1. Evaluation: Upon follow up client will have lower blood glucose readings, lower body weight, and improved eating habits shown in his food diary.
1.1. Modifications will need to be made if blood sugar levels and body weight are not met.
2. Dx ineffective self health management related to deficient knowledge Definition: pattern of regulating and inter grating into daily living a therapeutic regimen for the treatment of illness , unsatisfactory for meeting specific health goals
2.1. Outcome: client will keep blood glucose and food intake diary for 7 days
2.1.1. Intervention: nurse will provide food pyramid and diet handouts within time of shift.
2.1.1.1. Rationale: food pyramid emphasizes food from the five major food groups, each of these groups provides most of the nutrients an adult needs. B 72.
2.1.2. Intervention : nurse will teach client proper logging methods within time of shift
2.1.2.1. Rationale: To properly determine individual eating patterns, used to study nutritional status. B 70.
2.1.3. Intervention : nurse will asses client knowledge of healthy and unhealthy eating habits within first 8 hour shift.
2.1.3.1. Rationale: Helps estimate whether food intake is adequate and appropriate. Helps include methods of preparing food, sources available for food, food buying practices, use of supplements and income range. B 70-71
2.1.4. Intervention: nurse will administer prescribed insulin per glucose testing within time of shift
2.1.4.1. Rationale: Insulin is a storage hormone, transports and metabolizes glucose for energy, stimulates storage of glucose in the liver and muscle, signlas the liver to stop the release of glucose, enhances storage of dietary fat in adipose tissue, accelerates transport of amino acids, and inhibits the breakdown of stored glucose, protein and fat. And without proper insulin measures, any one of these components could malfunction and cause clients glucose levels to increase. B 1197.
2.1.5. Intervention nurse will consult dietary about about healthier meat cooking within 24 hours.
2.1.5.1. Rationale : grilling, baking or broiling will reduce dietary fat, and an unnecessary increase in sugar levels. K 1264
2.2. Outcome: client will eat 3 we'll balanced meals a day for 2 weeks
2.2.1. Intervention: nurse will consult dietary to teach client knowledge about what a well balanced meal is within 24 hours
2.2.1.1. Rationale:The responsibility for nutritional assessment and support is shared by the PCP, dietitian and nurse. Together they teach the requirements and recommendations for the total diet that allows food choices which result in nutrient rich and calorie-balanced intake. K 1264.
2.2.2. Intervention: nurse will monitor if client is adhering to prescribed diet at every meal for one week.
2.2.2.1. Rationale: In order for client to receive adequate nutrition, the nurse needs to make sure the client is getting needed nourishment that is within the limits of the prescribed diet. K 1277.
2.2.3. Intervention: nurse will assess client's BMI at beginning of the shift.
2.2.3.1. Rationale: Body mass index is an indicator of changes in body fat stores and whether a person's weight is appropriate for height. Is a reliable indicator of a person's 'healthy' weight. K 1253
2.2.4. Intervention: Nurse will follow physicians order on what type of diet the client should be put on, within 24 hours.
2.2.4.1. Rationale: Many special diets may be prescribed to meet requirements for disease processes or altered metabolism. Client may need a diet recommended by the America Diabetes Association. K 1280.
2.2.5. Intervention: nurse will teach client about healthy meals and provide client with a list of local cooking classes within 24 hours
2.2.5.1. Rationale : education on healthy meal preparation will promote adherence K 1264
2.3. Outcome: client will attend water aerobic exercise classes for a minimum of 4 weeks
2.3.1. Intervention: Nurse will teach the importance of maintaining an exercise regimen, especially in people who have diabetes; within 24 hours
2.3.1.1. Rationale: Exercise is extremely important in diabetes management because of its effects on lowering blood glucose and reducing cardiovascular risk factors. B 1205.
2.3.2. Intervention: Nurse will assess clients ROM within first 8 hour shift.
2.3.2.1. Rationale: Optimal function depends on the strength of the muscles and motion of the joints, To perform exercises, complications should not interfere. B 174-175
2.3.3. Intervention: Nurse will collaborate with physical therapists to assess mobility, and to possibly add other physical abilities to regimen within 24 hours.
2.3.3.1. Rationale: Physical therapists are needed to help determine positioning, ability to move, muscle strength and tone of muscles in order to incorporate exercise and activities into clients regimen. B 174.
