ASSESSMENT NONE

DIAGNOSIS Risk for unstable blood glucose related to deficient knowledge of diabetes

PLANNING SHORT TERM Patient will acknowledge factors that may lead to unstable glucose LONG TERM Maintain glucose in satisfactory range

INTERVENTION INDEPENDENT Determine individual factors that may contribute to unstable glucose Ascertain client s/SO s knowledge/understanding of condition and treatment needs Determine patient s awareness/ ability to be responsible for dealing with situation: age, maturity, and current health status, ability to provide own safety

RATIONALE

EVALUATION SHORT TERM

To assess risk/contributing factors

Patient acknowledged factors that may lead to unstable glucose LONG TERM Maintainedglucose in satisfactory range

All available machines will Ascertain whether patient/SO are adept at operating patient s provide satisfactory reading if home glucose monitoring device properly used and maintained and routinely calibrated Provide information on balancing food intake, antidiabetic agents

Discuss home glucose monitoring according to individual parameters (ex. 6x/day for normal day and more frequently during times of stress)

To identify and manage glucose variations

Review patient s common situations that contribute to glucose instability on daily, occasional, and crisis basis

Multiple factors can play a role at anytime, such as missing meals, adolescent growth spurt, or infection

Review patient s diet, especially carbohydrate intake

Glucose balance is determined by the amount of carbohydrates consumed, which should be determined in needed grams/day

Encourage patient to read labels and choose foods described as having a low glycemic index, higher fiber and low fat content

These foods produce a slower rise in blood glucose

Discuss how patient s antidiabetic medications work

Drugs and combinations of drugs work in varying ways with different blood glucose control and side effects. Understanding drug actions can help patient avoid/reduce risk of potential for hypoglycemic reactions

Review types of insulin and delivery method

Affects timing of effects and provides clues to potential timing of glucose instability Insulin absorption can vary from day to day in healthy sites and is less absorbable lypohyperthropic tissues Children, adolescents, and elderly patients may forget injections or be unable to inject and may need reminders and supervisions

Check injection sites periodically

Ascertain that all injections are being given

COLLABORATIVE Consult with dietitian about specific dietary needs based on individual situation

Refer to appropriate community resources, diabetic educator, and/or support groups as needed.

For lifestyle modification, medical management, referral to insulin pump or glucose monitor, financial assistance for supplies, etc.

CHRISTIAN MARK ORCULLO

N412