Assessment

Subjective:
"I look slimmer
than I was
before", as
verbalized by
the patient

Objective data:
Weight: 55
kilos (Feb. 12,
2015)
Weight: 51
kilos
(Mar 12, 2015)

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Nursing
Diagnosis
Imbalanced
nutrition less
than body
requirements
related to
insulin
deficiency as
evidenced by
recent weight
loss.

Inference

Planning

Diabetes is an
endocrine disorder
insulin deficiency
happens either
because the
pancreas produces
insufficient
insulin or the
body tissues
become resistant
to insulin. When
that happens,
there will be a
decrease in uptake
and utilization of
glucose by the
tissues, resulting
in increased
protein/fat
metabolism

After a week
of nursing
intervention,
the patient
will be able to
gain weight.

Implementation

Rationale

1. Weigh daily or as
ordered.

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

2. Ascertain patients
dietary program and usual
pattern then compare with
recent intake.

Identifies deficits and

deviations from
therapeutic needs.

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

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.

4. Provide liquids
containing nutrients and
electrolytes as soon as

Oral route is preferred

when patient is alert
and bowel function is

Evaluation
After a week
of nursing
intervention,
demonstrated
weight gain.

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patient can tolerate oral

fluids then progress to a
more solid food as
tolerated.

restored.

5. Identify food
preferences,
including ethnic and
cultural needs.

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

6. Include SO in meal
planning as indicated.

To promote sense of
involvement and
provide information to
the SO to understand
the nutritional needs of
the patient.

7. Observe for signs of

hypoglycemia: changes in
LOC, cold and clammy
skin, rapid pulse, hunger,
irritability, anxiety,
headache,
lightheadedness,
shakiness.

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 lifethreatening 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.
8. Perform fingerstick
glucose testing

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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 patients
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: 80120 mg/dL
(4.46.6 mmol/L)
before meals or when
waking up; 100140
mg/dL (5.57.7
mmol/L) at bedtime.

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9. Administer insulin as
ordered by the physician

Insulin is used to take

the place of insulin that
is normally produced
by the body. It works
by helping move sugar
from the blood into
other body tissues
where it is used for
energy. It also stops the
liver from producing
more sugar.

10. Administer glucose

solutions: dextrose and
half-normal saline

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.

11. Provide diet of

approximately 60%
carbohydrates, 20%
proteins, 20% fats in
designated number
of meals and snacks

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.
12. Administer other
medications as
indicated: metoclopramide
(Reglan); tetracycline as
ordered by the physician.

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