- Get link
- X
- Other Apps
4 Diabetes Mellitus Type 1 (Juvenile Diabetes) Nursing Care Plans
Insulin-dependent diabetes mellitus (IDDM) also known as type 1 diabetes or juvenile diabetes, is a metabolic disorder caused by a lack of insulin. The deficiency is believed to happen in people who are genetically prone to the disease and who have experienced a precipitating event, commonly a viral infection or environmental change, that causes an autoimmune response affecting the insulin-producing cells (beta cells) of the pancreas.
It is treated by injection of insulin and regulation of diet and activity that maintain body functions. Complications that occur from improper coordination of these include hypoglycemia and hyperglycemia which, if untreated, lead to insulin shock or ketoacidosis. Long-term effects of the disease include neuropathy, nephropathy, retinopathy, atherosclerosis, and microangiopathy.
Nursing Care Plans
Nurses have an essential role and responsibilities when caring for a client with diabetes such as providing child and family with education about the management of hyperglycemia and hypoglycemia including insulin administration, dietary regimen, and exercise needs for the child, helping the family to adjust to having a chronic disease, and preventing short-term and long-term complications of diabetes.
Here are four (4) nursing care plans (NCP) for diabetes mellitus type 1:
1. Deficient Knowledge
Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.
May be related to
- - Lack of information about the disease condition
Possibly evidenced by
- - New diagnosis of IDDM
- - Request for information regarding the pathology, blood and urine testing, insulin therapy, activity/exercise needs, dietary regimen, personal hygiene and health promotion
Desired Outcomes
- - Client will verbalize understanding of IDDM.
- - Client and parents will demonstrate appropriate blood-glucose monitoring insulin administration, dietary management, and exercise plan.
- - Client and parents will identify signs and symptoms of hypoglycemia and hyperglycemia and correct response.
| Nursing Interventions | Rationale |
|---|---|
| Assess parents and child understanding of disease and ability to perform procedures and care, for educational level and learning capacity, and for developmental level. | Provides information essential to develop a learning program; children ages 8 to 10 may be able to take responsibility for some of the care. |
| Provide a quiet, comfortable environment; allow time for teaching small amounts at a time and for reinforcement, demonstrations and return demonstration; start educating one day following diagnosis and limit sessions to 30 to 60 minutes. | Prevents distractions and facilitates learning. |
| Include as many family members in teaching sessions as possible. | Promotes understanding and support of family and feeling of security for the child. |
| Teach about the cause of disease, disease process and pathology; use pamphlets and other aids appropriate for the age of child and level of comprehension of parents. | Provides basic information that may be used as a rationale for treatments and care and allows for different teaching strategies. |
| Instruct parents and child in insulin administration including drawing up insulin into the syringe, rotating vial instead of shaking, drawing clear insulin first if mixing 2 types in the same syringe, injecting SC, storing insulin, rotating sites, adjusting dosages, reusing a syringe, and needle, and disposing of them. | Promotes proper technique of insulin administration to avoid complications. |
| Instruct in use of a syringe-loaded injector. | Provides an alternative method of insulin administration if the child is afraid of skin puncture. |
| Teach parents and child on how to operate a portable insulin pump to regulate insulin delivery. | Provides continuous subcutaneous insulin infusion. |
| Instruct parents and child to monitor blood glucose levels 4 times a day (before meals and before bed), with a lancet and blood-testing meter or a reagent strip compared to a color chart; collection and testing of urine with ketostix or Clinitest. | Monitors blood and urine for the presence of glucose and ketone. |
| Teach parents and child about dietary planning with an importance on proper meal times and adequate caloric intake according to age as ordered. Teach that food intake depends on activity, and describe methods to judge amounts of foods; provide a list of acceptable food items from “fast food” restaurants. | Provides information about an important aspect of the total care of the child with diabetes. |
| Teach parents and child about the role of exercise and changes needed in food and insulin intake with increased or decreased activity. | Provides information about common activity pattern and effect on dietary intake and insulin needs. |
| Teach parents and child about skin problems associated with diabetes, need for regular dental examinations, foot care, protection of and proper care of nails, prevention of infections and exposure to infections, eye examinations, immunizations. | Provides information about common complications as a result from chronic effects of the disease. |
| Instruct parents and child to keep a record of insulin administration, glucose monitoring, responses to diet and exercise, noncompliance in medical regimen and effects. | Provides a method to improve self-care and demonstrates the need to notify physician for treatment evaluation and possible modification. |
| Instruct the child to wear or carry identification and information about the disease, treatment, and physician name. | Provides information in case of an emergency. |
2. Compromised Family Coping
Compromised Family Coping: A usually supportive primary person (family member, significant other, or close friend) insufficient, ineffective, or compromised support, comfort, assistance or encouragement that may be needed by the individual to manage or master adaptive tasks related to his or her health challenge.
