Nursing care plan for Diabetes

Diabetes Mellitus

Scenario:

The focus of this nursing care plan for diabetes involves a client who was a 45-year-old Caucasian female presents to the hospital with complaints of serious weakness and fatigue with abdominal pain. She also stated that she has been urinating a lot. Client has a history of T1DM (diagnosed at 8 years) and hypothyroidism. Her home medications includes insulin detemir 30u SubQ daily, regular insulin 10u with meals and levothyroxine 125mcg PO daily. She states “trying” to take her regular insulin with meals but “sometimes forgets”. She states that she has not been getting much exercise and has had a lot of fast food as of late. When she started to feel weakness in her extremities, she became worried, so she had a friend drive her to the ER. When she arrived, her labs indicated a blood glucose of 580, arterial pH 7.25, urine ketone positive, serum ketone positive, sodium bicarb 16, anion gap 11, and serum K+ 2.7. Other electrolytes were WNL. Her vital signs were HR 90, BP 120/75mmHg, RR 23 and weighs 70kg.

Diagnosis:

Client presents with diabetic ketoacidosis as evidenced by T1DM diagnosis, arterial pH 7.25, blood glucose 580 mg/dL, urine and serum ketone positive, elevated sodium bicarb 16 and an elevated anion gap 11. Client also has hypokalemia with a lab reading of 2.7 as well as tachypnea RR 22.

Subjective:

Client presents with feelings of weakness and abdominal pain. She complains of “having to go pee every night” but still feels dehydrated after drinking “tons” water. She says that she “has eaten like crap” lately and has not had time to exercise due to the demands of her job. She indicates poor adherence to regular insulin regimen and that she “sometimes forgets” to take her doses prior to meals. Contributing factors for DKA and hypokalemia includes poor adherence to regular insulin, high carbohydrate diet, lack of exercise, and concurrent T1DM.

Objective:

This client has DKA as evidenced by BG elevations 580, arterial pH 7.25, abnormal anion gap 11, bicarb 16, urine ketone positive, and serum ketone positive as well as hypokalemia 2.7. Vital signs are HR 90, BP 120/75, O2 sat 96%, and RR 23. Physical assessment indicated dry skin turgor > 3 seconds, sunken eyes, and a fruity smelling breath.

Goals of therapy:

  • Reduce blood glucose to target 80-150 and restore serum potassium to 3.5-5.0 within 12 hours
  • Educate the clients on the importance of taking medications as prescribed to reduce hypoglycemia and other serious events
  • Ensure client can adequately check blood sugar and dose/inject insulin accordingly

Interventions:

There are several important interventions to provide for clients with conditions like these. This nursing care plan for diabetes provides an array of example interventions that will likely appear in practice.

  • Initiate insulin drip and titrate to target blood sugars per physician’s discretion
  • Provide potassium supplementation to restore serum potassium to target levels
    • Check BMP to ensure within range an hour after supplementation
  • Educate client on the importance of proper adherence to insulin regimen
  • Ensure client can self-test blood sugars and inject insulin with appropriate technique
  • Educate on the importance of having a low carb diet and to keep up with regular exercise regimens to improve blood sugars
  • Establish a follow up with PCP to check BG and A1c