Makassar Ministry of Health Polytechnic

Nursing DIII Study Program

Managing for Client

With Diabetic Mellitus
(DM)

Nurhikmah Usman (PO713201211127)

Anggi Rahmadani (PO713201211104) Group 8
Anggia Juliastri (PO713201211103)
Sri Susilawati Asri (PO713201211138)
Presentation Discussion Points

Definition Nursing Assessment Nursing Evaluation

Etiology Nursing Diagnosis

Pathophysiology Nursing Care Plan

Clinical Manifestations Nursing Implementation

 Definition
Diabetic Mellitus
DM is a metabolic disorder characterized by hyperglycemia which marked with
hyperglycemia associated with abnormalities in the metabolism of carbohydrates,
fats, and proteins caused by the decrease insulin or decreased insulin sensitivity or
both and cause complications chronic macro vascular, and neuropathy. (juliana
elin, 2009). DM is a metabolic glucose disorder and resulting from lack of insulin
hormone production.
 Etiology
Genetic Factors Chemicals and
Diet Obesity Pharmaceuticals

DM can be inherited from

Eating excessive and exceeds the The chemicals can irritate the
caloric content required by the parents to their children health pancreas which causes
body can stimulate the onset of experts also mentioned dm is a inflammation of the pancreas,
Obese people with a body
DM. Consumption of excessive disease-linked sex or pregnancy. inflammation of the pancreas will
eating and not offset by the weight over 90 kg tend to
Usually men into real patients, result in decreased pancreatic
secretion of insulin insufficient have a greater chance of whereas women as those who function so that no secretion of
quantities can cause high blood disease DM. hormone-hormone for the
carry the gene for inherited to
glucose level if the disturb of
his children. metabolism of the body, including
insulin production.
insulin.
 Etiology
Diseases and The high levels Drugs that can
Infections Lifestyle of corticosteroid damage the pancreas

If people are lazy to exercise at

Diseases and infections of the
high risk for the disease of
pancreas microorganisms and
diabetes because exercise is used Pregnancy gestational
viruses can also cause
inflammation of the pancreas
to burn excess calories in the diabetes, which will Toxins that affect the
body. Calorie that accumulate in
which will automatically cause
the body is a major contributing disappear after formation or effect of
the pancreas function down so
no-hormone secretion of
factor to the cause of diabetes in delivery insulin
addition to pancreatic
hormones for the metabolism of
dysfunction.
the body, including insulin.
Pathophysiology

In the process of metabolism , insulin plays an

important role , the introduction of glucose into the
cells that are used as fuel . Insulin is a substance or a
hormone produced by the beta cells in the pancreas .
When insulin is not there then the glucose can not
enter cells with glucose result will remain in the
blood vessels , which means the levels of glucose in
the blood rises.
Pathophysiology

In Diabetes mellitus type 1 abnormalities of insulin

secretion by pancreatic beta cells, This type of diabetes
patients inherit a genetic susceptibility which predispose to
autoimmune destruction of pancreatic beta cells .

In type 2 diabetes mellitus which frequently occurs in the

elderly , the amount of normal insulin but the number of
insulin receptors located on the cell surface that are less so
glucose into the cells a bit and glucose in the
Clinical Manifestations
Polyuria Polydipsia Polyphagia
(frequent (much to drink) (increased desire
urinary) to eat)

Weight loss, fatigue,

Blurred Recurrent
quickly tired, lacking
energy vision infections of
the skin
Clinical Manifestations

High sugar levels Glycosuria

in the blood.
means glucose
Glucose in the
blood vessels is could be in the
higher than 120 ml urine
 Nursing Assessment
Assessment on the client with the endocrine system
disorders Diabetes Mellitus carried out from data
collection that includes: bio, medical history, the
main complaint the nature of the complaint, past
medical history, physical examination the pattern of
daily activities.

Things need to be assessed on the client degan

Diabetes Mellitus:
 Nursing Assessment
Activity and Rest Circulation Elimination
Weakness, difficulty walking / History of hypertension, heart disease Polyuria, nocturia, pain,
moving, muscle cramps, rest and such as IMA, pain, numbness in the burning sensation, diarrhea,
sleep disorders, tachycardia / lower extremities, which are difficult
flatulence and pale.
tachypnea during activity and coma. to heal wounds, dry skin, red, and
sunken eyes.