May be related to
- - Inadequate or inaccurate information
- - Prolonged disease or disability progression that depletes the physical and emotional supportive capacity of caretakers
Possibly evidenced by
- - Expression and/or confirmation of concern and inadequate knowledge about long-term care needs, problems and complications
- - Anxiety and guilt
- - Overprotection of child
Desired Outcomes
- - Family will explore feelings regarding the child’s long-term needs.
- - Family will determine appropriate support systems and coping skills.
| Nursing Interventions | Rationale |
|---|---|
| Assess family coping mechanisms and its effectiveness, family dynamics and expectations related to longterm care, developmental level of family, response of siblings, knowledge, and use of support systems and resources, presence of guilt and anxiety, overprotection and overeating behaviors. | Recognizes coping methods that work and the need to develop new coping skills and behaviors, family attitudes; child with special long-term needs may tighten or strain family relationships, and that over-protection may be deleterious to child’s growth and development. |
| Allow family members and child to express difficult areas, anxiety and explore solutions responsibly. | Lessens anxiety and improves understanding; provides the family with an opportunity to recognize problems and generate problem-solving methods. |
| Assist family to establish short- and long-term goals for the child and to involve the child in the activities of the family; include the participation of all family members in care routines. | Promotes engagement in and control over situations and keeps the role of family members and parents. |
| Encourage family members to verbalize feelings, to tell how they handle the chronic needs of the family member, and to define coping patterns that support or inhibit adjustment to the problems. | Encourages expression of feelings to identify the need for information and support and to dismiss guilt and anxiety. |
| Provide support social worker, counselor, clergy, or other as needed. | Provides assistance to the family dealing with the long-term care of a child with chronic illness. |
| Teach family about long-term care and treatments. | Improves family’s understanding of treatment regimen and responsibilities of family. |
| Teach family that overprotective behavior may inhibit growth and development so they should treat the child as normally as possible. | Facilitates understanding of the significance of making the child a part of the family and illustrates the unfavorable effects of being overprotective. |
| Explain the importance of attending follow-up appointments for physical examinations, laboratory tests. | Promotes positive outcome when family collaborates with the physician and health team to monitor disease. |
3. Risk for Injury
Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.
May be related to
- [not applicable]
Possibly evidenced by
- - Hyperglycemia— headache, confusion, blurred vision, irritability, fatigue, dry mouth, abdominal pain, weight loss, polyuria, polydipsia, polyphagia
- - Hypoglycemia— sweating, shakiness, nervousness, lightheadedness, weakness, hunger, nausea, palpitations, moodiness, pale skin, loss of consciousness
Desired Outcomes
- - Client’s blood glucose levels will maintain between 60 mg/dL and 120 mg/dL.
- - Client’s urine will be free from ketones and glucose.
| Nursing Interventions | Rationale |
|---|---|
| Assess for signs and symptoms of hyperglycemia; Monitor serum glucose level, urine for glucose and ketones, pH and electrolyte levels. | Provides information about the effect of increased blood glucose levels caused by an illness, inappropriate diet, stress or failure to administer insulin; glucose is unable to enter the cells, and protein is broken down and converted to glucose by the liver, causing the hyperglycemia; fat and protein stores are depleted to provide energy for the body when carbohydrates are not able to be used for energy. |
| Assess for signs and symptoms of hypoglycemia, serum glucose level. | Provides information about the occurrence of hypoglycemia caused by an increased activity without additional food intake or failure or incomplete ingestion of meals, improper insulin administration, illness. |
| Administer insulin subcutaneously as prescribed, increase dosage depending on the glucose levels; rotate injection sites, minimize food intake during an infection or illness and modify the dosage of insulin during an illness. | Provides insulin replacement to maintain normal blood glucose levels without causing hypoglycemia; two or more injections may be given daily subcutaneous (SC) using a portable syringe pump or by intermittent bolus injections with a syringe and needle. |
| Encourage a diet with calories that balance with the energy requirements and paired with the type and action of insulin, and snacks between meals and at bedtime as appropriate. | Provides nutritional needs of the child for proper growth and development using the exchange system or by carbohydrate counting— monitoring carbohydrate intake only, maintaining consistent level at meals and snacks, and adjusting insulin as needed (requires close supervision of a physician). |
| Promote exercise program compatible with insulin regimen; instruct to increase carbohydrate intake prior a strenuous activities. | Guides in the utilization of dietary intake, regular activity may decrease the amount of insulin required; an insulin reduction and increased carbohydrate intake prior to a strenuous exercise may avoid hypoglycemia. |
