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NURSING CARE PLAN
DIABETES MELLITUS — NURSING CARE PLAN
NCP 1: Risk for Unstable Blood Glucose Level
Name: __________
Level: ______
Date: ______
Patient: __________
Age/Gender: ____
Diagnosis: Diabetes Mellitus
Assessment
Nursing Diagnosis
Objectives
Intervention
Rationale
Evaluation
Subjective:�Irregular meals and inconsistent insulin use.��Objective:�CBG 58–320 mg/dL over 24 hours.
Risk for unstable blood glucose level as evidenced by irregular meals, inconsistent insulin use and CBG readings from 58 to 320 mg/dL over 24 hours.
Short term: CBG stays within the ordered range during the shift, with no hypoglycemia below 70 mg/dL.��Long term: Patient keeps HbA1c near their personal target (often below 7% for many adults) at follow-up.
Goal met if CBG stays in range, no hypoglycemic episodes occur, and the patient can name signs of low and high glucose.
1. Check CBG before meals and at bedtime, or as ordered.
1. Shows patterns and guides insulin doses.
2. Watch for hypoglycemia: sweating, shaking, confusion, fast pulse.
2. Early signs allow quick treatment before seizures or loss of consciousness.
3. Watch for hyperglycemia: thirst, polyuria, fatigue, blurred vision.
3. Persistent high glucose can lead to DKA or HHS.
4. Give insulin and oral medicines as prescribed; double-check insulin type and dose.
4. Insulin is a high-alert medicine; errors cause severe harm.
5. Match insulin timing with meals; hold or adjust per protocol if NPO.
5. Insulin without food causes hypoglycemia.
6. Keep fast-acting glucose at the bedside.
6. Hypoglycemia must be treated within minutes.
7. Report CBG below 70 or above 250–300 mg/dL, or as per protocol.
7. Allows prompt adjustment of treatment.
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DIABETES MELLITUS — NURSING CARE PLAN
NCP 2: Deficient Fluid Volume (Hyperglycemia, DKA, HHS)
Name: __________
Level: ______
Date: ______
Patient: __________
Age/Gender: ____
Diagnosis: Diabetes Mellitus
Assessment
Nursing Diagnosis
Objectives
Intervention
Rationale
Evaluation
Subjective:�May report thirst, weakness or dehydration symptoms.��Objective:�CBG 420 mg/dL; dry mucous membranes; BP 94/60 mmHg; pulse 118; urine output 900 mL/4 h.
Deficient fluid volume related to osmotic diuresis from hyperglycemia as evidenced by CBG 420 mg/dL, dry mucous membranes, BP 94/60 mmHg, pulse 118 and urine output 900 mL in 4 hours.
Within 24 hours patient shows stable vital signs, moist mucous membranes, urine output ≥0.5 mL/kg/hour and falling glucose.
Vital signs stable, mucous membranes moist, urine output adequate, electrolytes within normal range.
1. Monitor BP, pulse, intake and output hourly in the acute phase.
1. Shows response to fluid replacement.
2. Give IV fluids as prescribed, usually isotonic saline first.
2. Restores circulating volume and kidney perfusion.
3. Give IV insulin infusion per protocol once potassium is checked.
3. Insulin lowers glucose and stops ketone production; it moves potassium into cells.
4. Monitor potassium, sodium, glucose, ketones and blood gases as ordered.
4. Potassium can fall quickly during treatment and cause dysrhythmias.
5. Watch neurological status.
5. Rapid glucose/fluid shifts can cause confusion or cerebral oedema, especially in children.
6. Encourage oral fluids when allowed.
6. Supports rehydration.
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NURSING CARE PLAN
DIABETES MELLITUS — NURSING CARE PLAN
NCP 3: Ineffective Health Self-Management
Name: __________
Level: ______
Date: ______
Patient: __________
Age/Gender: ____
Diagnosis: Diabetes Mellitus
Assessment
Nursing Diagnosis
Objectives
Intervention
Rationale
Evaluation
Subjective:�“I eat what I want and take extra tablets later.”��Objective:�HbA1c 9.4%; irregular CBG checks; complex treatment plan and limited support.
Ineffective health self-management related to complex treatment plan and limited support as evidenced by HbA1c 9.4%, irregular CBG checks and statements like “I eat what I want and take extra tablets later.”
Before discharge, the patient describes a daily routine for meals, medicines, CBG checks and activity, and shows the routine in practice.
Patient follows the schedule, keeps a CBG log and states when to call for help.
1. Ask about barriers: cost, work hours, beliefs, family meals, fear of injections.
1. A plan works only when real barriers are addressed.
2. Build a simple daily schedule with the patient.
2. Routines improve adherence.
3. Teach CBG monitoring and how to record results.
3. Self-monitoring helps patients see the effect of food and medicines.
4. Involve family members who cook or help with care.
4. Family support improves control.
5. Refer to a diabetes educator or dietitian.
5. Specialist education improves outcomes.
6. Arrange follow-up and explain why HbA1c is checked regularly.
6. Regular review keeps control on track.
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NURSING CARE PLAN
DIABETES MELLITUS — NURSING CARE PLAN
NCP 4: Inadequate Health Knowledge (Deficient Knowledge)
Name: __________
Level: ______
Date: ______
Patient: __________
Age/Gender: ____
Diagnosis: Diabetes Mellitus
Assessment
Nursing Diagnosis
Objectives
Intervention
Rationale
Evaluation
Subjective:�Questions about diet and diabetes care.��Objective:�New diagnosis with incorrect insulin injection technique.
