Diabetes mellitus is a metabolic disease characterized by dysregulation of carbohydrate, protein,

and lipid metabolism. The primary feature of this disorder is elevation in blood glucose levels
(hyperglycemia), resulting from either a defect in insulin secretion from the pancreas, a change
in insulin action, or both. Sustained hyperglycemia has been shown to affect almost all tissues in
the body and is associated with significant complications of multiple organ systems, including
the eyes, nerves, kidneys, and blood vessels.

Deficient Fluid Volume

Glucose appears in the urine (glycosuria) because the kidney excretes the excess glucose to make
the blood glucose level normal. Glucose excreted in the urine acts as osmotic diuretic and causes
excretion of increased amount of water, resulting in fluid volume deficit or polyuria.

Assessment Nursing Planning Nursing Rationale Evaluation

Diagnosis Interventions
Subjective: (none) Deficient Short Establish Friendly Short
Objective: Fluid Term:After 3° rapport Take relationship Term:After
Volume r/t of NI, patient and record vital with patient 3° of NI,
 elevated     intracellula shall have signs and to be patient will
temperature r DHN 2° verbalized able to each have
of the DM II understanding Monitor the other’s verbalized
38.4°C/axilla of causative temperature concern To understanding
 increased factors and obtain of causative
urine output. purpose of Assess skin baseline data factors and
 sweating of individual turgor and purpose of
the skin therapeutic mucous To monitor individual
 thirst interventions membranes for changes in therapeutic
 exhaustion and signs of temperature interventions
 weight loss medications. dehydration and
Long Term: Dry skin and medications.
 dry skin or 
Encourage the mucous Long Term:
mucous
After 2 days of patient to membranes
membrane
NI, the patient increase fluid are signs of After 2 days
shall have intake dehydration of NI, the
maintained fluid patient will
volume at a Administer To replace have
functional level IVF as ordered fluid loss and maintained
as evidenced by by the Doctor prevent fluid volume
individual good dehydration at a functional
skin turgor, Administer level as
moist mucous anti-pyretic as To replace evidenced by
membrane and prescribed by electrolytes individual
stable vital the Doctor. and fluid loss good skin
signs. turgor, moist
To decrease mucous
 body membrane and
temperature stable vital
and will have signs
less
occurrence of
dehydration.

Imbalanced Nutrition: Less Than Body

Requirements
Due to decrease of lack of insulin in the body, the glucose level continuously rises because
glucose can’t be utilized without the presence of insulin. Glucose is the source of energy, while
insulin is the vehicle to transport glucose to the body tissues. Because of decrease insulin level in
the blood stream, the cells starved, leading to alteration of metabolism. The body needs glucose
for metabolism; there will be a breakdown of energy reserved from adipose tissue, muscles and
liver (glucagons). This will result to weight loss. But the energy breaks down, the glucose level
continuously increase because there is less amount of insulin. The body tissues need to be fed,
this will lead to polyphagia and polydipsia because the tissue are not being fed and need glucose
for metabolism.

Assessment Nursing Planning Nursing Rationale Evaluation

Diagnosis Interventions
Subjective: Imbalanced Short Term: After Establish rapport Friendly Short Term:
Æ Objective: Nutrition: 3° of NI, patient Ascertain relationship After 3° of NI,
less than shall have understanding of with patient patient will
Pt. body verbalized individual and to be able have
manifested: requiremen understanding of nutritional needs to each other’s verbalized
t r/t insulin causative factors concern To understanding
- poor deficiency when known and Discuss eating determine of causative
muscle tone necessary habits and what factors when
interventions and encourage information to known and
- generalized identified diabetic diabetic diet as be provided to necessary
weakness client. prescribed by the client/SO interventions
Doctor and identified
- increased Long Term: - To achieve diabetic client.
thirst Document actual health needs of
After 1-4 months weight, do not the patient Long Term:
- increased of NI, the patient estimate. with the
urination shall have proper food After 1-4
demonstrated Note total daily diet for is/her months of NI,
-polyphagia weight gain intake including disease the patient will
toward goal. patterns and time have
Pt. may    - Patient may demonstrated
manifest: of eating. be un aware of weight gain
their actual toward goal.
- loss of Consult  weight or
weight dietician/physicia weight loss
n for further due to
assessment and estimating
recommend- weight.
dation regarding
food preferences - To reveal
and nutri-tional changes that
support should be
made in
client’s dietary
intake

- For greater
understanding
and further
assessment of
specific foods.

