eNursing Care Plan 48-1

Patient With Diabetes Mellitus

Nursing Diagnosis*
Ineffective health management related to deficient knowledge of diabetes management and
lack of understanding of diabetes management plan as evidenced by inaccurate statements
regarding diabetes and its management and stated confusion regarding diabetes management
tasks

Patient Goals
1. Verbalizes key elements of the therapeutic regimen, including knowledge of disease and
treatment plan
2. Describes self-care measures that may prevent or slow progression of chronic complications

Outcomes (NOC) Interventions (NIC) and Rationales

Knowledge: Diabetes Teaching: Disease Process
Management · Assess the patient’s current level of knowledge
· Cause and contributing related to specific disease process to determine the
factors _____ scope and extent of required teaching.
· Role of diet in blood glucose · Describe the disease process.
control _____ · Describe rationale behind
· Prescribed meal plan _____ management/therapy/treatment recommendations
to enable patient to better understand rationale
· Role of exercise in blood behind treatment plan and lifestyle changes.
glucose control ____
· Instruct the patient on measures to
· Role of sleep in blood glucose control/minimize symptoms to promote
control _____ management of disease.
· Correct use of · Discuss lifestyle changes that may be required to
insulin/prescribed prevent future complications and/or control the
medication/nonprescription disease process to encourage patient to actively
medication _____ participate in determining changes that will lead
· When to obtain assistance to healthy outcomes.
from a health care professional · Describe possible chronic complications to
_____ increase awareness of the long-term effects of
· Reputable sources of diabetes disease process.
information _____ · Instruct the patient on which signs and
· Benefits of disease symptoms to report to health care provider to
management _____ ensure prompt treatment.
· Refer the patient to local community
agencies/support groups to provide continuing
Measurement Scale support and education.
1 = No knowledge
2 = Limited knowledge
3 = Moderate knowledge
Copyright © 2017, Elsevier Inc. All rights reserved.
Herdman, T.H. & Kamitsuru, S. (Eds.). (2014). NANDA International Nursing Diagnoses: Definitions & Classification,
2015-2017. Oxford: Wiley Blackwell.
eNursing Care Plan 48-2

4 = Substantial knowledge
5 = Extensive knowledge

*Nursing diagnoses listed in order of priority.

Nursing Diagnosis
Risk for unstable blood glucose levels related to infrequent blood glucose monitoring and lack
of adherence to diabetes management plan

Patient Goal
Maintains a balance of nutrition, activity, and insulin availability that results in stable, safe, and
healthy blood glucose levels
Outcomes (NOC) Interventions (NIC) and Rationales
Self-Management: Diabetes Teaching: Prescribed Diet
· Follows recommended diet · Assess the patient’s current level of knowledge
_____ about prescribed diet to accurately develop a
teaching plan.
· Participates in recommended
exercise _____ · Instruct the patient about how to keep a food
diary to evaluate patient’s food intake.
· Uses diary to monitor blood
glucose level over time___ · Determine patient’s and caregiver’s
perspectives, cultural backgrounds, and other
· Performs correct procedure factors that may affect the patient’s willingness to
for blood glucose monitoring follow prescribed diet to determine readiness to
_____ change.
· Monitors blood glucose _____ · Assist patient to accommodate food preferences
· Recognizes and treats into the prescribed diet to improve health
symptoms of hyperglycemia outcomes.
_____ · Refer patient to dietitian to provide continuing
· Recognizes and treats nutrition education and evaluation.
symptoms of hypoglycemia
_____
· Monitors frequency of Exercise Promotion
hypoglycemic episodes _____ · Inform individual about health benefits of
· Obtains health care if blood exercise to improve understanding.
glucose levels consistently · Explore barriers to exercise to increase
fluctuate outside of commitment to exercise.
recommendations _____
· Instruct individual about conditions warranting
cessation of or alteration in the exercise
Measurement Scale programto prevent injury.
1 = Never demonstrated _____ · Assist individual to schedule regular periods for
the exercise program into weekly routines because
2 = Rarely demonstrated _____ it is an integral part of diabetes management.
3 = Sometimes demonstrated _____
4 = Often demonstrated _____ Hypoglycemia Management
5 = Consistently demonstrated · Provide assistance in making self-care decisions
Copyright © 2017, Elsevier Inc. All rights reserved.
Herdman, T.H. & Kamitsuru, S. (Eds.). (2014). NANDA International Nursing Diagnoses: Definitions & Classification,
2015-2017. Oxford: Wiley Blackwell.
eNursing Care Plan 48-3

_____ to prevent hypoglycemia (e.g., reducing

insulin/oral agents and/or increasing food intake
for exercise) to prevent hypoglycemia.
Blood Glucose Level · Instruct patient and significant others on signs,
· Blood glucose _____ symptoms, risk factors, and treatment of
hypoglycemia to facilitate blood glucose balance.
· Glycosylated hemoglobin
_____ · Determine recognition of hypoglycemia signs
and symptoms to alert patient to glucose/insulin
· Urine glucose_____ imbalance and need for treatment.
· Urine ketones _____ · Provide complex carbohydrate and protein to
treat a hypoglycemic event.
Measurement Scale · Instruct patient to have simple carbohydrate
available at all times to treat hypoglycemia.
1 = Severe deviation from normal
range · Provide feedback regarding appropriateness of
self-management of hypoglycemia to reinforce new
2 = Substantial deviation from learning.
normal range
· Instruct patient to obtain and carry/wear
3 = Moderate deviation from normal appropriate emergency medical identification.
range
4 = Mild deviation from normal
range Hyperglycemia Management
5 = No deviation from normal range · Monitor for signs and symptoms of
hyperglycemia: polyuria, polydipsia, polyphagia,
weakness, lethargy, malaise, blurring of vision, or
headache to alert patient to glucose/insulin
imbalance and need for treatment.
· Anticipate situations in which insulin
requirements will increase (e.g., infection, illness)
to allow patient to adjust insulin dosage
appropriately and avoid undue fatigue.
· Facilitate adherence to diet and exercise
regimen to promote diabetes management.
· Restrict exercise when blood glucose levels are
greater than 250 mg/dL, especially if urine ketones
are present, to decrease the body’s requirement
for unavailable glucose.

