NURSING CARE PLAN FOR

CLIENT TYPE 2 DM

By
Fitratunnisa
Harni Septria Fiza

Case
A 68 years old client has had type 2
diabetes for several years. She
complains of burning and tingling
sensation in her feet and tells you
that her feet are always cold. She
has a history of an ulcer on the
plantar surface of her left foot,
which developed after she stepped
on a sharp object on her kitchen
floor.

Introduction
Type 2 diabetes is a progressive
disorder in which the pancreas
makes less insulin over time.
Client with type 2 diabetes have
reduce ability of most cells to
responds to insulin (insulin resistant),
poor control of liver glucose output,
and decrease beta cell function,
eventually leading to beta cell failure

Etiology
The specific causes of type 2 DM are
not known
Both insulin resistance and beta cell
failure have many genetic and not
genetic causes
Heredity plays a major role in the
development of type 2 DM

Risk Factors
Genetic
Over the age of 40 years
Overweight
Lifestyle

Pathophysiology
the pancreas usually continues
to produce some endogenous
(self made) insulin.
The insulin that in produce is
either insufficient for the bodys
needs and / or in poorly utilized
by the tissues.

Continue
Pathophysiology

Three major metabolic abnormalities play

a role in the development of type 2 DM:
insulin resistance, which is a condition in
which body tissues do not respond to the
action of insulin.
decrease in the ability of the pancreas to
produce insulin, as the beta cell become
fatigued from the compensatory
overproduction of insulin.
inappropriate glucose production by the liver.

Clinical Manifestation
Polyuria
Polydipsia
Polyphagia
Fatigue
Recurrent infections
Prolonged wound healing
Visual changes

Nursing diagnosis
Risk for injury related to sensory
alterations
High risk for ineffective therapeutic
regimen management related to
insufficient knowledge of diabetes,
monitoring of blood glucose,
medications, meal planning, treatment,
weight control, foot care, risk
complications

Nursing interventions
Risk for injury related to sensory
alterations
Advice the client to:

monitor blood glucose level frequently

prevent decrease blood glucose with scheduled
meals
Wear diabetes identification

Inspect skin for irritation, cracking, lesion,

corns, calluses, deformities, or edema

Continue interventions
Inspect clients shoes for proper it.
Dry carefully between toes, Apply lotion,
Clean nails, Apply moisture-absorbing
powder, as indicated.
Instruct client/family on the importance of
foot care.

Continue interventions
High risk for ineffective therapeutic
regimen management related to
insufficient knowledge of diabetes,
monitoring of blood glucose,
medications, meal planning,
treatment, weight control, foot care,
risk complications
Create an environment of trust by listening
to concerns, being available

Continue interventions
Work with patient in setting mutual goals
for learning
Teach the client about:
The diabetes process, monitoring of
blood glucose, medications, meal
planning, treatment, weight control, foot
care, risk complications

Health Educations
Teach and discuss essential elements of DM:
What the normal blood glucose range and
how it compares with patients levels the
type DM patient has, the relationship
between insulin deficiency and a high
glucose level, complications of the disease
(chronic and acute)
Teach the sign and symptoms of
hyperglycemia and the causes of
hyperglycemia
Discuss the rational for blood glucose
monitoring, the specific BG goal, the
frequently of BG monitoring

Continue Educations
Teach the need for increased BG monitoring
when meals are delayed, before exercise and
when sick
Discuss dietary plan, limiting intake of sugar,
fat, salt, and alcohol: eating complex
carbohydrates, especially high in fiber
Teach the importance of daily foot inspection
and prevent foot problems
Teach client and family to contact the health
care provider with unexplained condition or a
foot injury and signs of infection