Learning Need Regarding Diabetic Condition

Nursing Care Plan for Diabetes Mellitus

Learning Need regarding diabetic condition, related to misinterpretation of information and/or lack of recall as evidenced by inaccurate follow-through of instructions regarding home glucose monitoring and foot care and failure to recognize signs and symptoms of hyperglycemia.

Outcomes
Knowledge: Diabetes Management (NOC) Indicators:

Client Will
Perform procedure of home glucose monitoring correctly within 36 hr (6/30, 7 a.m.).
Verbalize basic understanding of disease process and treatment within 38 hr (6/30, 9 a.m.).
Explain reasons for actions within 38 hr (6/30, 9 a.m.).
Perform insulin administration correctly within 60 hr (7/1, 7 a.m.).

Nursing care plan intervention with rationale:
1. Determine client’s level of knowledge, priorities of learning needs, and desire and need for including wife in instruction.
Rationale: Establishes baseline and direction for teaching and planning. Involvement of wife, if desired, will provide additional resource for recall and understanding and may enhance client’s follow-through.

2. Provide teaching guide, “Understanding Your Diabetes,” 6/28 p.m. Show film Living With Diabetes, 6/29, 4 p.m., when wife is visiting. Include in group teaching session, 6/30 a.m. Review information and obtain feedback from client and wife.
Rationale: Provides different methods for accessing and reinforcing information and enhances opportunity for learning and understanding.

3. Discuss factors related to and altering diabetic control, such as stress, illness, and exercise.
Rationale: Drug therapy and diet may need to be altered in response to both short- and long-term stressors and changes in activity level.

4. Review signs and symptoms of hyperglycemia (e.g., fatigue, nausea, vomiting, polyuria, polydipsia). Discuss how to prevent and evaluate this situation and when to seek medical care. Have client identify appropriate interventions.
Rationale: Recognition and understanding of these signs and symptoms and timely intervention will aid client in avoiding recurrences and preventing complications.

5. Review and provide information about necessity for routine examination of feet and proper foot care (e.g., daily inspection for injuries, pressure areas, corns, calluses; proper nail cutting; daily washing; application of good moisturizing lotion such as Eucerin, Keri, or Nivea bid). Recommend loose-fitting socks and shoes that fit (break new shoes in gradually), and avoid going barefoot. If foot injury or skin break occurs, wash with soap or dermal cleanser and water, cover with sterile dressing, inspect wound, and change dressing daily; report redness, swelling, or presence of drainage.
Rationale: Reduces risk of tissue injury and promotes understanding and prevention of stasis ulcer formation and wound healing difficulties.

6. Instruct regarding prescribed insulin therapy:
Rationale: May be a temporary treatment of hyperglycemia with infection or may be permanent replacement of oral hypoglycemic agent.

a. Humulin N insulin, SC.
Rationale: Intermediate-acting insulin generally lasts 18 to 28 hr, with peak effect 6 to 12 hr.
b. Keep vial in current use at room temperature (if used within 30 days).
Rationale: Cold insulin is poorly absorbed.
c. Store extra vials in refrigerator.
Rationale: Refrigeration prolongs the drug shelf-life by preventing wide fluctuations in temperature.
d. Roll bottle and invert to mix, or shake gently, avoiding bubbles.
Rationale: Vigorous shaking may create foam, which can interfere with accurate dose withdrawal and damage the insulin molecule. Note: New research suggests that gently shaking the vial may be more effective in mixing suspension.

7. Choice of injection sites (e.g., across lower abdomen in Z pattern).
Rationale: Provides for steady absorption of medication. Site is easily visualized and accessible by client, and Z pattern minimizes tissue damage.

8. Demonstrate, then observe client in drawing insulin into syringe, reading syringe markings, and administering dose. Assess for accuracy.
Rationale: May require several instruction sessions and practice before client and wife feel comfortable drawing up and injecting medication.

9. Instruct in signs and symptoms of insulin reaction and hypoglycemia: fatigue, nausea, headache, hunger, sweating, irritability, shakiness, anxiety, and difficulty concentrating.
Rationale: Knowing what to watch for and appropriate treatment such as 1/2 cup grape juice for immediate response and snack within 30 min (e.g., one slice bread with peanut butter or cheese, fruit and slice of cheese for sustained effect) may prevent or minimize complications.

10. Review “sick day rules,” for example, call doctor if too sick to eat normally or stay active; take insulin as ordered. Keep record as noted in Sick Day Guide.
Rationale: Understanding of necessary actions in the event of mild to severe illness promotes competent self-care and reduces risk of hyperglycemia or hypoglycemia.

11. Instruct client and wife in fingerstick glucose monitoring to be done four times per day until stable, then B.I.D. at rotating times, such as FBS and before dinner, before lunch, and at bedtime. Observe return demonstrations of the procedure.
Rationale: Fingerstick monitoring provides accurate and timely information regarding diabetic control. Return demonstration verifies correct learning.

12. Recommend client maintain record or log of fingerstick testing, antidiabetic medication and insulin dosage/site, unusual physiological response, and dietary intake. Outline desired goals, for example, FBS 80 to 110, premeal 80 to 120.
Rationale: Provides accurate record for review by caregivers for assessment of therapy effectiveness and needs.

13. Discuss other healthcare issues, such as smoking habits, self-monitoring for cancer (breasts and testicles), and reporting changes in general well-being.
Rationale: Encourages client involvement, awareness, and responsibility for own health; promotes wellness. Note: Smoking tends to increase client’s resistance to insulin.