Nursing Diagnosis
Risk for injury related to decreased tactile sensation, episodes of hypoglycemia

Patient Goals
1. Experiences no injury resulting from decreased sensation in feet
2. Experiences no injury resulting from hypoglycemia
Outcomes (NOC) Interventions (NIC) and Rationales
Risk Control Teaching: Foot Care

Copyright © 2017, Elsevier Inc. All rights reserved.

Herdman, T.H. & Kamitsuru, S. (Eds.). (2014). NANDA International Nursing Diagnoses: Definitions & Classification,
2015-2017. Oxford: Wiley Blackwell.
eNursing Care Plan 48-4

· Acknowledges personal risk · Provide information regarding the relationship

factors _____ between neuropathy, injury, and vascular disease
and the risk for ulceration and lower extremity
· Modifies lifestyle to reduce amputation in persons with diabetes to promote
risk _____ preventive measures.
· Avoids exposure to health · Caution about potential sources of injury to the
threats _____ feet (e.g., heat, cold, cutting corns or calluses,
· Monitors changes in general chemicals, use of strong antiseptics or astringents,
health changes _____ use of adhesive tape, and going barefoot or
wearing thongs or open-toe shoes) to promote
preventive measures.
Self-Management: Diabetes · Recommend daily foot inspection over all
· Performs preventive foot care surfaces and between the toes looking for redness,
practices _____ swelling, warmth, dryness, maceration,
tenderness, or open areas to identify and provide
· Uses preventive measures to early treatment of foot lesions.
reduce risk for complications
_____ · Instruct individual to inspect inside of shoes
daily for foreign objects, nail points, torn linings,
· Reports nonhealing breaks in and rough areas to avoid injury by factors that are
skin to primary care provider not felt.
_____
· Recommend daily washing of feet using warm
· Recognizes and treats water and mild soap to remove irritants.
symptoms of hypoglycemia
_____ · Recommend specialist care for thick fungal or
ingrown toenails, corns, or calluses to ensure safe
treatment of feet.
Measurement Scale
1 = Never demonstrated Hypoglycemia Management
2 = Rarely demonstrated · As per prior nursing diagnosis.
3 = Sometimes demonstrated
4 = Often demonstrated
5 = Consistently demonstrated

Nursing Diagnosis
Risk for peripheral neurovascular dysfunction related to vascular effects of diabetes

Patient Goals
1. Verbalizes effects of diabetes on peripheral arterial circulation
2. Implements measures to increase peripheral circulation
Outcomes (NOC) Interventions (NIC) and Rationales
Tissue Perfusion: Peripheral Circulatory Care: Arterial Insufficiency
· Capillary refill, toes _____ · Perform a comprehensive assessment of
peripheral circulation (e.g., check peripheral
· Pedal pulse strength (right) pulses, edema, capillary refill, color, and
_____ temperature) to establish baseline findings.
· Pedal pulse strength (left)
Copyright © 2017, Elsevier Inc. All rights reserved.
Herdman, T.H. & Kamitsuru, S. (Eds.). (2014). NANDA International Nursing Diagnoses: Definitions & Classification,
2015-2017. Oxford: Wiley Blackwell.
eNursing Care Plan 48-5

_____ · Inspect skin for arterial ulcers or tissue

breakdown to provide treatment to prevent
· Extremity skin temperature infection and additional necrosis.
_____
· Protect extremities from injury (e.g., sheepskin
under feet and lower legs, footboard/bed cradle at
Measurement Scale foot of bed; well-fitted shoes) to prevent conditions
that favor skin breakdown.
1 = Severe deviation from normal
range · Maintain adequate hydration to decrease blood
viscosity.
2 = Substantial deviation from
normal range · Encourage the patient to exercise, as tolerated,
to increase peripheral circulation.
3 = Moderate deviation from normal
range · Instruct the patient on factors that interfere with
circulation (e.g., smoking, restrictive clothing,
4 = Mild deviation from normal exposure to cold temperatures, crossing of legs
range and feet) to prevent decreased circulation.
5 = No deviation from normal range · Instruct the patient on proper foot care (see
Table 48-21) to prevent injury and infection.
· Localized extremity pain ____
· Necrosis _____
· Numbness _____
· Skin breakdown _____
· Tingling _____
· Pallor _____

Measurement Scale
1 = Severe
2 = Substantial
3 = Moderate
4 = Mild
5 = None

Copyright © 2017, Elsevier Inc. All rights reserved.

Herdman, T.H. & Kamitsuru, S. (Eds.). (2014). NANDA International Nursing Diagnoses: Definitions & Classification,
2015-2017. Oxford: Wiley Blackwell.