Risk for Infection | Nursing Care Plan for Diabetes Mellitus

Risk factors may include
High glucose levels, decreased leukocyte function, alterations in circulation
Preexisting respiratory infection or UTI

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Knowledge: Infection Control
Identify interventions to prevent or reduce risk of infection.
Demonstrate techniques and lifestyle changes to prevent development of infection.

Nursing intervention with rationale:
1. Observe for signs of infection and inflammation—fever, flushed appearance, wound drainage, purulent sputum, and cloudy urine.
Rationale: Client may be admitted with infection, which could have precipitated the ketoacidotic state, or may develop a nosocomial infection.

2. Promote good hand washing by staff and client.
Rationale: Reduces risk of cross-contamination.

3. Maintain aseptic technique for IV insertion procedure, administration of medications, and providing site care. Rotate IV sites, as indicated.
Rationale: High glucose in the blood creates an excellent medium for bacterial growth.

4. Provide catheter and perineal care. Teach the female client to clean from front to back after elimination.
Rationale: Minimizes risk of UTI. Comatose client may be at particular risk if urinary retention occurred before hospitalization. Note: Elderly female diabetic clients are especially prone to UTIs and vaginal yeast infections. Many UTIs are asymptomatic, possibly related to neurogenic bladder.

5. Provide conscientious skin care, gently massage bony areas, keep the skin dry, and keep linens dry and wrinkle-free.
Rationale: Peripheral circulation may be impaired, placing client at increased risk for skin irritation and breakdown and infection.

6. Inspect client’s feet, noting presence of ulcers or infected ingrown toenails, or other problems requiring medical or nursing intervention.
Rationale: Foot injuries and impaired circulation are associated with many complications in diabetics, including cellulitis and amputations. Note: Cellulitis can precipitate episode of DKA.

7. Auscultate breath sounds.
Rationale: Rhonchi indicate accumulation of secretions possibly related to pneumonia or bronchitis that may have precipitated the DKA.

8. Place in semi-Fowler’s position.
Rationale: Facilitates lung expansion and reduces risk of aspiration.

9. Reposition and encourage coughing and deep breathing if client is alert and cooperative. Otherwise, suction airway, using sterile technique, as needed.
Rationale: Aids in ventilating all lung areas and mobilizing secretions. Prevents stasis of secretions with increased risk of infection.

10. Provide tissues and trash bag in a convenient location for sputum and other secretions. Instruct client in proper handling of secretions.
Rationale: Minimizes spread of infection.