Diabetes is one of the most common conditions you will come across as a nurse and carries with it many complications and considerations. When considering nursing diagnosis for diabetes, you must understand and take these complications into account.
Diabetes carries many risk factors, such as elevated blood sugars, difficulty with fluid balance, difficulty with nutritional plans, skin and healing problems, and problems with sensation. While not all these diagnoses may apply to your patient, always consider other factors such as education level, history, and social supports when choosing a nursing diagnosis.
Nursing Diagnosis for Diabetes: Nutrition and Fluid Balance
The first group of possible nursing diagnoses for your patients with diabetes include those involved in fluid balance and nutrition. Diabetes affects the body’s ability to control blood sugar levels in the cells, and as such even if a patient is eating sufficient calories, without a way to bring that sugar into the cells to use as energy, the body essentially starves.
Risk for Imbalanced Nutrition
While a patient may be ingesting sufficient calories, without a way to bring those sugars into the cells the body may not be receiving enough calories. This may be more typical for Type I or insulin dependent diabetics.
Risk for Unstable Blood Glucose
If blood sugars are not carefully regulated in a diabetic patient, they are at risk for instability in their blood glucose levels. Many times, with poorly controlled diabetics they start to go down the blood sugar roller coaster – They get a low blood sugar, treat it with too much sugar, and then battle high blood sugars until they again are low.
Risk for Deficient or Imbalanced Fluid Volume
When blood sugars rise, the body attempts to remove that excess sugar by increasing the release of fluid through excessive urination and thirst. The increase may cause the body to become dehydrated and have electrolyte imbalances. When choosing a diagnoses, you may select either deficient or imbalanced fluid volume depending on your patient’s situation.
Nursing Diagnosis for Diabetes: Skin Integrity
When nerves and blood vessels are exposed to prolonged elevated blood sugars, they may become damaged, causing diabetic neuropathy and peripheral vascular disease. These conditions may lead to an increase in wounds and infections in the body, particularly in the feet. Elevated blood sugars also affect neutrophil functioning, one of the most important white blood cells involved in fighting bacterial infections. This causes a delay and more difficulty in the healing process.
Risk for Impaired Skin Integrity
If your patient has developed peripheral neuropathy because of their diabetes, the risk for a wound or ulcer developing is significantly increased. Often patients with neuropathy have a lowered sensation of pain, and so they may not realize if they have received an injury to their feet or if a pressure ulcer is developing.
Risk for Thermal Injury
Peripheral neuropathy also affects a patient’s ability to feel high temperatures, and they are more likely to scald or burn themselves without realizing it. These burns may be slow to heal and are more likely to get infected, due to the stunting of the immune system from reduced neutrophil functioning.
Risk for Infection
Hyperglycemia impairs the ability of the immune system to fight infections and reduces the body’s defenses against skin infections. Furthermore, peripheral vascular disease impairs blood flow, which slows down healing time for ulcers and infections.
Risk for Delayed Surgical Recovery
If your patient has just undergone surgery, then this diagnosis may apply to their situation. When blood sugars are chronically elevated both the immune and circulatory systems are impaired. Without proper blood circulation, wounds are slower to heal and are more likely to get infected. Coupled with a weakened immune system, your diabetic patient may have great difficulty with wound healing and surgical recovery.
Nursing Diagnosis for Diabetes: Health Management
Diabetes is a complicated disease to manage and depending on your patients’ education level or socioeconomic status, managing and learning about their condition may be challenging.
If your patient has just been diagnosed with diabetes or seems to have a poor understanding of the disease process, then teaching them about the disease will be of the highest priority. Not all patients will have gone to college or even completed grade school, so they may struggle with the concepts around diabetes. Repetition and reanalysis may be required to ensure they have a complete understanding of their disease. Consider evaluating if your patients can read and try to find alternative ways of teaching if the patient seems to be struggling.
Ineffective Health Management
Diabetes can be a complicated disease to manage. Often patients become complacent with elevated blood sugars or are fearful of hypoglycemia, so they keep their blood sugar levels higher than average. Understanding the reasons why your patient is not managing their disease is as important as providing strategies. Considering strategies to help your patients managing their diabetes can be beneficial when developing a nursing care plan.
Many people with diabetes develop peripheral neuropathy and suffer from chronic pain in their hands and feet. This pain can be quite severe and difficult to manage, and may affect their quality of life and independence and may even affect their ability to walk around. Developing strategies to help your patient’s manage chronic pain can significantly affect their quality of life and their future prognosis.
Diabetes is a common disease that will affect many of your patients. Understanding the appropriate nursing diagnoses will help you develop a comprehensive care plan to help your patients achieve their health goals and further their recovery from illness or surgery.
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