20 Diabetes Mellitus Nursing Diagnosis & Care Plans
MED -SURG STUDY GUIDE
Utilize this comprehensive nursing care plan and management guide to provide effective care
for patients experiencing diabetes mellitus. Gain valuable insights on nursing assessment,
interventions, goals, and nursing diagnosis specifically tailored for patients with diabetes
mellitus in this guide.
What is Diabetes Mellitus?
Diabetes mellitus (DM) is a chronic disease characterized by insufficient insulin production in
the pancreas or when the body cannot efficiently use the insulin it produces. This leads to an
increased concentration of glucose in the bloodstream (hyperglycemia). It is characterized by
disturbances in carbohydrate, protein, and fat metabolism. Sustained hyperglycemia has been
shown to affect almost all tissues in the body. It is associated with significant complications of
multiple organ systems, including the eyes, nerves, kidneys, and blood vessels.
Classifications of diabetes mellitus include
• Type 1 diabetes is characterized by destruction of the pancreatic beta cells leading to
absolute insulin deficiency including latent autoimmune diabetes of adulthood.
• Types 2 diabetes is characterized by progressive loss of pancreatic beta cells and
involves insulin resistance and impaired insulin secretion.
• Specific types of diabetes due to other causes such as monogenic diabetes syndromes
(neonatal diabetes and maturity-onset diabetes of the young), diseases affecting the
exocrine pancreas (cystic fibrosis and pancreatitis), and drug- or chemical-induced
diabetes (as a result of glucocorticoid use, treatment of HIV/AIDS, or organ
transplantation).
, • Gestational diabetes mellitus (GDM) refers to the onset of diabetes diagnosed during
the second or third trimester of pregnancy, which was not clearly present as overt
diabetes prior to conception.
The criteria for the screening and diagnosis of prediabetes and diabetes are as follows:
Screening Test Prediabetes Diabetes
A1C 5.7-6.4% 6.5% or greater
FPG 100-125 mg/dL 126 mg/dL or greater
2-hour plasma glucose 75-g OGTT 140-199 mg/dL 200 mg/dL or greater
Random plasma glucose – 200 mg/dL or greater
Nursing Care Plans and Management
Nursing care planning goals for patients with diabetes include effective treatment to normalize
blood glucose levels and decrease complications using insulin replacement, a balanced diet, and
exercise. The nurse should stress the importance of complying with the prescribed treatment
program through comprehensive diabetes education. Tailor your teaching to the patient’s
needs, abilities, and developmental stage. Stress the effect of blood glucose control on long -
term health.
Nursing Problem Priorities
The following are the nursing priorities for patients with diabetes:
1. Glycemic control. Managing and maintaining blood glucose levels through medication,
diet, and lifestyle modifications.
2. Education and self-management. Providing patient education on diabetes management,
including medication administration, monitoring blood glucose levels, meal planning,
exercise, and recognizing signs of hyperglycemia or hypoglycemia.
3. Preventing potential complications. Addressing risk factors for cardiovascular diseases,
nephropathy, retinopathy, and neuropathies common among patients with diabetes.
4. Weight management. Promoting a healthy weight through appropriate nutrition and
physical activity, considering individual needs and comorbidities
, 5. Foot care. Ensuring proper foot hygiene, regular inspection, and addressing any signs of
neuropathy or foot ulcers to prevent diabetic foot complications.
Nursing Assessment
Diabetes symptoms depend on hyperglycemia levels, including polyuria, polydipsia, and
polyphagia. Other symptoms include fatigue, vision changes, numbness, dry skin, slow wound
healing, and infections. Diagnosis involves measuring blood glucose levels. Ongoing specialized
assessment and evaluation for complications are essential for diabetes management.
Assess for the following subjective and objective data:
• Polyuria. Increased urination due to excess loss of fluid caused by osmotic diuresis.
• Polydipsia. Increased thirst as a result of fluid loss and dehydration.
• Polyphagia. Increased appetite resulting from the catabolic state caused by insulin
deficiency and breakdown of proteins and fats.
• Fatigue and weakness. Feeling tired and lacking energy.
• Sudden vision changes. Rapid alterations in visual acuity.
• Tingling or numbness in hands or feet. Sensations of pins and needles or loss of
sensation in extremities.
• Dry skin. Skin lacking moisture and becoming rough or flaky.
• Slow-healing skin lesions or wounds. Delayed wound healing and impaired skin
regeneration.
• Recurrent infections. Frequent and persistent infections due to compromised immune
function.
