Diabetic Foot Ulcer Nursing Care Plan example nursing care plan for diabetic foot ulcer is important information accompanied by photo and HD pictures sourced from all websites in the world. The nurse understands that: The client can have a higher-calorie diet. Restrict carbohydrate intake to less than 30% of the total caloric intake. Use foot cradle on the bed. If this activity does not load, try refreshing your browser. Registered Nurse, Free Care Plans, Free NCLEX Review, Nurse Salary, and much more. Imbalanced Nutrition: less than body requirement r/t insulin deficiency. Nursing implications Insulin injections are necessary for Type I, since the body is unable to produce insulin to transport glucose into the cells. patient also appears much more comfortable with skin care then she did a couple days ago. When administering glargine (Lantus) insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa. Answer D is incorrect because the desired range for glycosylated hemoglobin in the adult client is 2.5%–5.9%. A patient with a history of diabetes mellitus is in the second post-operative day following cholecystectomy. Join the nursing revolution. Skin on lower extremity pressure points is at great risk for ulceration. Which of the following clinical characteristics is associated with Type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus [NIDDM])? Rationale: Dry mucous membranes are signs of dehydration. Which history finding is a major risk factor for infective endocarditis? The client should take glipizide twice a day, 30 minutes before a meal, because food decreases its absorption. Any items you have not completed will be marked incorrect. Rationale: To replace lost electrolytes and fluids. Diet, exercising, oral medications, giving insulin (peak times), drugs that increase blood glucose and lower glucose etc. Rationale: Education may provide motivation to increase activity level even though patient may feel too weak initially. Making appropriate referrals is a valid part of planning the client’s care. Rationale: Constant energy and thought required for diabetic control often shifts the focus of a relationship. Answer A is incorrect because the client would develop hypoglycemia while sleeping. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. The glycosylated hemoglobin of a 40-year-old client with diabetes mellitus is 2.5%. Wounds should be cleaned from the most contaminated area to the least contaminated area—for example, from the center outward. Identify interventions to prevent/reduce risk of infection. Treatment: Eat a bedtime snack….a dose of bedtime insulin will prevent it from dropping so low or decreasing insulin amounts at night. Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. When teaching the client and family how diet and exercise affect insulin requirements, Nurse Joy should include which guideline? “I’m sweaty, cold, and clammy….give me some candy”, “Sweating, clammy, confusion, light headedness, double vision, tremors”. The nurse would first... Glucagon causes increased blood sugar and causes slow breakdown of glycogen in the liver. Excessive gastric losses: diarrhea, vomiting, Dry skin/mucous membranes, poor skin turgor, Hypotension, tachycardia, delayed capillary refill. During discharge planning, nurse Pauleen would be aware of the client’s need for additional teaching when the client states: “If I have hypoglycemia, I should eat some sugar, not dextrose.”, “The drug makes my pancreas release more insulin.”, “I should never take insulin while I’m taking this drug.”, “It’s best if I take the drug with the first bite of a meal.”. Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. The standard OGTT includes a fasting blood glucose test. Investigate and look for ulcers, reddened areas, pressure points, loss of pedal pulses. PREVENTION. Maintain NPO status as indicated. Promote comfortable environment. A nursing note is a document that contains the history, treatment, care and response of a patient while under the care of a healthcare provider This note is written by the nurse who has been observing the client and is meant to provide data for quality assurance towards expected outcome. Elevated blood glucose levels contribute to complications of diabetes, such as diminished vision. Insulin also should never be frozen because the insulin protein molecules may be damaged. Endogenous chemical alteration: glucose/insulin and/or electrolyte imbalance. Don't incorporate opinion or try to make your writing beautiful. Symptoms of Shingles ahmednasser000. Many nurses are playing now! Patient will improve or maintain fluid volume at a functional level as evidenced by individual good skin turgor, moist mucous membrane, and stable vital signs. An insulin unit is a measure of effect, not a standard measure of weight or quantity. Encourage patient and/or SO to express feelings about hospitalization and disease in general. Note that if you use the word insulin you can divide the word and separate it into specific categories of insulin types. Rationale: Changes in mentation can be due to abnormally high or low glucose, electrolyte abnormalities, acidosis, decreased cerebral perfusion, or developing hypoxia. able to talk better, move better and take sips w/o as much pain. Which statement indicates that the client knows when the peak action of the insulin occurs? A review of dietary modifications is important once the woman is pregnant. Include SO in meal planning as indicated. A useful adjunct to the management of DM is exercise. Individuals with Type 2 diabetes rarely demonstrate ketosis, except in stress or infection. Also, this page requires javascript. Patient whose locus of control is internal usually looks at ways to gain control over own treatment program. SOAP Notes - Dentistry - Example Ashley Mark. Rationale: Hypovolemia may be manifested by hypotension and tachycardia. