1

PLAN OF CARE

NURSING PLAN OF CARE

Nayith Enciso

Delaware Technical Community College

NUR 320

Dr Michele Gamble

4/26/2019
 2

PLAN OF CARE

DIABETES CARE PLAN

NURSING DIAGNOSIS

INEFFECTIVE HEALTH MAINTENANCE

Related to demonstration of uncontrolled diabetes as evidence by high blood glucose

Risk for unstable blood glucose

Knowledge deficit

Related to her stating that she new very minimum about diabetes.

Impaired Skin integrity

Related to diabetic neuropathy as evidence by prolong of exposure to elevated blood glucose

( Healthy people 2020 )

Subjective data

Patient states that her blood glucose is still very high at night when she checks her finger stick

And that she feels tingling on her finger tips and occasional sharp pain on the heels.

Objective data

A 51 year old with a 3 year diagnosis of diabetes type 2 who just has been going to the

Doctor to control her diabetes. Up on my interview, the patient was asked about the

knowledge of diabetes and knew very minimum and also does not follow a dietary regimen for

diabetes.

Patient goals
 3

Maintain normal range of blood glucose

Prevent neuropathy complications

PLAN OF CARE

Take medication exactly as prescribed

Interventions and rationale

Educate patient about the sign and symptoms of diabetes such as hyperglycemia: blood glucose

Grater than 180 mg/dL, polydipsia, polyphagia, polyuria, blurred vision, dry mouth, leg pain

Increased tiredness, nausea and vomiting, hypoglycemia: <70 mg/dL, confusion ,weakness,

Numbness around the mouth, nervousness/anxiety. (ADA, 2019)

Promote and support healthful eating habits especially in low carbohydrates low sodium

low fat, for type 2 diabetics it has shown that it decreases a1c (ADA, 2019 ).

This would be a good time to get the dietician involved. The patient needs to learn how to

count carbs.

Educate patient on what the target range glucose level should be for her,.the physician will

determine that target (+NRSNG )

Educate patient how to use the glucometer and when to test blood glucose levels, encourage

The patient to contact the physician when glucose levels are higher than their target or if they

have 2 readings greater than 300, or readings lower than 70 ( +NRSNG )

Monitor feet and educate about monitoring feet.

Decrease blood flow to the feet and neuropathy may decrease feeling to the feet and if

wounded it will take longer to heal. ( Healthy People 2020 )

Teach patient to check feet every day, cutting their toe nails straight across, and scrubbing
 4

PLAN OF CARE

Off calluses. The patient may have a podiatrist involved in their care as well. ( Healthy People

2020).

Medication education

Instruct patient on proper preparation and administration of insulin.

Absorption of insulin is more consistent when insulin is always injected in the same site,

Absorption is fastest in the abdomen, followed by the arms, thighs, and buttocks. it is

recommended by the American Diabetes Association to administer insulin into the

subcutaneous tissue of the abdomen.

Projected evaluations/outcomes

Check the patient’s blood glucose diary and check the HbA1c lab.

Checking HbA1C will assure of current glucose level.

On next visit inspect the injection sites to check for skin integrity.

Have the patient give verbal understanding of risks if she does not check her feet Avery day

And ask for a demonstration on how to check the feet.

Ask patient what medication and how much insulin is she using every time the blood glucose is

Checked.

On following visit ask patient to describe what she is having for dietary consumption and how

much of it.
 5

PLAN OF CARE

Community resources and referrals

La Red Health Center

21444 Carmean Way, Georgetown, DE 19941

302-855-1233

Www.laredhealthcenter.org

Nanticoke Center for Diabetes & Endocrinology/ Seaford, DE

801 Middleford Road, Seaford, DE 19973

Https:/www.nanticoke.org/programs-

Diabetes Initiative- healthier Sussex County

Https:/www.healthiersussexcounty.com/knowledge/diabetes.html

SUMMARY

My client is a 51 year old female with a 3 year diagnosis of type 2 diabetes and she just recently

started going to the doctor to seek care for her diabetes, the reason she gave me was

procrastination, but through interviewing her, I concluded that she needed a lot of education

about her disease, since she had stated that she new very minimum about diabetes. this lady is

otherwise healthy house wife who has been married about 32 years and has a 25 year old son.

One of my priorities as I mentioned above was. Ineffective health maintenance and the reason

for this was that I was considering the effects of uncontrolled diabetes, which increases the risk

For many health problems such as foot complications like neuropathies, calluses, foot ulcers

skin changes like dry skin that can peel back and cause cracks, poor circulation, and also kidney
 6

PLAN OF CARE

Disease ,heart disease, stroke, high blood pressure, neuropathy, eye complications, mental

health , ketoacidosis, gastroparesis ( ADA, nov, 2018 ). So I consider this disease to be very

damaging and debilitating to the body if left uncontrolled.

I consider my other nursing diagnosis to be just as important as the first since knowledge is

power and my patient voiced her lack of knowledge about the disease, so I needed to

empower her and informed her starting with the symptoms of diabetes and how to recognize

Them as well as how to use the glucometer to check her blood glucose, and also how often,

As well as injecting the insulin and where on the body to do it, and precautions on not to use

the same site so that lipoatrophy and lipohypertrophy is prevented which reduces the insulin

absorption (Nurses Labs ).

The patient also needs to be educated on weight management and the reason and importance

Of a low carbohydrate, low salt, and low cholesterol diet , since is proven that a diabetic diet

Will reduce A1C levels in the blood (ADA, 2019). This is also a good time to get a dietician

Involved for this particular case.

My third nursing diagnosis for my patient was, impaired skin integrity, related to diabetic

Neuropathy cause by prolong exposure to elevated blood glucose ( Healthy People, 2020)

And also skin integrity due to the lack of rotating injection sites as to where it could cause

Skin infections or lipoatrphy and lipohypertrophy with reduced insulin absorption.

 7

PLAN OF CARE

I think that this plan of care that I formulated for my patient is consider a dynamic and it will be

Taylor to my patient as her blood glucose is controlled and it will be changing, but I think that

Most of the bases are covered for , when I formulated this care plan I was thinking of her as a

new diagnosed patient, even though she has had diabetes for about 3 years, but then she was

Non compliant with treatment, now the patient seems to be committed to have this disease

Treated and is willing to participate in the care and decision making.

 8

PLAN OF CARE

References

American Diabetes Association, November 2018. Retrieved from

Https:/www.diabetes.org/living-with-diabetes/complications

Healthy People, 2020 diabetes. Retrieved from

Https:/www.healthypeople.gov2020/topics-objectives/topic/diabetes

+NRSNG. Retrieve from

Https:/www.nursing.com/diabetes-Mellitus

Nurseslabs. Retrieved from.

Https://nurseslabs.com/diabetes-Mellitus-nursing-care-plans