| Encourage rest periods and provide a quick source of a simple carbohydrate such as fruit juice, milk products followed by a complex carbohydrate such as bread in amounts of 15 gm; repeat intake in 10 minutes for an expected response of a reduced pulse rate; administer 50 percent glucose per IV or glucagon IM if hypoglycemia is severe. | Relieves the symptoms of hypoglycemia as soon as observed; glucagon releases the glycogen stored in the liver to assist in restoring glucose levels; Administration of IV glucose is done when the condition is severe and child is unable to take glucose source orally. Glucagon, a hormone, releases stored glycogen from the liver and increases blood glucose within 5 to 15 minutes. |
| Educate parents and child about signs and symptoms, reasons why they happen, and measures to take. | Provides information about abnormal blood glucose levels causing complications of hyperglycemia, hypoglycemia, and the consequences. |
| Educate parents and child to regulate insulin, control dietary intake, and exercise to accommodate needs of an individual child. | Supports the child’s growth and development needs while avoiding complications. |
| Educate parents and child to modify administration of insulin depending on the blood glucose testing and glycosuria, during an illness or after changes in food intake or activities. | Prevents and treats hyperglycemia; Prevents serious complication of ketoacidosis. |
| Instruct parents and child to take a quick-acting carbohydrate followed by a longer-acting carbohydrate and to have Lifesavers, sugar cubes, Instaglucose on hand at all times; instruct parents that, in the case of severe hypoglycemia, if the child is unconscious or unable to take oral fluids, to rub honey or syrup on the child’s buccal surface until alert enough to take fluids/foods by mouth. | Prevents and/or treats hypoglycemia. |
| Instruct parents and child to notify irregular blood and urine test results, difficulty in managing blood glucose levels, presence of an infection or illness. | Avoids more severe complications and long-term effects of the disease; poor control leads to serious and severe consequences in a few hours. |
4. Risk for Unstable Blood Glucose Level
Risk for Unstable Blood Glucose Level: Risk for variation of blood glucose/sugar levels from the normal range.
May be related to
- - Deficient knowledge of diabetes management
- - Developmental level
- - Inadequate blood glucose monitoring
- - Lack of adherence to diabetes management
Possibly evidenced by
- [not applicable]
Desired Outcomes
- - Client will maintain a blood glucose reading of less than 180 mg/dL; fasting blood glucose levels of less than <140 mg/dL; hemoglobin A1C level <7%.
| Nursing Interventions | Rationale |
|---|---|
| Monitor for signs of hyperglycemia such as fatigue, blurred vision, dry mouth. | Hyperglycemia happens due to an inadequate amount of insulin to glucose. Excess glucose in the blood creates an osmotic effect that results in polyuria, polydipsia, polyphagia. |
| Monitor for signs of hypoglycemia such as sweating, lightheadedness, weakness, nausea, tachycardia. | Manifestations of hypoglycemia may depend on every individual but are consistent in the same individual. The signs are the result of both increased adrenergic activity and decreased glucose delivery to the brain. |
| Assess feet for temperature, pulses, color, and sensation. | Monitors peripheral perfusion and neuropathy |
| Monitor blood glucose level prior meals and at bedtime. | Blood glucose should be between 140 to 180 mg/dL. Non-intensive care patients should be maintained at pre-meal levels <140 mg/dL. |
| Review client’s HbA1c-glycosylated hemoglobin. | Measures blood glucose levels over the past 2 to 3 months. A level of 6.5% to 7% is acceptable. |
| Assess child’s and parent’s current knowledge and understanding about the prescribed diet. | Noncompliance to dietary guidelines can result in hyperglycemia. An individualized diet plan is recommended. |
| Assess the pattern of physical activity. | Regular exercise is a core part of diabetes management and reduces the risk for cardiovascular complications. |
| Instruct the proper use of insulin as directed: | |
| Have an onset of action within 15 minutes of administration. The duration of action is 2 to 3 hours for Humalog and 3 to 5 hours for aspart. |
| Has an onset of action within 30 minutes of administration; duration of action is 4 to 8 hours. |
| Onset of action for the intermediate-acting is one hour after administration; duration of action is 18 to 26 hours. |
| Premixed concentration has an onset of action similar to that of rapid-acting insulin and a duration of action similar to that of intermediate-acting insulin. |
| Have an onset of one hour after administration. Duration of action is 36 hours for Ultralente is 36 hours and for glargine is at least 24 hours. |
| Instruct the patient on the proper preparation and administration of insulin. | |
| Absorption of insulin is more consistent when insulin is always injected in the same anatomical site. Absorption if 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. |
| Injection of insulin in the same site over time will result in lipoatrophy and lipohypertrophy with reduced insulin absorption. |
| Insulin should be refrigerated at 2º to 8º C (36º to 46º F). Unopened vials may be stored until their expiration date. To prevent irritation from “cold insulin,” vials may be stored at temperatures of 15º to 30ºC (59º to 86ºF) for 1 month. Opened vials are to be discarded after that time. |
References and Sources : nurseslabs.com
- Get link
- X
- Other Apps
Comments
Post a Comment
Osamaedres7@gmail.com