Diabetes mellitus is a metabolic disease characterized by dysregulation of carbohydrate, protein, and lipid metabolism.

The primary feature of this disorder is elevation in blood glucose levels (hyperglycemia), resulting from either a defect
in insulin secretion from the pancreas, a change in insulinaction, or both. Sustained hyperglycemia has been shown to
affect almost all tissues in the body and is associated with significant complications of multiple organ systems, including
the eyes, nerves, kidneys, and blood vessels.

Deficient Fluid Volume

Glucose appears in the urine (glycosuria) because the kidney excretes the excess glucose to make the blood glucose
level normal. Glucose excreted in the urine acts as osmotic diuretic and causes excretion of increased amount of water,
resulting in fluid volume deficit or polyuria.

Assessment Nursing Planning Nursing Rationale Evaluation

Diagnosis Interventio
ns
Subjective: (none) Deficient Short Establish
Friendly Short
Objective: Fluid Term:After rapportrelationshi Term:After
Volume 3° of NI, Take and
p with 3° of NI,
 elevated temper r/t patient shall record vital
patient patient will
ature of intracellul have signs and to be have
38.4°C/axilla ar DHN verbalized able to verbalized
 increased urine 2° the understanding Monitor the each understanding
output. DM II of causative temperature other’s of causative
 sweating of the factors and concern factors and
skin purpose of Assess skin To obtain purpose of
 thirst individual turgor and baseline individual
 exhaustion therapeutic mucous data therapeutic
 weight loss interventions membranes interventions
 dry skin andmedicatio for signs of To andmedicatio
or mucous ns. dehydration monitor ns.
membrane Long Term: changes in Long Term:
Encourage temperatur
After 2 days the patient e After 2 days
of NI, the to increase of NI, the
patient shall fluid intake Dry skin patient will
have and have
maintained Administer mucous maintained
fluid volume IVF as membrane fluid volume
at a ordered by s are signs at a
functional the Doctor of functional
level as dehydratio level as
evidenced by Administer n evidenced by
individual anti-pyretic individual
good skin as To replace good skin
turgor, moist prescribed fluid loss turgor, moist
mucous and mucous
 membrane by the prevent membrane
and stable Doctor. dehydratio and stable
vital signs. n vital signs

To replace
electrolyte
s and fluid
loss

To
decrease
body
temperatur
e and will
have less
occurrenc
e of
dehydratio
n.

Imbalanced Nutrition: Less Than Body

Requirements
Due to decrease of lack of insulin in the body, the glucose level continuously rises because glucose can’t be utilized
without the presence of insulin. Glucose is the source of energy, while insulin is the vehicle to transport glucose to the
body tissues. Because of decrease insulin level in the blood stream, the cells starved, leading to alteration of
metabolism. The body needs glucose for metabolism; there will be a breakdown of energy reserved from adipose
tissue, muscles and liver (glucagons). This will result to weight loss. But the energy breaks down, the glucose level
continuously increase because there is less amount of insulin. The body tissues need to be fed, this will lead to
polyphagia and polydipsia because the tissue are not being fed and need glucose for metabolism.

Assessment Nursing Planning Nursing Rationale Evaluatio

Diagnosis Interventions n
Subjective: Imbalanced Short Establish rapport Friendly Short
Æ Nutrition: less Term: Ascertain relationship Term:
Objective: than body After 3° of understanding of with patient After 3° of
requirement NI, patient individual nutritionaland to be able NI, patient
Pt. r/t insulindefici shall have needs to each other’s will have
manifested: ency verbalized concern verbalized
understand Discuss eating habits To determine understand
- poor ing of and encourage what ing of
muscle tone causative diabetic diet as information to causative
factors factors
 - when prescribed by the be provided to when
generalized known Doctor client/SO known
weakness and and
necessary Document actual - To achieve necessary
- increased interventio weight, do not health needs of interventio
thirst ns and estimate. the patient with ns and
identified the proper food identified
- increased diabetic Note total daily diet for is/her diabetic
urination client. intake including disease client.
patterns and time of
-polyphagia Long eating. - Patient may Long
Term: be un aware of Term:
Pt. Consult dietician/ph their actual
may mani After 1-4 ysician for weight or After 1-4
fest: months of furtherassessment an weight loss due months of
NI, the d recommend-dation to estimating NI, the
- loss of patient regarding food weight. patient
weight shall have preferences and will have
demonstra nutri-tional support - To reveal demonstra
ted weight changes that ted weight
gain should be made gain
toward in client’s toward
goal. dietary intake goal.

- For greater
understanding
and
furtherassessme
nt of specific
foods.