• Sudden weight loss (Type 1 diabetes). Unexplained and rapid weight loss.
• Nausea, vomiting, or abdominal pain (Type 1 diabetes with DKA). Symptoms
associated with diabetic ketoacidosis, such as gastrointestinal distress.
Nursing Diagnosis
After thorough assessment, nursing diagnoses are formulated to address the challenges of
diabetes mellitus, guided by the nurse’s clinical judgment and understanding of the patient’s
unique condition. While nursing diagnoses help organize care, their use may vary across clinical
settings. Ultimately, the nurse’s expertise and judgment shape the care plan to prioritize each
, patient’s needs. Here are examples of nursing diagnoses that may be useful for common
concerns associated with diabetes:
• Imbalanced Nutrition: Less Than Body Requirements related to inadequate (or
excessive) dietary intake and increased metabolic demands as evidenced by weight loss,
decreased muscle mass, and reports of fatigue.
• Unstable Blood Glucose Levels related to inconsistent meal patterns, physical inactivityy,
and insufficient knowledge of diabetes management.
• Knowledge Deficit related to new diagnosis of diabetes mellitus as evidenced by
patient’s questions about disease management and insulin administration.
• Risk for Infection as evidenced by hyperglycemia and delayed wound healing.
• Ineffective Health Maintenance related to lack of understanding of diabetes
management as evidenced by irregular blood glucose monitoring and
missed medication doses.
• Fatigue related to decreased energy production as evidenced by patient reports of
tiredness and inability to perform usual activities.
• Risk for Impaired Skin Integrity as evidenced by decreased sensation in feet and poor
circulation.
• Activity Intolerance related to muscle weakness as evidenced by shortness of breath
during exertion and patient reports of fatigue.
• Risk for Disturbed Sensory Perception as evidenced by reports of blurred vision and
difficulty reading.
Nursing Goals
Goals and expected outcomes may include:
• The patient will consistently maintain blood glucose readings of less than 180
mg/dL, fasting blood glucose levels of less than 140 mg/dL, and a hemoglobin A1C level
below 7%. Additionally, the patient will demonstrate understanding of key factors that
can impact glucose stability.
• The patient will accurately demonstrate knowledge of insulin injection techniques,
recognize symptoms and appropriate treatment of hypoglycemia, and exhibit
understanding of dietary requirements for managing their condition.
MED -SURG STUDY GUIDE
Utilize this comprehensive nursing care plan and management guide to provide effective care
for patients experiencing diabetes mellitus. Gain valuable insights on nursing assessment,
interventions, goals, and nursing diagnosis specifically tailored for patients with diabetes
mellitus in this guide.
What is Diabetes Mellitus?
Diabetes mellitus (DM) is a chronic disease characterized by insufficient insulin production in
the pancreas or when the body cannot efficiently use the insulin it produces. This leads to an
increased concentration of glucose in the bloodstream (hyperglycemia). It is characterized by
disturbances in carbohydrate, protein, and fat metabolism. Sustained hyperglycemia has been
shown to affect almost all tissues in the body. It is associated with significant complications of
multiple organ systems, including the eyes, nerves, kidneys, and blood vessels.
Classifications of diabetes mellitus include
• Type 1 diabetes is characterized by destruction of the pancreatic beta cells leading to
absolute insulin deficiency including latent autoimmune diabetes of adulthood.
• Types 2 diabetes is characterized by progressive loss of pancreatic beta cells and
involves insulin resistance and impaired insulin secretion.
• Specific types of diabetes due to other causes such as monogenic diabetes syndromes
(neonatal diabetes and maturity-onset diabetes of the young), diseases affecting the
exocrine pancreas (cystic fibrosis and pancreatitis), and drug- or chemical-induced
diabetes (as a result of glucocorticoid use, treatment of HIV/AIDS, or organ
transplantation).
, • Gestational diabetes mellitus (GDM) refers to the onset of diabetes diagnosed during
the second or third trimester of pregnancy, which was not clearly present as overt
diabetes prior to conception.
The criteria for the screening and diagnosis of prediabetes and diabetes are as follows:
Screening Test Prediabetes Diabetes
A1C 5.7-6.4% 6.5% or greater
FPG 100-125 mg/dL 126 mg/dL or greater
2-hour plasma glucose 75-g OGTT 140-199 mg/dL 200 mg/dL or greater
Random plasma glucose – 200 mg/dL or greater
Nursing Care Plans and Management
Nursing care planning goals for patients with diabetes include effective treatment to normalize
blood glucose levels and decrease complications using insulin replacement, a balanced diet, and
exercise. The nurse should stress the importance of complying with the prescribed treatment
program through comprehensive diabetes education. Tailor your teaching to the patient’s
needs, abilities, and developmental stage. Stress the effect of blood glucose control on long -
term health.