Fatigue
Diabetes Mellitus is a group of metabolic diseases characterized by increased levels of glucose in
the blood resulting from defects in insulin secretion, insulin action, or both. In type 2 diabetes,
people have decreased sensitivity to insulin and impaired beta cell functioning resulting in
decreased insulin production. Glucose derived from food cannot be stored in the liver thereby
remaining into the bloodstream. The beta cells of the islets of Langerhans release glucagon
which stimulates the liver to release the stored glucose. After 8 – 12 hours, the liver forms
glucose from the breakdown of noncarboghydrate substances, including amino acids resulting to
muscle wasting which results to weakness.

Assessment Nursing Planning Nursing Rationale Evaluation

Diagnosi Interventions
s
Subjective: (none) Fatigue Short -Assess -Response to The patient
Objective: related to Term:After 2-3º response to an activity can shall have
decreased of nursing activity -Asses be evaluated been able to
 generalized muscular interventions, muscle strength to achieve identify
weakness strength the patient will of patient and desired level measures to
 increased be able to functional level of tolerance. conserve and
respiratory identify of activity. -To determine increase body
rate of 25cpm measures to the level of energy The
conserve and -Discuss with patient shall
 presence of increase body activity have been
non-healing energy. Long patient the need free from
wound on both Term: for activity -Education signs of
feet may provide fatigue
 body After 3-5 days of -Alternate motivation to
weakness nursing activity with increase
 wt. loss interventions, periods of rest/ activity level
 fatigue the patient will uninterrupted even though
 limited ROM be free from sleep. patient may
 inability to signs of fatigue feel too weak
perform ADL -Monitor pulse, initially
 altered VS respiration rate
and blood -Prevents
 altered
pressure excessive
sensorium
before/after fatigue
activity
-Indicates
-Perform physiological
activity slowly levels of
with frequent tolerance
rest periods
-Tolerance
-Promote develops by
energy adjusting
conservation frequency,
techniques by duration and
discussing intensity until
ways of desired
conserving activity level
energy while is achieved.
bathing,
transferring and -Interventions
so on. should be
directed at
-Provide delaying the
adequate onset of
ventilation fatigue and
optimizing
-Provide muscle
comfort and efficiency.
safety Symptoms of
fatigue are
-Instruct patient alleviated
to perform deep with rest. 
breathing Also, patient
exercises will be able to
 -Instruct client accomplish
to increase more with a
Vitamins A, C decreased
and D and expenditure of
protein in her energy.
diet.
-For proper
-Instruct also oxygenation
patient to
increase iron in -To be free
diet from injury

-Administer -Promotes
oxygen as relaxation
ordered.
-For muscle
strength and
tissue repair

-To prevent
weakness and
paleness

-To provide
proper
ventilation

Risk for Infection

Risks for infection is a increased probability of invasion of pathogenic organisms for a pt. with DM wound is
possible in the furure.Clients with diabetes are susceptible to infections because of polymorphonuclear leukocyte
function, diabetic neuropathies, and vascular insufficiency as a result is a poor glycemic control; thus making a
wound to heal slowly because the damaged of the vascular system cannot carry sufficient oxygen, WBC, nutrients,
and antibodies to the injured site. Thereby infections increase and enhance possibility of further complications.

Assessment Nursing Planning Nursing Rationale Evaluation

Diagnosis Interventions
Subjective:Æ Risk for Short Term: After -Establish - to obtain Short Term:
Objective: infection 4 hours of NPI the rapport -Take patient’s trust -The pt. shall
related to risks factors of and record vital and have identified
Pt. disease occurrence of signs cooperation - risks factors of
manifested: condition. infection will be To obtain occurrence of
reduce or control -Encourage baseline data infection shall
-purulent to a manageable expression of have reduced
discharge level by a clean feelings and - facilitates or controlled to
 bed and maintain a manageable
-hyperthermia skin intact. anxieties grieving the level by a
loss clean bed and
Pt. may Long Term: - Observe non – skin intact.
manifest: verbal cues - non – verbal
After 1-2 weeks cues is more Long Term:
-altered of NPI, pt will be -Encourage accurate than
circulation free of purulent client to look verbal cues -The patient
drainage or at/touch affected shall be free of
- erythema and be body part - to begin to purulent
immunologica afebrile incorporate damage or
l deficit -Encourage changes into erythema and
verbalization of body image be febrile
and role play
anticipated - to enhance
conflicts handling of
potential
-encourage to problems
increase fluid
intake -to prevent
dehydration
-increase Vit. C
in the diet -to boost
immune
-increase CHON system and
intake promote
collagen
-change dressing formation

-provide a safe -for tissue

and quiet repair
environment
-to promote
-Take Due meds healing and
on time prevent
contamination
of the wound

-to promote
pt’s comfort

- To met the
body’s
requirements

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