2.3.4. Intervention: Nurse will perform medical evaluation of client, per physicians orders, within first 8 hour shift.
2.3.4.1. Rationale: Patients should undergo a careful medical evaluation with appropriate diagnostic studies before beginning an exercise program in case of any contraindications or disease limiting aspects B 1205.
2.3.5. Intervention: Nurse will provide information and instructional pamphlets on simple techniques and exercises to improve functional ability with aerobics; within 24 hours.
2.3.5.1. Rationale:in general, a slow gradual increase in the exercise period should be encouraged, and requires no special equipment, is not complicated for client to follow, and tolerance of new activity is increased. B 1206.
3. Assessment
3.1. Subjective
3.1.1. "Quite unhappy about sudden diagnoses"
3.1.2. "Had a Work related accident 4 years ago, resulted in permanent disability"
3.1.3. Has weight lifting restriction of 10lbs and can't walk or stand for more than 20 min.
3.1.4. Typical meal pattern is one meal a day for 3-4 days per week.
3.1.5. Doesn't eat other days of the week.
3.1.6. Prefers to fry his meat for meals
3.1.7. States "has been watching what he eats and trying to eat more regularly."
3.1.8. Not exercising
3.2. Objective
3.2.1. 6ft, 272lbs Temp- 101.6 pulse-68 resp-18
3.2.2. Urine test: Glucose ++ Protein + Ketones-trace Blood-trace Specific gravity- 1.020 Leukocyte sand nitrates-none
3.2.3. Glucose 274
3.2.4. Follow -up glucose' 168
3.2.5. 3 month follow-up log shows fasting blood sugar of 155-210, evening of blood sugar 220-286. Weight: 255lbs
4. Dx impaired mobility related to work related accident Definition: limitation in independent purposeful physical movements of the body or of one or more extremities
4.1. Outcome: Client will perform physical therapy exercises on a daily basis
4.1.1. Intervention:Nurse will educate client on RoM excercises, within 24 hours.
4.1.1.1. So client knows proper technique of the exercise to improve the clients strengths and abilities by doing the ROM. K. Pg. 1165
4.1.2. Intervention:Nurse will consult with physical therapist for further evaluation, strength training, and mobility plan, within 24 hours.
4.1.2.1. Collaboration with physical therapy will offer a wider variety of techniques and options for the patient. K 1152
4.1.3. Intervention:Nurse will monitor and record clients ability to tolerate activity, once a week for the next two weeks.
4.1.3.1. To monitor the progress and correct technique and strength increasing. K 1176
4.1.4. Intervention:Nurse will encourage supplement high protein meals, per physician order, within the first 8 hour shift
4.1.4.1. Proper nutrition is required to maintain adequate energy level. K 1253
4.1.5. Intervention: Nurse will teach patient energy saving techniques , within 24 hours.
4.1.5.1. To optimize patients limited reserves and enhance their abilites. K 1165
4.2. OUtcome: Client will keep a excercise diary on a daily basis for one month.
4.2.1. Intervention : Nurse will teach proper exercise documentation techniques to patient within 24 hours.
4.2.1.1. Correct ROM is needed to achieve individual goals and improve strengths and ADL's. K 1124
4.2.2. Intervention: Nurse will communicate with physical therapy regarding correct excercises that patient will need to record in diary within 24 hours.
4.2.2.1. Collaboration with physical therapy will offers wide variety and correct technique. K 1152
4.2.3. Intervention : Nurse will assess clients understanding about ROM excercises and documenting is correct within 24 hours.
4.2.3.1. Nurse will need to know that the method used to teach the patent was understood correctly and strength is being increased. K 1134
4.2.4. Intervention : Nurse will provide pamphlets and visual documents displaying correct Techniques of excercise and journaling within 24 hours.