Nursing Problem Priorities
The following are the nursing priorities for patients with diabetes:
1. Glycemic control. Managing and maintaining blood glucose levels through medication,
diet, and lifestyle modifications.
2. Education and self-management. Providing patient education on diabetes management,
including medication administration, monitoring blood glucose levels, meal planning,
exercise, and recognizing signs of hyperglycemia or hypoglycemia.
3. Preventing potential complications. Addressing risk factors for cardiovascular diseases,
nephropathy, retinopathy, and neuropathies common among patients with diabetes.
4. Weight management. Promoting a healthy weight through appropriate nutrition and
physical activity, considering individual needs and comorbidities
, 5. Foot care. Ensuring proper foot hygiene, regular inspection, and addressing any signs of
neuropathy or foot ulcers to prevent diabetic foot complications.
Nursing Assessment
Diabetes symptoms depend on hyperglycemia levels, including polyuria, polydipsia, and
polyphagia. Other symptoms include fatigue, vision changes, numbness, dry skin, slow wound
healing, and infections. Diagnosis involves measuring blood glucose levels. Ongoing specialized
assessment and evaluation for complications are essential for diabetes management.
Assess for the following subjective and objective data:
• Polyuria. Increased urination due to excess loss of fluid caused by osmotic diuresis.
• Polydipsia. Increased thirst as a result of fluid loss and dehydration.
• Polyphagia. Increased appetite resulting from the catabolic state caused by insulin
deficiency and breakdown of proteins and fats.
• Fatigue and weakness. Feeling tired and lacking energy.
• Sudden vision changes. Rapid alterations in visual acuity.
• Tingling or numbness in hands or feet. Sensations of pins and needles or loss of
sensation in extremities.
• Dry skin. Skin lacking moisture and becoming rough or flaky.
• Slow-healing skin lesions or wounds. Delayed wound healing and impaired skin
regeneration.
• Recurrent infections. Frequent and persistent infections due to compromised immune
function.
• Sudden weight loss (Type 1 diabetes). Unexplained and rapid weight loss.
• Nausea, vomiting, or abdominal pain (Type 1 diabetes with DKA). Symptoms
associated with diabetic ketoacidosis, such as gastrointestinal distress.
Nursing Diagnosis
After thorough assessment, nursing diagnoses are formulated to address the challenges of
diabetes mellitus, guided by the nurse’s clinical judgment and understanding of the patient’s
unique condition. While nursing diagnoses help organize care, their use may vary across clinical
settings. Ultimately, the nurse’s expertise and judgment shape the care plan to prioritize each
, patient’s needs. Here are examples of nursing diagnoses that may be useful for common
concerns associated with diabetes:
• Imbalanced Nutrition: Less Than Body Requirements related to inadequate (or
excessive) dietary intake and increased metabolic demands as evidenced by weight loss,
decreased muscle mass, and reports of fatigue.
• Unstable Blood Glucose Levels related to inconsistent meal patterns, physical inactivityy,
and insufficient knowledge of diabetes management.
• Knowledge Deficit related to new diagnosis of diabetes mellitus as evidenced by
patient’s questions about disease management and insulin administration.
• Risk for Infection as evidenced by hyperglycemia and delayed wound healing.
• Ineffective Health Maintenance related to lack of understanding of diabetes
management as evidenced by irregular blood glucose monitoring and
missed medication doses.
• Fatigue related to decreased energy production as evidenced by patient reports of
tiredness and inability to perform usual activities.
• Risk for Impaired Skin Integrity as evidenced by decreased sensation in feet and poor
circulation.
• Activity Intolerance related to muscle weakness as evidenced by shortness of breath
during exertion and patient reports of fatigue.
• Risk for Disturbed Sensory Perception as evidenced by reports of blurred vision and
difficulty reading.
Nursing Goals
Goals and expected outcomes may include:
• The patient will consistently maintain blood glucose readings of less than 180
mg/dL, fasting blood glucose levels of less than 140 mg/dL, and a hemoglobin A1C level
below 7%. Additionally, the patient will demonstrate understanding of key factors that
can impact glucose stability.
• The patient will accurately demonstrate knowledge of insulin injection techniques,
recognize symptoms and appropriate treatment of hypoglycemia, and exhibit
understanding of dietary requirements for managing their condition.
