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 EstablishFriendly Short
Objective: Fluid Term:After rapport relationshi Term:After
Volume 3° of NI, Take and p with 3° of NI,
 elevated     r/t patient shall record vital
patient and patient will
temperature of intracellul have signs to be able have
38.4°C/axilla ar DHN verbalized to each verbalized
 increased urine 2° the DM understanding Monitor the other’s understanding
output. II of causative temperature concern of causative
 sweating of factors and To obtain factors and
the skin purpose of Assess skin baseline purpose of
 thirst individual turgor and data individual
 exhaustion therapeutic mucous therapeutic
interventions membranes To interventions
 weight loss
andmedicatio for signs of monitor andmedicatio
 dry skin or 
ns. dehydration changes in ns.
mucous membrane
Long Term: temperatur Long Term:
Encourage e
After 2 days the patient After 2 days
of NI, the to increase Dry skin of NI, the
patient shall fluid intake and patient will
have mucous have
maintained Administer membrane maintained
fluid volume IVF as s are signs fluid volume
at a functional ordered by of at a functional
level as the Doctor dehydratio level as
evidenced by n evidenced by
individual Administer individual
good skin anti-pyretic To replace good skin
turgor, moist as fluid loss turgor, moist
mucous prescribed 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
occurrence
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 and After 3° of
requirement NI, patient individual nutritional to be able to NI, patient
Pt. r/t insulindefici shall have needs 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 prescribed by the be provided to factors
- when when
generalized known and Doctor client/SO
known and
weakness necessary necessary
interventioDocument actual - To achieve interventio
- increased ns and weight, do not health needs of ns and
thirst identified estimate. the patient with identified
diabetic the proper food diabetic
- increased client. Note total daily diet for is/her client.
urination intake including disease
Long patterns and time of Long
-polyphagia Term: eating. - Patient may be Term:
un aware of
Pt. may    After 1-4 Consult  their actual After 1-4
manifest: months of dietician/physician weight or months of
NI, the for weight loss due NI, the
- loss of patient furtherassessment and to estimating patient
weight shall have recommend-dation weight. will have
demonstrat regarding food demonstrat
ed weight preferences and nutri- - To reveal ed weight
gain tional support changes that gain
toward should be made toward
goal. in client’s goal.
dietary intake

- 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 Evaluatio

Diagnosis Interventio n
ns
Subjective: (none) Fatiguerelat Short -Assess -Response to The
ed to Term:After response to an activity can patient
decreased 2-3º of activity be evaluated shall have
Objective: muscular nursing -Asses to achieve been able
strength intervention muscle desired level to identify
 generalized s, the strength of of tolerance. measures
weakness patient will patient and -To determine to
 increasedrespir be able to functional the level of conserve
atoryrate of 25cpm identify level of activity and
 presence of measures to activity. increase
non-healing wound conserve -Education body
on both feet and -Discuss may provide energy
 body weakness increase with patientmotivation to The
 wt. loss body the need forincrease patient
energy. activity activity level shall have
 fatigue
Long even though been free
 limited ROM
Term: -Alternate patient may from
 inability to signs
activity with feel too weak
perform ADL of fatigue
After 3-5 periods of initially
 altered VS days of rest/
 altered nursing uninterrupte -Prevents
sensorium intervention d sleep. excessivefatig
s, the ue
patient will -Monitor
be free pulse, -Indicates
from signs respiration physiological
offatigue rate and levels of
blood tolerance
pressure
before/after -Tolerance
activity develops by
adjusting
-Perform frequency,
activity duration and
slowly with intensity until
frequent rest desired
periods activity level
is achieved.
-Promote
energy -Interventions
conservation 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 rest. 
-Provide Also, patient
adequate will be able to
ventilation accomplish
more with a
-Provide decreased
comfort and expenditure of
safety energy.

-Instruct -For proper

patient to oxygenation
perform
deep -To be free
breathing from injury
exercises
-Promotes
-Instruct relaxation
client to
increase -For muscle
Vitamins A, strength and
C and D and tissue repair
protein in
her diet. -To prevent
weakness and
-Instruct paleness
also patient
to increase -To provide
iron in diet proper
ventilation
-Administer
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. shall
to disease of NPI the -Take and and have
Pt. manifested: condition. risks factors of record vital cooperation identified
occurrence of signs - To obtain risks factors
-purulent infection will baseline data of
discharge be reduce or -Encourage occurrence
control to a expression of - facilitates of infection
-hyperthermia manageable feelings and grieving the shall have
level by a clean anxieties loss reduced or
Pt. may 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 and
conflicts be febrile
-to prevent
-encourage to dehydration
increase fluid
intake -to boost
immune
-increase Vit. system and
C in the diet promote
collagen
-increase formation
CHON intake
-for tissue
-change repair
dressing
-to promote
-provide a safe healing and
and quiet prevent
contaminatio
 environment n of the
wound
-Take Due
meds on time -to promote
pt’s comfort

- To met the
body’s
requirements

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