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise? Regardless of the cause, impaired consciousness can predispose patient to aspiration. Rationale: Unrealistic expectations or pressure from others or self may result in feelings of frustration and loss of control. The client starts to need increased insulin in the second trimester. Which of the following would the nurse expect the physician to do? Cover patient with light sheets. Encourage patients to avoid alcohol and refined sugars and to distribute nutrients to maintain a balanced blood sugar throughout the 24-hour period. The outside of containers, such as sterile saline bottles, aren’t sterile. People (usually with type 1 diabetes) may also present with diabetic ketoacidosis, a state of metabolic dysregulation characterized by the smell of acetone, a rapid, deep breathing known as Kussmaul breathing, nausea, vomiting and abdominal pain, and altered states of consciousness. Which of the following is not considered an endocrine hormone? White fabric enables easy visualization of blood or exudates. Acetone breath is due to breakdown of acetoacetic acid and should diminish as ketosis is corrected. Place bed in low position and pad bed rails if patient is prone to seizures. Instruct patient in the importance of accuracy of insulin preparation and meal timing to avoid hypoglycemia. NPH insulin peaks in 8–12 hours, so a snack should be eaten at the expected peak time. It’s a measure of effect, not a standard measure of weight or quantity. The nurse's best response is.... To check for any cuts, sores, or dry cracked skin so they can be treated early to prevent infection or gangrene. The client’s diabetes is well under control. Symptoms may have been present for varying amounts of time (hours to days). When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Rationale: To reveal changes that should be made in the client’s dietary intake. Organizing Information . Always check blood sugar prior to exercising: if, Example of simple carbs:  hard candy, honey, crackers/graham crackers, fruit juice, Remember from the hypertension lecture that Beta Blockers (mask symptoms of hypoglycemia), Other medication that cause it: ETOH, ASA, Sulfonylureas (medications used to treat type 2: Glyburide, Glipizide, Diabinese), and MAO inhibitors (meds for depression) , Bactrim (common antibiotic), When mixing insulin (clear to cloudy) clean=regular, cloudy=NPH, Don’t massage site after administration increase hypoglycemia due to absorption. ", "I will eat a snack around three o’clock each afternoon. She has been taking 20 units of NPH insulin for diabetes mellitus daily for six years. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Health care system barriers Note: Normal levels for fingerstick glucose testing may vary depending on how much the patient ate during his last meal. dispo. Rationale: Identifies concerns and facilitates problem solving. The nurse should refer this client to a sex counselor or other professional. Advise them to control their diabetes by changing their lifestyle and diet. As for drug history, patient was only on 10mg of lovastatin (tablet) once at night and according to the patient, he was compliant to the medication. Individuals with type 1 DM require subcutaneous insulin administration. ", "Sometimes when I put my shoes on I don't know where my toes are. Other risk factors include a history of heart disease (especially mitral valve prolapse), chronic debilitating disease, IV drug abuse, and immunosuppression. Rationale: Knowledge of individual’s style helps determine needs for treatment goals. Copyright © 2020 RegisteredNurseRN.com. Patient will be free of infections as evidenced by normothermia, negative cultures, and WBC within normal levels. The client must continue to monitor the blood glucose level during glipizide therapy. However, when you have insulin problems (not enough of it) the increased blood sugar causes HYPERGLYCEMIA. Rationale: To replace fluid loss and prevent dehydration. By accessing any content on this site or its related media channels, you agree never to hold us liable for damages, harm, loss, or misinformation. Everyone with type 1 diabetes and some people with type 2 diabetes must take insulin every day to replace what their pancreas is unable to produce. Imbalanced Nutrition: Less Than Body Requirements, Insulin deficiency (decreased uptake and utilization of glucose by the tissues, resulting in increased protein/fat metabolism), Decreased oral intake: anorexia, nausea, gastric fullness, abdominal pain; altered consciousness, Hypermetabolic state: release of stress hormones (e.g., epinephrine, cortisol, and growth hormone), infectious process, Reported inadequate food intake, lack of interest in food, Recent weight loss; weakness, fatigue, poor muscle tone, Increased ketones (end product of fat metabolism). Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Rationale: To determine what information to be provided to client or SO. The nurses role include educating, assessing, planning, administering medications, and evaluating treatment. Patient’s skin on legs and feet remains intact while the patient is hospitalized. Many diabetic women have pregnancies with successful outcomes if they receive good care. A client has a medical history of rheumatic fever, type 1 (insulin dependent) diabetes mellitus, hypertension, pernicious anemia, and appendectomy. Have they received, or would they like to receive, any educational input to help them improve their understanding of their condition an… However, in recent years the concept of nursing care plans has been in the limelight as some healthcare experts argue that it is a mere time-waster. The client should be instructed to take the medication: Glucotrol XL is given once a day with breakfast. Draw up the drug first, then add regular insulin. The patient will be able to describe the diabetic medications that they are on and how to properly take the medication. Assess for dysuria, tachycardia, diaphoresis, nausea, vomiting, and abdominal pain. Therefore, it wouldn’t be appropriate to initiate insulin therapy at this time. Pregnant and lactating women aren’t prescribed oral antidiabetic agents because the