Care Plan Snapshot
Assignment Overview
This evidence-based nursing care plan for diabetes 2 was created for a senior medical-surgical rotation that required students to synthesize assessment cues, select priority NANDA-I statements, and justify interventions with current clinical guidelines. The patient was recently diagnosed with type 2 diabetes mellitus (T2DM) during a hospitalization for hyperglycemia.
Course: NUR 415 – Complex Adult Health | Clinical Setting: Acute care telemetry floor | Deliverables: Two complete nursing diagnoses with SMART outcomes, interventions, rationales, evaluation data, and patient education evidence.
Instructor Rubric Highlights
- Assessment Accuracy: Correlate subjective statements, labs, and physical findings with the pathophysiology of T2DM.
- Prioritization: Select a primary nursing diagnosis that reflects immediate safety or metabolic control.
- Goal Alignment: Write outcomes using measurable targets (fasting glucose, HbA1c, foot integrity, medication adherence).
- Intervention Rationale: Cite ADA 2024 Standards of Care, endocrine references, or peer-reviewed journals for every action.
Patient Profile & Assessment Data
The following data points anchor the care plan for type 2 diabetes and inform nursing documentation:
- Age/Sex: 54-year-old male, BMI 32 kg/m², sedentary desk job.
- Subjective: “I forget doses when work runs late,” reports numbness in toes, drinks two sugary sodas daily.
- Objective: Fasting glucose 212 mg/dL, HbA1c 9.1%, BP 146/92 mmHg, diminished pedal pulses, cracked heels.
- Medications: Metformin 1000 mg BID recently initiated; patient unsure about titration schedule.
- Labs/Diagnostics: LDL 148 mg/dL, microalbumin 65 mg/g creatinine, eGFR 78 mL/min.
Priority Nursing Diagnosis
Diagnosis: Ineffective Health Management related to insufficient knowledge of medication regimen and lifestyle modifications as evidenced by HbA1c 9.1%, inconsistent oral hypoglycemic adherence, and verbalized confusion about carbohydrate counting.
SMART Outcome (72 hours): Patient will demonstrate correct glucometer technique twice daily, verbalize medication schedule with 100% accuracy, and select two carbohydrate-controlled meals that keep pre-prandial glucose between 90–130 mg/dL.
| Intervention | Rationale | Evaluation |
|---|---|---|
| Provide teach-back session on metformin timing, emphasizing GI side-effect mitigation with meals. | Improves adherence and reduces early discontinuation, aligning with ADA teaching best practices (ADA, 2024). | Patient repeats schedule without prompts and logs doses in mobile reminder app. |
| Co-create a carbohydrate-consistent plate plan using foods from patient’s cultural background. | Individualized nutrition planning increases sustained lifestyle change and glucose stability. | Food diary shows 45–60 g carbs per meal with added fiber sources. |
| Introduce structured blood glucose log synced to provider portal. | Real-time data sharing allows rapid insulin/metformin adjustments and boosts accountability. | Log contains four readings daily with trend notes for triggers. |
Secondary Nursing Diagnosis
Diagnosis: Risk for Unstable Blood Glucose Level related to inconsistent nutritional intake, stress, and medication mismanagement.
Outcome (1 week): Maintain fasting glucose between 80–130 mg/dL and prevent hypoglycemic episodes (<70 mg/dL) via self-monitoring and medication coordination.
- Collaborate with diabetes educator to align meal delivery service with ADA plate method.
- Teach early symptom recognition of hypo/hyperglycemia using color-coded cue cards.
- Schedule follow-up telehealth visit within 48 hours to review log and adjust plan.
Skin Integrity & Foot Care Focus
Because peripheral neuropathy symptoms are emerging, the nursing care plan for diabetes 2 adds a third diagnosis—Risk for Impaired Skin Integrity related to neuropathy, hyperglycemia, and decreased peripheral circulation.
- Perform daily foot inspections with mirror, documenting any fissures, calluses, or color changes.
- Moisturize heels with urea-based cream and reinforce breathable socks plus shoe fit.
- Schedule podiatry consult before discharge and include foot assessment checklist in after-visit summary.
Documentation & Evaluation Tips
To maximize rubric scores, add the following to your clinical paperwork:
- Link each intervention to a measurable indicator (glucometer logs, HbA1c, weight trend, capillary refill).
- Capture patient quotes that prove understanding or barriers (“I set alarms for meds now”).
- Include interprofessional coordination (dietitian, pharmacist, podiatry) to demonstrate comprehensive care.
- Close the loop by documenting evaluation results and plan revisions if glucose goals are unmet.
Technical SEO & Maintenance Checklist
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Sample Nursing Diagnosis Narrative (Excerpt)
Assessment Summary: “I only check my blood sugar when I feel off,” the patient states while rubbing the ball of his foot. Fasting glucose logged at 215 mg/dL on admission, and HbA1c remains above goal at 9.1%. Pedal pulses are 1+, capillary refill is 4 seconds, and heels show superficial fissures.
Nursing Diagnosis #1: Ineffective Health Management related to limited understanding of oral hypoglycemic therapy as evidenced by elevated HbA1c, dietary indiscretions, and inconsistent monitoring.
Goal: Patient will verbalize the purpose and timing of metformin, demonstrate glucometer use, and adopt a carb-consistent meal plan for the next three days, keeping fasting glucose between 90–130 mg/dL.
Nursing Diagnosis #2: Risk for Impaired Skin Integrity related to peripheral neuropathy and poor circulation.
Intervention Highlights: Teach daily monofilament self-assessment, schedule weekly moisturizing routine, and coordinate podiatry referral. Reinforce wearing breathable footwear and checking shoes for debris before each shift at his warehouse job.
Evidence-Based Talking Points
- Medication Adherence: Combining reminder apps with pharmacist-led pill synchronization raises oral agent adherence by 28% (Grunberger et al., 2024).
- Nutrition Coaching: Carb-consistent meal kits paired with telehealth check-ins lowered HbA1c by 0.7% in eight weeks (ADA, 2024).
- Foot Surveillance: Daily foot inspections and moisturizing decreased ulcer incidence by 43% in patients with early neuropathy (Singh et al., 2023).
References (APA 7th Edition)
- American Diabetes Association. (2024). Standards of medical care in diabetes. Diabetes Care, 47(Supplement 1), S1–S154.
- Grunberger, G., et al. (2024). Technology-enabled adherence interventions in type 2 diabetes. Journal of Diabetes Science and Technology, 18(2), 145–158.
- Singh, N., Armstrong, D. G., & Lipsky, B. A. (2023). Preventing diabetic foot ulcers. Clinical Podiatric Medicine and Surgery, 40(3), 345–360.
Why This Care Plan Earned Full Credit
- Connects lab data, physical assessment, and patient statements to each PES format.
- Uses measurable outcomes tied to the ADA Standard of Care benchmarks.
- Integrates interprofessional referrals (dietitian, pharmacist, podiatry) with nursing-led education.
- Documents evaluation data and plan adjustments for continuous quality improvement.
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