Inadequate health knowledge about diabetes and insulin therapy related to new diagnosis as evidenced by incorrect insulin injection technique and questions about diet.
Before discharge the patient correctly demonstrates insulin injection and explains diet, hypoglycemia treatment and sick-day rules using teach-back.
Patient demonstrates correct injection and explains key points in their own words.
1. Assess current knowledge, literacy, language and vision.
1. Teaching must match the learner.
2. Teach insulin storage, dose, injection technique and site rotation; observe return demonstration.
2. Correct technique gives reliable absorption and prevents lipohypertrophy.
3. Teach meal planning: plate method, carbohydrate awareness and regular meal times.
3. Balanced meals stabilise glucose.
4. Teach the “rule of 15” for hypoglycemia.
4. Patients must be able to treat lows on their own.
5. Teach sick-day rules: continue insulin unless told otherwise, check glucose/ketones more often and drink fluids.
5. Illness raises glucose and DKA risk.
6. Use teach-back for each topic.
6. Confirms understanding.
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NURSING CARE PLAN
DIABETES MELLITUS — NURSING CARE PLAN
NCP 5: Risk for Infection
Name: __________
Level: ______
Date: ______
Patient: __________
Age/Gender: ____
Diagnosis: Diabetes Mellitus
Assessment
Nursing Diagnosis
Objectives
Intervention
Rationale
Evaluation
Subjective:�May report reduced sensation in feet or difficulty with skin/wound care.��Objective:�Persistent hyperglycemia; reduced sensation in feet; IV cannula present.
Risk for infection as evidenced by persistent hyperglycemia, reduced sensation in feet and an IV cannula.
Patient remains free of infection, with normal temperature, clean wound and cannula sites, and normal WBC count.
No signs of infection; patient explains how to prevent infection at home.
1. Hand hygiene before and after every contact.
1. Most effective way to prevent infection.
2. Inspect skin, feet, cannula and injection sites every shift.
2. Early detection of redness, swelling or discharge.
3. Monitor temperature and WBC.
3. Signs of developing infection.
4. Keep glucose in target range.
4. High glucose impairs white blood cell function and wound healing.
5. Teach daily foot care and oral hygiene.
5. Feet, skin, urinary tract and gums are common infection sites in diabetes.
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DIABETES MELLITUS — NURSING CARE PLAN
NCP 6: Risk for Impaired Skin Integrity (Diabetic Foot)
Name: __________
Level: ______
Date: ______
Patient: __________
Age/Gender: ____
Diagnosis: Diabetes Mellitus
Assessment
Nursing Diagnosis
Objectives
Intervention
Rationale
Evaluation
Subjective:�May report numbness or reduced sensation in feet.��Objective:�Peripheral neuropathy with loss of monofilament sensation; dry cracked heels; poorly fitting footwear.
Risk for impaired skin integrity as evidenced by peripheral neuropathy (loss of monofilament sensation), dry cracked heels and poorly fitting footwear.
Skin of both feet stays intact; patient demonstrates daily foot inspection and care.
Feet remain intact; patient shows daily foot check with a mirror.
1. Inspect feet daily: colour, temperature, pulses, cracks, blisters, ulcers.
1. Neuropathy means the patient may not feel injuries.
2. Test sensation with a monofilament as per protocol.
2. Identifies feet at high risk.
3. Wash feet daily, dry well between toes, moisturise heels but not between toes.
3. Prevents cracks and fungal infection.
4. Teach: never walk barefoot; wear well-fitting shoes; check shoes before wearing.
4. Prevents unnoticed injury.
5. Refer to podiatry for nails, calluses or deformities.
5. Specialist care prevents ulcers.
6. Teach to report any wound, colour change or swelling the same day.
6. Early treatment prevents amputation.
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DIABETES MELLITUS — NURSING CARE PLAN
NCP 7: Overweight (Type 2 Diabetes)
Name: __________
Level: ______
Date: ______
Patient: __________
Age/Gender: ____
Diagnosis: Diabetes Mellitus
Assessment
Nursing Diagnosis
Objectives
Intervention
Rationale
Evaluation
Subjective:�High-calorie diet and low physical activity.��Objective:�BMI 28.5 kg/m²; waist circumference above the recommended limit.
Overweight related to high-calorie diet and low physical activity as evidenced by BMI 28.5 kg/m² and waist circumference above the recommended limit.
Patient sets a realistic weight goal, e.g. 5% loss in 6 months, and names three diet and activity changes.
Patient follows the agreed meal and activity plan and shows gradual weight loss at follow-up.
1. Assess diet history, meal pattern and activity level.
1. Gives a starting point for realistic change.
2. Agree small, specific goals with the patient.
2. Small steps are easier to keep.
3. Teach the plate method: half vegetables, a quarter protein, a quarter whole grains.
3. Simple, culture-friendly portion control.
4. Encourage regular physical activity as advised by the care team.
4. Activity improves insulin sensitivity and lowers glucose.
5. Refer to a dietitian.
5. Personalised nutrition support.
6. Weigh at each visit and give positive feedback.
6. Monitoring and encouragement maintain motivation.
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