Fatigue
Diabetes Mellitus is a group of metabolic diseases characterized by increased levels of glucose in the blood resulting
from defects in insulin secretion, insulin action, or both. In type 2 diabetes, people have decreased sensitivity
to insulin and impaired beta cell functioning resulting in decreased insulin production. Glucose derived from food cannot
be stored in the liver thereby remaining into the bloodstream. The beta cells of the islets of Langerhans release glucagon
which stimulates the liver to release the stored glucose. After 8 – 12 hours, the liver forms glucose from the breakdown
of noncarboghydrate substances, including amino acids resulting to muscle wasting which results to weakness.

Assessment Nursing Planning Nursing Rationale Evaluati

Diagnosis Interventio on
ns
Subjective: (none) Fatiguerelat Short -Assess -Response to The
Objective: ed to Term:Afte response to an activity patient
decreased r 2-3º of activity can be shall have
 generalized muscular nursing -Asses evaluated to been able
weakness strength interventio muscle achieve to
 increasedrespirator ns, the strength of desired level identify
yrate of 25cpm patient will patient and of tolerance. measures
 presence of non- be able to functional -To determine to
healing wound on identify level of the level of conserve
both feet measures to activity. activity and
 body weakness conserve increase
 wt. loss and -Discuss -Education body
 fatigue increase with patient
may provide energy
 limited ROM body the need for
motivation to The
 inability to perform energy. activity increase patient
ADL Long activity level shall have
 altered VS Term: -Alternate even though been free
 altered sensorium activity patient may from
After 3-5 with periods feel too weak signs
days of of rest/ initially of fatigue
nursing uninterrupte
interventio d sleep. -Prevents
ns, the excessivefatig
patient will -Monitor ue
be free pulse,
from signs respiration -Indicates
offatigue rate and physiological
blood levels of
pressure tolerance
before/after
activity -Tolerance
develops by
-Perform adjusting
activity frequency,
slowly with duration and
frequent intensity until
rest periods desired
activity level
-Promote is achieved.
energy
conservatio -Interventions
n should be
techniques directed at
by delaying the
discussing onset
 ways of of fatigueand
conserving optimizing
energy muscle
while efficiency.
bathing, Symptoms
transferringoffatigue are
and so on. alleviated
with
-Provide rest. Also,
adequate patient will be
ventilation able to
accomplish
-Provide more with a
comfort and decreased
safety expenditure
of energy.
-Instruct
patient to -For proper
perform oxygenation
deep
breathing -To be free
exercises from injury

-Instruct -Promotes
client to relaxation
increase
Vitamins A, -For muscle
C and D strength and
and protein tissue repair
in her diet.
-To prevent
-Instruct weakness and
also patient paleness
to increase
iron in diet-To provide
proper
-Administer ventilation
oxygen as
ordered.

Risk for Infection

Risks for infection is a increased probability of invasion of pathogenic organisms for a pt. with DM wound
is possible in the furure.Clients with diabetes are susceptible to infections because of polymorphonuclear
leukocyte function, diabetic neuropathies, and vascular insufficiency as a result is a poor glycemic control;
thus making a wound to heal slowly because the damaged of the vascular system cannot carry sufficient
oxygen, WBC, nutrients, and antibodies to the injured site. Thereby infections increase and enhance
possibility of further complications.

Assessment Nursing Planning Nursing Rationale Evaluation

Diagnosis Interventions
Subjective:Æ Risk for Short Term: -Establish - to obtain Short Term:
Objective: infectionrelated After 4 hours rapport patient’s trust-The pt.
to disease of NPI the -Take and and shall have
Pt. manifested: condition. risks factors record vital cooperation identified
of occurrence signs - To obtain risks factors
-purulent of infection baseline data of
discharge will be reduce -Encourage occurrence
or control to a expression of - facilitates of infection
-hyperthermia manageable feelings and grieving the shall have
level by a anxieties loss reduced or
Pt. may clean bed and controlled to
manifest: maintain skin - Observe non - non – verbal a
intact. – verbal cues cues is more manageable
-altered accurate than level by a
Long Term: -Encourage verbal cues clean bed
circulation
client to look and skin
After 1-2 at/touch - to begin to intact.
-
immunological weeks of NPI, affected body incorporate
deficit pt will be free part changes into Long Term:
of purulent body image
drainage or -Encourage -The patient
erythema and verbalization - to enhance shall be free
be afebrile of and role handling of of purulent
play potential damage or
anticipated problems erythema
conflicts and be
-to prevent febrile
-encourage to dehydration
increase fluid
intake -to boost
immune
-increase Vit. system and
C in the diet promote
collagen
-increase formation
CHON intake
 -change -for tissue
dressing repair

-provide a safe -to promote

and quiet healing and
environment prevent
contamination
-Take Due of the wound
meds on time
-to promote
pt’s comfort

- To met the
body’s
requirements

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