Comprehensive Nursing Care Plan for Type 1 Diabetes Mellitus

 Nursing Care Plan for Type 1 Diabetes Mellitus

Assessment Data:

• Subjective Data: The patient reports persistent thirst (polydipsia), excessive urination (polyuria), fatigue, and unintended weight loss.
• Objective Data: Blood glucose readings consistently elevated (≥200 mg/dL), presence of ketones in urine, glycated haemoglobin (HbA1c) exceeding 7%.

Nursing Diagnoses:

1. Risk of unstable blood glucose levels due to insufficient insulin production and ineffective insulin management.
2. Deficient knowledge regarding the condition, its management, and the correct administration of insulin.
3. Risk of infection as a result of hyperglycaemia compromising immune function.
4. Imbalanced nutrition: less than body requirements, linked to metabolic dysfunction.

Goals and Expected Outcomes:

1. The patient will maintain blood glucose levels within the recommended range (70–130 mg/dL fasting; under 180 mg/dL postprandial).
2. The patient will demonstrate accurate insulin administration and adherence to prescribed dietary recommendations.
3. The patient will verbalise understanding of the signs and symptoms of both hypoglycaemia and hyperglycaemia.
4. The patient will remain free from infection during the care period.

Nursing Interventions and Rationales:

1. Risk of Unstable Blood Glucose Levels

• Interventions:
  • Monitor blood glucose levels routinely before meals and at bedtime.
  • Administer insulin as prescribed, adjusting doses as per sliding scale orders and glucose trends.
  • Educate the patient on carbohydrate counting and its role in glycaemic control.
  • Observe for signs of hypoglycaemia (e.g., sweating, shakiness, confusion) and hyperglycaemia (e.g., dry mouth, fatigue, fruity-smelling breath).
  • Provide a rapid-acting glucose source, such as glucose tablets or juice, for hypoglycaemic events.
• Rationale:
  • Regular monitoring and appropriate intervention prevent extremes of blood glucose levels, reducing the risk of acute complications.

2. Deficient Knowledge

• Interventions:
  • Offer comprehensive education on Type 1 Diabetes, emphasising the significance of insulin therapy and frequent glucose monitoring.
  • Demonstrate the correct use of glucometers and insulin administration devices.
  • Discuss the importance of balanced nutrition and regular physical activity.
  • Educate on recognising and responding to the early symptoms of hypoglycaemia and hyperglycaemia.
• Rationale:
  • Enhanced understanding enables the patient to manage their condition effectively, improving long-term outcomes.

3. Risk of Infection

• Interventions:
  • Inspect the skin regularly for signs of infection, particularly on the feet.
  • Encourage diligent hand hygiene and appropriate wound care practices.
  • Monitor for indications of urinary or respiratory tract infections.
  • Use aseptic techniques when administering insulin or performing wound care.
• Rationale:
  • Preventing infection is critical as hyperglycaemia impairs the body’s ability to fight pathogens.

4. Imbalanced Nutrition: Less than Body Requirements

• Interventions:
  • Collaborate with a dietitian to develop an individualised meal plan tailored to the patient’s needs and lifestyle.
  • Recommend small, frequent meals aligned with insulin schedules to maintain energy balance.
  • Monitor weight and dietary intake regularly.
  • Address barriers to adequate nutrition, such as nausea or lack of appetite.
• Rationale:
  • Proper nutrition ensures adequate energy levels and reduces the risk of complications such as ketoacidosis.

Evaluation:

• Blood glucose levels are maintained within the recommended range.
• The patient demonstrates confidence and accuracy in insulin administration and blood glucose monitoring.
• The patient identifies symptoms of hypo- and hyperglycaemia and responds appropriately.
• There are no signs of infection or delayed wound healing during the care period.