4.2.4.1. Illustration will help with education of proper technique a a good reference. K 1125
4.2.5. Nurse will asses patients excercise journal in one month.
4.2.5.1. To assess and make sure the correct techniques and time is efficient. K 1176
4.3. Outcome: Client will keep record of pain levels before and after exercise practices for one month.
4.3.1. Intervention : Nurse will provide client with various pain scales to document on within 24 hours.
4.3.1.1. Rationale: Use of a pain scale can help determine proper treatment to give. K. 1148
4.3.2. Intervention: Nurse will teah client ways to mange pain levels within 24 hours.
4.3.2.1. Rationale: management of pain levels help promote further healing. K. 937
4.3.3. Intervention: Nurse will consult with doctor on whether client should use cold or hot compress to help relieve pain within 12 hours
4.3.3.1. Rationale:Non- Pharmaceutical measures to intervene with pain are beneficial to the client. K. 940
4.3.4. Intervention: Nurse will provide client with a list of proper body mechanics to help avoid further or new injury 12 hours
4.3.4.1. Rationale: Proper body mechanics promotes health and well-being. K 1124
4.3.5. Intervention : Nurse will asses the client's ability to use proper body mechanics within 24 hours.
4.3.5.1. Rationale: Client ability to perform proper mechanics promotes better physical health. K. 1124
5. Dx risk for unstable glucose level related to dietary inteke Definition: at risk for variation of blood glucose level from the normal range that may compromise health
5.1. Outcome: client will adhere to blood glucose testing 4 times a day within 72 hours.
5.1.1. Intervention: nurse will teach client how to use home blood glucose meter within 24 hours
5.1.1.1. Rationale: improving the clients knowledge deficit pertaining to blood glucose levels. K 818
5.1.2. Intervention: nurse will consult dietary about foods that don't significantly elevate blood glucose levels within 24 hours.
5.1.2.1. Rationale: dietitians may design special diets to meet the nutritional needs of individual clients. K 105
5.1.3. Intervention: nurse will assess client's ability to test blood glucose on their own within 24 hours.
5.1.3.1. Rationale : being comfortable and confident in testing blood glucose levels will promote control of diabetes. K 815
5.1.4. Intervention: nurse will show client different sites to obtain capillary blood specimens for blood glucose testing within 24 hours.
5.1.4.1. Rationale: capillary blood specimens are commonly obtained from the side of finger to avoid nerve endings, but can also use earlobe or areas on the arms, legs, or abdomen. K 815
5.1.5. Intervention: nurse will show client how to prepare the vascular puncture site by wrapping finger in warm cloth or holding finger below heart level within 24 hours.
5.1.5.1. Rationale: these actions increase blood flow to the area, ensure adequate specimen, and reduce need for repeated puncture. K 816
5.2. Outcome: client will document in a dietary intake journal for one week
5.2.1. Intervention: nurse will consult dietary about foods that help maintain proper blood glucose levels within 24 hours.
5.2.1.1. Rationale: dietitians may design special diets to meet the nutritional needs of individual clients. K 105
5.2.2. Intervention: nurse will provide examples of effective journaling methods with 8 hour shift.
5.2.2.1. Rationale: it is an important educational tool to show importance of consistent eating habits. B 1202
5.2.3. Intervention: nurse teach importance of documentation of foods and drinks within 24 hours.
5.2.3.1. Rationale: many beverages contain sweeteners and calories that need to be taken into account as well. B 1205
5.2.4. Intervention: nurse will assess client understanding of what to record in journal within 24 hours.
5.2.4.1. Rationale: certain aspects of meal planning may be difficult to learn. B 1202
5.2.5. Intervention: nurse will communicate pertinent information to the dietitian within 24 hours.
5.2.5.1. Rationale: this will help the dietitian design a diet for the client and the nurse can reinforce the patient's understanding. B 1202
5.3. Outcome: client will adhere to a diabetic diet within 24 hours.
5.3.1. Intervention: nurse will teach client how to read food label to promote adherence to diabetic diet within 24 hours.
5.3.1.1. Rationale: many food labels can be misleading and may say they are "sugar free" but still have same amount of calories as other sugar containing products. B 1205
5.3.2. Intervention: nurse will consult with dietitian about client's diet within 24 hours.
5.3.2.1. Rationale: dietitian has the major responsibility of designing the dietary aspect of the client's care plan. B 1202
5.3.3. Intervention: nurse will assess client understanding of effects of carbohydrates within 24 hours.
5.3.3.1. Rationale: carbohydrate foods have the greatest effect on blood glucose levels because they are digested quickly and rapidly converted to glucose. B 1203
5.3.4. Intervention: nurse will review client's diet history within 24 hours.
5.3.4.1. Rationale: this is the first step in preparing an individualized meal plan for the client. B 1202
5.3.5. Intervention: nurse will ask client if they have any questions withing 24 hours.
5.3.5.1. Rationale: certain aspects of meal planning may be difficult to learn. B 1202