Nutrition Neurosensory Pain

Nausea, vomiting, weight Headache, said such like Abdominal swelling, grimacing.
loss, poor skin turgor, vomiting, tingling, muscle
nausea / vomiting. weakness, disorientation, lethargy,
coma and confusion.
 Nursing Assessment
Respiration Security
Tachypnea, Kussmaul, Ranchi, wheezing and shortness Damaged skin, lesions / ulcers, decreased general
of breath. strength.

Sexuality
Inflammation of the vaginal area, and orgasm decreased
and impotence occurs in men.
Nursing
Diagnosis
• Shortage of body fluid volume associated
with osmotic diuresis.

• Changes in nutritional status are less than

body requirements related to insulin
insufficiency, decreased oral input.
• Risk of infection associated with
hyperglycemia
 Nursing Care Plan
Objectives and Expected
No. Nursing Diagnoses Intervention Rational
Outcomes
• Hypovolemic may be
• Monitor vital signs
manifested by
Fluid volume, After nursing action 3 x 24 hypotension and
• Monitor the input and
hours then expected no tachycardia
output, record the
deficient associated shortage of development of
1. specific gravity. Assess
with osmotic diuresis. the body fluid volume with • Is an indicator of the
the peripheral pulses,
expected outcomes. level of dehydration, or
capillary refill, skin
adequate circulating
turgor, and mucous
blood volume.
membranes
 Nursing Care Plan
Objectives and Expected
No. Nursing Diagnoses Intervention Rational
Outcomes
• Demonstrate adequate
hydration
• Provide estimates of the
need for fluid
• Evidenced by stable • Weigh weight every
replacement, kidney
vital signs day.
function. Gives the best
assessment of the fluid
• Palpable peripheral • Give the fluid therapy
status of ongoing and
as indicated.
further in providing
• Skin turgor and
replacement fluid.
capillary
 Nursing Care Plan
Objectives and Expected
No. Nursing Diagnoses Intervention Rational
Outcomes

• The type and amount of

• Right individually urine
liquid depends on the
output and electrolyte
degree of lack of fluids
levels within normal
and response of the
limits.
individual patient.
 Nursing Care Plan
Objectives and Expected
No. Nursing Diagnoses Intervention Rational
Outcomes
• Identifying shortcomings and
irregularities of therapeutic
• Determine the diet and
Changes in nutritional status needs.
eating patterns of
of less than body
Nutrition imbalanced: patients and compare it • Assessing adequate food
requirements related to
less than body with the food that can intake (including absorption
insulin insufficiency, oral
2. requirements related to be consumed by the and utilization)
Decreased input After
insulin insufficiency, patient.
nursing action 3 x 24 hours • If the preferred food the
decreased oral input
then expected to nutritional patient can be included in
• Weigh weight every meal planning, this
needs are met with outcomes
day or as indicated cooperation can be pursued
 Nursing Care Plan
Objectives and Expected
No. Nursing Diagnoses Intervention Rational
Outcomes
• Increase the sense of
• Identify the food involvement; provide
• The client is able to preferred / desired information on the
spend a portion of a including the needs of
patient's family to
given meal ethnic / cultural.
understand nutrition.

• The general state of • Involve the patient's

• Regular Insulin has a
clients family in meal planning
as indicated rapid onset and therefore
• Provide regular insulin quickly as well to help
• Stable weight
treatment as indicated. move glucose into the
 Nursing Care Plan
Objectives and Expected
No. Nursing Diagnoses Intervention Rational
Outcomes
• Observe signs of
infection and • Patients may sign with an
inflammation infection that usually has
Identify interventions to sparked a state of
prevent lower the risk of • Increase efforts to ketoacidosis or may
Risk for infection
infection. Demonstrating the prevention by good experience nosocomial
3. associated with
technique, lifestyle changes hand washing on infections.
hyperglycemia.
to prevent infection. everyone
• Preventing the
• Maintain aseptic emergence of cross-
technique for invasive infection
 Nursing Care Plan
Objectives and
Nursing
No. Expected Intervention Rational
Diagnoses
Outcomes

• Provide skin care • A high glucose levels in the blood would

regularly and be the best medium for the growth of
earnestly. germs
• Peripheral circulation can be impaired
• Change of body which puts patients at increased risk of
position regularly, damage to the skin / skin irritation and
encourage effective infection.
cough and breathe • Helps in all lung regions and mobilize
deeply. secretions
Nursing
Implementation

Implementaltion is the
management and the realization of
nursing care plans that had been
developed at the planning stage.
Nursing Evaluation

Evaluation is the final step in the

nursing process to identify to what
extent the objectives of the nursing
plan has been reached.
 Thank you!
Thank you for your listening, may all those we have share be benifical for all of us.
Thank you so much for you attention.