Nursing diagnosis for diabetes
1. Nursing diagnosis for diabetes (An overview)
For patients with diabetes, nursing care plan goals include: nursing the patients and responding to their call, needs and abilities (by staying beside their bed like the family members). Nursing is indispensable (even after taking balanced diet, physical activity and effective medical treatment prescribed by the physician) in order to normalize blood glucose and reduce related complications. More importantly, nursing involves priority on complying with prescribed treatment programs. In this connection, nursing diagnosis/ nursing care plan/ nursing intervention come into play. (Diabetes is a disease in which the body fails to control blood sugar level. This occurs when the body is unable to produce enough insulin or the body is resistant to insulin. In consequence, this leads to increased concentration of glucose in the blood stream known as hyperglycemia.
The condition is characterized by disturbances in the carbohydrate /protein/fat metabolism. Sustained hyperglycemia is believed to affect almost all the tissues in the body. Hyperglycemia also invites significant complications in multiple organ system including eyes/nerves/ kidneys/ blood vessels).
2. What is nursing diagnosis
Nursing diagnosis is a part of nursing procedure. It is a clinical judgment made on the patient’s feelings/ experiences/ responses to actual or potential; health problems. Nursing diagnosis fosters the nurse’s independent action (pertaining to patient’s comfort and relief) in contrast to nurse’s dependent intervention (pertaining to the physician’s order for prescribed medications).
3. What is nursing care plan
A nursing care plan is a document or record of actions and responsibilities (which a patient may need). The care plan includes a set of actions applied to support nursing diagnosis (identified by nursing assessment). Nursing procedure has 5 stages. Assessment is the 1st stage of nursing procedure (the rest 4 are: diagnosis/ planning/ implementation/ evaluation). Assessment involves critical thinking skills and relevant data collection (both subjective and objective).
4. Importance of nursing intervention in diabetes:
In the treatment plan for the diabetic patients, nursing interventions involve the following procedures.
4.1) Improving nutrition
- Assess correct timing and nutritional aspect of meals.
- Advise the patient on the importance of meal plan while meeting the goal of attaining an ideal healthy weight. In this connection reduction of carb intake is recommended.
- Advise the diabetic patients (with overweight and obesity), for setting more or less 10% weight loss goal over a month. it will be health friendly in reducing blood sugar and other metabolic parameters.
- Instruct the patient to follow a healthy life style with dietary restriction.
- Explain to the patient the importance of physical activity for achieving a healthy weight through maintaining calorie balance in a healthy way.
4.2) Teaching about insulin
- Advise the patient to shake off the fear of insulin injection (insulin is a hormone produced by the beta cells of the pancreatic islets. Insulin helps the body to store and use glucose).
- Demonstrate and thoroughly explain to the patient the procedure for self-injection of insulin.
- Allow the patient to take time to handle insulin and syringe in order to become familiar with the equipment’s (of insulin injection).
- Teach self-injection to exterminate the fear of pain (from injection).
- Review dosage and time of injection according to quality and quantity of meals/ physical activity and bed time (based on the patient’s individualized regimen).
4.3) Preventing insulin (secondary to hypoglycemia).
4.3.1) Closely monitor blood glucose level to detect hypoglycemia (low blood glucose level).
4.3.2) Instruct the patient about the importance of accuracy in insulin preparation and meal timing (to avoid hypoglycemia)
4.3.3) Assess the patient for the signs and symptoms of hypoglycemia (early symptoms include: sweating/ tremor/ tachycardia i.e... rapid heart rate caused by the problem in the heart’s electrical system/ palpitation/ nervousness from the release of adrenaline when blood glucose falls rapidly. Adrenaline is a hormone produced by both adrenal glands and small number of neurons in the medulla oblongata. And later symptoms include: headache/ confusion/ irritability/ slurred speech/ lack of coordination /staggering gait arising from depression of central nervous system when glucose level falls drastically).
4.3.4) Treat hypoglycemia promptly (with fast acting carbohydrates) Add ½ cup (or 4 oz.) juice / 1 cup skim milk / 3 glucose tablet (glucose is the fuel that feeds the body) /4 sugar cubes / 5-6 pieces of hard candy (may be taken orally)/ nutrition bar (especially designed for diabetes. It supplies glucose from sacrose, starch and protein sources with some fat to delay gastric emptying. This may prevent relapse) / 1 mg glucagon (the effects of glucagon is just the opposite of the effects of insulin. Glucagon is given to raise very low level of blood glucose to normal level. Glucagon is used if the patient cannot ingest a sugar treatment. The family members along with the nurse must administer the injection. If the patient fails to respond to glucagon within 15 minutes, then IV bolus of 50 ml. of 50% dextrose solution can be given).
4.3.5) Instruct the patient to carry a portable treatment equipment’s (to control hypoglycemia) at all times.
4.3.6) Assess the patient for cognitive or physical impairment that may interfere with ability to accurately administer insulin.
4.3.7) Exercise should be encouraged (well before meals or early in the morning before breakfast) to prevent hypoglycemia.
4.3.8) Instruction may be given to the patient to wear an identification bracelet or card (that may help for prompt treatment during hypoglycemic emergency).
4.4) Improving activity tolerance
- Advise the patient to assess blood glucose level (before and after strenuous exercise).
- Instruct the patient to eat a carb-snack (well before exercise to avoid hypoglycemia).
- Instruct the patient to take increased food at bed time (in case of prolonged strenuous exercise) to avoid nocturnal hypoglycemia.
- Counsel the patient to inject insulin into the abdominal site (on the days when the arms and legs are used during exercise).
- Instruct the patient to avoid exercise when random blood glucose level exceeds 13.9 mm ol/ L and urine ketone is present. If the blood glucose level remains elevated, then the patient may be instructed to immediately contact the healthcare provider. (Ketone is an organic compound of carbonyl group. It is a by -product of the breakdown of fatty acid.).
4.5) Providing information about oral anti-diabetic agents
In this connection the patient may be informed about the action/ use /adverse effects of anti-diabetic agents.
4.6) Maintaining the skin integrity
- Examine skin and legs for skin temperatures/ sensation /soft tissue injuries/ dryness/ pulse rate/ hair distribution/ deep tendon reflexes.
- Instruct the patient about foot care guidelines.
- Advise the patient to avoid all bad habits (including smoking and alcohol).
4.7) Improving coping strategies
- Explore the coping skills and strategies that exert positive impact on diabetes management.
- Encourage the patient as well as the family members to participate in self-care (to foster confidence).
- Extend all-out support for lifestyle changes (to bring diabetes under control).
5. Concluding remarks:
5.1) Nurses are the nearest, most trusted and dependable healthcare professionals. They remain with the patients like a shadow (sometimes at home and mostly in the hospital/ clinic) until and unless the patient is fully cured. Nurses simultaneously play the role of caregiver/counselor / physician/ guide/ observer/ thinker/ innovator.
5.2) Nurses not only extend medical service to the patient. Patients may experience stress/ fear/despair in the wake of sufferings from disease / injuries/ surgery. In addition to medical need, a nurse often has to extend service (like a family member) with affection and consolation to meet the emotional need of the patient.
5.3) In the nursing ethics, nursing care for older patients (irrespective of diabetic or non-diabetic) is more complex. Veritably, the sufferings and complications relating to various health problems increase with aging. In order to extend due care and services to the older people, sustainable home-based care is essential. (For instance, in the Netherlands, the Ministry of Health, Welfare and Sports commissioned a nationwide program for the older people between 2008- 2016. The main objective of the program was to promote proactive integrated healthcare for older people with complex healthcare needs.