effect on the fetus is uncertain. A rare but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 diabetes and is mainly the result of dehydration. Rationale: Complex carbohydrates (apples, broccoli, peas, dried beads, carrots, peas, oats) decrease glucose levels/insulin needs, reduce serum cholesterol levels, and promote satiation. A nursing note typically carries a patient’s basic and general information which may include information on the patient’s appearance, along with his/her past and current medical condition. Of primary importance for the diabetic woman who is considering pregnancy should be. Possibly evidenced by The dietitian selects an appropriate calorie allotment depending on the patient’s age, body size, and activity level. The major sources of the glucose that circulates in the blood are through the absorption of ingested food in the gastrointestinal tract and formation of glucose by the liver from food substances. Many believe the continuous method is the optimal way to facilitate transition to carbohydrate metabolism and reduce incidence of hypoglycemia. There are various strategies for organizing and prioritizing the vast amount of information that must be taught to diabetic patients. Provide opportunity for SO to express concerns and discuss ways in which he or she can be helpful to patient. A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. Any symptoms of IDDM or hard to heal wounds, Provide a meal or source of complex protein or carbohydrates, Monitor: Level of consciousness, vital signs, intake and output, and electrolytes. Diabetic clients must exercise at least three times a week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Respiratory pattern: Kussmaul’s respirations, acetone breath. Moist, transparent dressings contain exudate and provide a moist wound environment. Provide bed cradle. The nurse's first action upon finding a patient with mild hypoglycemia is to... Once you are finished, click the button below. Exercise, reduced food intake, hypothyroidism, and certain medications decrease the insulin requirements. They protect the wound from mechanical trauma and promote healing. Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. Writing a SOAP Clinic Note Cheat Sheet Justin Berk. Reinforce that patients cannot miss a dosage and there may be a need for increasing dosages during times of stress or illness. Which drug fits this description? Assist in planning own care and independently take responsibility for self-care activities. The classic symptoms of untreated diabetes are loss of weight, polyuria (frequent urination),polydipsia (increased thirst) and polyphagia (increased hunger).Symptoms may develop rapidly (weeks or months) in type 1 diabetes, while they usually develop much more slowly and may be subtle or absent in type 2 diabetes. Demonstrate stabilized weight or gain toward usual/desired range with normal laboratory values. A client with type 1 diabetes mellitus has been on a regimen of multiple daily injection therapy. Rationale: Patients may be unaware of their actual weight or weight loss due to estimation of weight. Which of the following is not true about Type I DM? High glucose levels, decreased leukocyte function, alterations in circulation, Preexisting respiratory infection, or UTI. patient feels overall much improved. In addition to strict dietary adherence to control blood glucose, obese patients with type 2 DM also need weight reduction. The nurse should refer this client to a sex counselor or other professional. ****If patient plans on exercising for an extended period of time, check glucose prior, during, and after. It’s safe to be on a regimen that includes insulin and an alpha-glucosidase inhibitor. Rationale: Promotes patient safety, especially when sense of balance is affected. Reposition and encourage coughing or deep breathing if patient is alert and cooperative. Rationale: In contrast, increased work of breathing, shallow, rapid respirations, and presence of cyanosis may indicate respiratory fatigue and/or that patient is losing ability to compensate for acidosis. Financial limitations 9. Rationale: Moisturizers soften and lubricate dry skin, preventing skin cracking. It’s the basis for solids in the avoirdupois system. As carbohydrate metabolism approaches normal, care must be taken to avoid hypoglycemia. The nurse doesn’t normally provide sex counseling. Provide support for the spouse or significant other. The physician has prescribed NPH insulin for a client with diabetes mellitus. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. Display improved ability to participate in desired activities. Can I do them less frequently?”. ****If blood glucose is higher than 250 with ketones present in urine prior to exercise avoid exercise until glucose and ketones stabilize. Temperature, skin color, moisture, and turgor. Assess patients for cognitive or sensory impairments, which may interfere with the ability to accurately administer insulin. Prescribe an additional oral antidiabetic agent. Rationale: Weighing serves as an assessment tool to determine the adequacy of nutritional intake. Note: A snack at bedtime of complex carbohydrates is especially important (if insulin is given in divided doses) to prevent hypoglycemia during sleep and potential Somogyi response. If the patient is to self-administer insulin, have the patient demonstrate the appropriate preparation and administration techniques. Rationale: Minimizes risk of UTI. Is partly inherited, and then triggered by certain infections, with some evidence pointing at Coxsackie B4 virus. Diabetes Nursing Care Plans. When diet, exercise and maintaining a healthy weight aren’t enough, you may need the help of medication. Assess temperature every four (4) hours. Patient will verbalize understanding of causative factors and purpose of individual therapeutic interventions and medications. The nurse can’t conclude that the result occurs from poor dietary management or inadequate insulin coverage. 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