Care plan TYPE 1 Diabetes PDF

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Summary

Case Study...

Description

TYPE 1 Diabetes Compromised Family Coping Nursing Diagnosis 

Compromised Family Coping

May be related to  

Inadequate or inaccurate information Prolonged disease or disability progression that depletes the physical and emotional supportive capacity of caretakers

Possibly evidenced by   

Expression and/or confirmation of concern and inadequate knowledge about long-term care needs, problems and complications Anxiety and guilt Overprotection of child

Desired Outcomes  

Family will explore feelings regarding the child’s long-term needs. Family will determine appropriate support systems and coping skills.

Nursing Interventions Assess family coping mechanisms and its effectiveness, family dynamics and expectations related to longterm care, developmental level of family, response of siblings, knowledge, and use of support systems and resources, presence of guilt and anxiety, overprotection and overeating behaviors. Allow family members and child to express difficult areas, anxiety and explore solutions responsibly. Assist family to establish short- and long-term goals for the child and to involve the child in the activities of the family; include the participation of all family members in care routines. Encourage family members to verbalize feelings, to tell how they handle the chronic

Rationale Recognizes coping methods that work and the need to develop new coping skills and behaviors, family attitudes; child with special long-term needs may tighten or strain family relationships, and that over-protection may be deleterious to child’s growth and development. Lessens anxiety and improves understanding; provides the family with an opportunity to recognize problems and generate problemsolving methods. Promotes engagement in and control over situations and keeps the role of family members and parents. Encourages expression of feelings to identify the need for information and support and to

needs of the family member, and to define coping patterns that support or inhibit adjustment to the problems.

dismiss guilt and anxiety.

Provides assistance to the family dealing with the long-term care of a child with chronic illness. Teach family about long-term care and Improves family’s understanding of treatment treatments. regimen and responsibilities of family. Facilitates understanding of the significance of Teach family that overprotective behavior may making the child a part of the family and inhibit growth and development so they should illustrates the unfavorable effects of being treat the child as normally as possible. overprotective. Explain the importance of attending follow-up Promotes positive outcome when appointments for physical examinations, family collaborates with the physician laboratory tests. and health team to monitor disease. Provide support social worker, counselor, clergy, or other as needed.

Risk for Injury Nursing Diagnosis 

Risk for Injury

May be related to 

[not applicable]

Possibly evidenced by  

Hyperglycemia— headache, confusion, blurred vision, irritability, fatigue, dry mouth, abdominal pain, weight loss, polyuria, polydipsia, polyphagia Hypoglycemia— sweating, shakiness, nervousness, lightheadedness, weakness, hunger, nausea, palpitations, moodiness, pale skin, loss of consciousness

Desired Outcomes  

Client’s blood glucose levels will maintain between 60 mg/dL and 120 mg/dL. Client’s urine will be free from ketones and glucose.

Nursing Interventions Assess for signs and symptoms of hyperglycemia; Monitor serum glucose level,

Rationale Provides information about the effect of increased blood glucose levels caused by an

illness, inappropriate diet, stress or failure to administer insulin; glucose is unable to enter the cells, and protein is broken down and converted to glucose by the liver, causing the urine for glucose and ketones, pH and electrolyte levels. hyperglycemia; fat and protein stores are depleted to provide energy for the body when carbohydrates are not able to be used for energy. Provides information about the occurrence of hypoglycemia caused by an increased Assess for signs and symptoms of activity without additional food intake hypoglycemia, serum glucose level. or failure or incomplete ingestion of meals, improper insulin administration, illness. Provides insulin replacement to maintain Administer insulin subcutaneously as normal blood glucose levels without causing prescribed, increase dosage depending on the hypoglycemia; two or more injections may be glucose levels; rotate injection sites, minimize given daily subcutaneous (SC) using a portable food intake during an infection or illness and syringe pump or by intermittent bolus injections modify the dosage of insulin during an illness. with a syringe and needle. Provides nutritional needs of the child for proper growth and development using the exchange system or by carbohydrate Encourage a diet with calories that balance with the energy requirements and paired with counting— monitoring carbohydrate intake only, maintaining consistent level at meals and the type and action of insulin, and snacks between meals and at bedtime as appropriate. snacks, and adjusting insulin as needed (requires close supervision of a physician). Guides in the utilization of dietary intake, Promote exercise program compatible with regular activity may decrease the amount of insulin regimen; instruct to increase insulin required; an insulin reduction and carbohydrate intake prior a strenuous increased carbohydrate intake prior to a activities. strenuous exercise may avoid hypoglycemia. Encourage rest periods and provide a quick Relieves the symptoms of hypoglycemia as source of a simple carbohydrate such as fruit soon as observed; glucagon releases the juice, milk products followed by a glycogen stored in the liver to assist in restoring complex carbohydrate such as bread in glucose levels; Administration of IV glucose is amounts of 15 gm; repeat intake in 10 done when the condition is severe and child is minutes for an expected response of a unable to take glucose source orally. Glucagon, reduced pulse rate; administer 50 percent a hormone, releases stored glycogen from the liver and increases blood glucose within 5 to 15 glucose per IV or glucagon IM if minutes. hypoglycemia is severe. Provides information about abnormal Educate parents and child about signs and blood glucose levels causing complications symptoms, reasons why they happen, and of hyperglycemia, hypoglycemia, and measures to take. the consequences. Educate parents and child to regulate Supports the child’s growth and development

insulin, control dietary intake, and exercise to accommodate needs of an individual needs while avoiding complications. child. Educate parents and child to modify administration of insulin depending on Prevents and treats hyperglycemia; Prevents the blood glucose testing and glycosuria, during serious complication of ketoacidosis. an illness or after changes in food intake or activities. Instruct parents and child to take a quick-acting carbohydrate followed by a longeracting carbohydrate and to have Lifesavers, sugar cubes, Instaglucose on hand at all times; instruct parents that, in the case of severe Prevents and/or treats hypoglycemia. hypoglycemia, if the child is unconscious or unable to take oral fluids, to rub honey or syrup on the child’s buccal surface until alert enough to take fluids/foods by mouth. Instruct parents and child to notify Avoids more severe complications and longirregular blood and urine test results, difficulty term effects of the disease; poor control leads to in managing blood glucose levels, presence of serious and severe consequences in a few hours. an infection or illness.

Risk for Unstable Blood Glucose Level Nursing Diagnosis 

Risk for Unstable Blood Glucose Level

May be related to    

Deficient knowledge of diabetes management Developmental level Inadequate blood glucose monitoring Lack of adherence to diabetes management

Possibly evidenced by 

[not applicable]

Desired Outcomes 

Client will maintain a blood glucose reading of less than 180 mg/dL; fasting blood glucose levels of less than...