon concernlng Lhe
dlagnosls and LreaLmenL of ul

WaLer deprlvaLlon AuP sLlmulaLlon LesL 1hls LesL may be done Lo dlfferenLlaLe
nephrogenlc causes from neurogenlc causes of
ul 1he paLlenL ls lnsLrucLed Lo Lake noLhlng by
mouLh (nC) for 12 hours before a blood sample
ls drawn Lo measure AuP levels 1he AuP level ls
lncreased ln nephrogenlc ul and decreased ln
neurogenlc (cenLral) ul vasopressln may be
glven Lo evaluaLe renal response 1here ls no
response Lo Lhe drug ln nephrogenlc ul
CompuLed Lomography scan or magneLlc
resonance lmaglng
1hese scans may be ordered lf a plLulLary Lumor
ls suspecLed
uesmopressln aceLaLe (uuAv) 1hls ls Lhe drug of cholce for Lhe managemenL of
ul 1hls medlcaLlon ls a synLheLlc form of AuP
and ls admlnlsLered lnLranasally
Aqueous form of AuP (vasopressln) 1hls drug has a shorLer halfllfe Lhan uuAv and
Lherefore requlres more frequenL dally
admlnlsLraLlon vasopressln ls usually glven
parenLerally and ls noL recommended for Lhe
longLerm managemenL of chronlc ul
CLher drugs used ln comblnaLlon Lo manage
ul lncludlng chlorpropamlde (ulablnese)
cloflbraLe (ALromld) carbamazeplne
(1egreLol) and hydrochloroLhlazlde
1hese secondary drugs work on Lhe kldney or Lhe
posLerlor plLulLary gland Lo lncrease plLulLary
release of AuP or lncrease renal response Lo
AuP
1each Lhe paLlenL Lhe necesslLy of closely
monlLorlng fluld balance lncludlng dally welghLs
(same Llme of day wlLh same amounL of
cloLhlng) fluld lnLake and ouLpuL and
measuremenL of urlne speclflc gravlLy
1hls asslsLs Lhe paLlenL ln monlLorlng Lhe
condlLlon so LhaL ad[usLmenLs can be made
accordlngly helplng prevenL underLreaLmenL or
overLreaLmenL wlLh Lhe medlcaLlon
ulscuss when Lo seek furLher medlcal aLLenLlon
(aL slgns of underdosage or overdosage of
medlcaLlons)
aLlenLs wlLh chronlc dlsease need Lo be able Lo
recognlze lmporLanL changes ln Lhelr condlLlon
Lo averL compllcaLlons and posslble
hosplLallzaLlon
lnsLrucL Lhe paLlenL Lo wear a medlcal alerL
braceleL llsLlng ul and Lhe medlcaLlons LhaL Lhe
paLlenL ls uslng
1hls allows for prompL lnLervenLlon ln Lhe evenL
of an emergency
Sources: (1) (2)