Diabetes Care Plan: Imbalanced Nutrition: Less Than Body Requirements

question

Nursing Diagnosis Imbalanced Nutrition
answer

Less Than Body Requirements
question

May be related to
answer

Insulin deficiency (decreased uptake and utilization of glucose by the tissues, resulting in increased protein/fat metabolism) Decreased oral intake: anorexia, nausea, gastric fullness, abdominal pain; altered consciousness Hypermetabolic state: release of stress hormones (e.g., epinephrine, cortisol, and growth hormone), infectious process
question

Possibly evidenced by
answer

Increased urinary output, dilute urine Reported inadequate food intake, lack of interest in food Recent weight loss; weakness, fatigue, poor muscle tone Diarrhea Increased ketones (end product of fat metabolism)
question

Desired Outcomes
answer

Ingest appropriate amounts of calories/nutrients. Display usual energy level. Demonstrate stabilized weight or gain toward usual/desired range with normal laboratory values.
question

*NURSING INTERVENTIONS*
answer

*RATIONALE*
question

Weigh daily or as ordered.
answer

Weighing serves as an assessment tool to determine the adequacy of nutritional intake.
question

Ascertain patient’s dietary program and usual pattern then compare with recent intake.
answer

Identifies deficits and deviations from therapeutic needs.
question

Auscultate bowel sounds. Note reports of abdominal pain, bloating, nausea, vomiting of undigested food. Maintain NPO status as indicated.
answer

Hyperglycemia and fluid and electrolyte disturbances can decrease gastric motility and/or function (due to distention or ileus) affecting choice of interventions. Note: Chronic difficulties with decreased gastric emptying time and poor intestinal motility may suggest autonomic neuropathies affecting the GI tract and requiring symptomatic treatment.
question

Provide liquids containing nutrients and electrolytes as soon as patient can tolerate oral fluids then progress to a more solid food as tolerated.
answer

Oral route is preferred when patient is alert and bowel function is restored.
question

Identify food preferences, including ethnic and cultural needs.
answer

If patient’s food preferences can be incorporated into the meal plan, cooperation with dietary requirements may be facilitated after discharge.
question

Include SO in meal planning as indicated.
answer

To promote sense of involvement and provide information to the SO to understand the nutritional needs of the patient. Note: Various methods available or dietary planning include exchange list, point system, glycemic index, or pre selected menus.
question

Observe for signs of hypoglycemia: changes in LOC, cold and clammy skin, rapid pulse, hunger, irritability, anxiety, headache, lightheadedness, shakiness.
answer

Hypoglycemia can occur once blood glucose level is reduced and carbohydrate metabolism resumes and insulin is being given. If the patient is comatose, hypoglycemia may occur without notable change in LOC. This potentially life-threatening emergency should be assessed and treated quickly per protocol. Note: Type 1 diabetics of long standing may not display usual signs of hypoglycemia because normal response to low blood sugar may be diminished.
question

Perform fingerstick glucose testing.
answer

Beside analysis of serum glucose is more accurate than monitoring urine sugar. Urine glucose is not sensitive enough to detect fluctuations in serum levels and can be affected by patient’s individual renal threshold or the presence of urinary retention. Note: Normal levels for fingerstick glucose testing may vary depending on how much the patient ate during his last meal. In general: 80-120 mg/dL (4.4-6.6 mmol/L) before meals or when waking up; 100-140 mg/dL (5.5-7.7 mmol/L) at bedtime.
question

Administer regular insulin by intermittent or continuous IV method: IV bolus followed by a continuous drip via pump of approximately 5-10 U
answer

hr so that glucose is reduced by 50 mg/dL/hr./Regular insulin has a rapid onset and thus quickly helps move glucose into cells. The IV route is the initial route of choice because absorption from subcutaneous tissues may be erratic. Many believe the continuous method is the optimal way to facilitate transition to carbohydrate metabolism and reduce incidence of hypoglycemia.
question

Administer glucose solutions: dextrose and half-normal saline.
answer

Glucose solutions may be added after insulin and fluids have brought the blood glucose to approximately 400 mg/dL. As carbohydrate metabolism approaches normal, care must be taken to avoid hypoglycemia.
question

Provide diet of approximately 60% carbohydrates, 20% proteins, 20% fats in designated number of meals and snacks.
answer

Complex carbohydrates (apples, broccoli, peas, dried beads, carrots, peas, oats) decrease glucose levels/insulin needs, reduce serum cholesterol levels, and promote satiation. Food intake is scheduled according to specific insulin characteristics and individual patient response. Note: A snack at bedtime of complex carbohydrates is especially important (if insulin is given in divided doses) to prevent hypoglycemia during sleep and potential Somogyi response.
question

Administer other medications as indicated: metoclopramide (Reglan); tetracycline.
answer

May be useful in treating symptoms related to autonomic neuropathies affecting GI tract, thus enhancing oral intake and absorption of nutrients.

Get instant access to
all materials

Become a Member