OUR LADY OF FATIMA UNIVERSITY
College of Nursing
BSN2
NAME:
COURSE:
Eleina Marie L. Jar
NCMA 219
SECTION: YB 12
SCHEDULE:
GROUP #
DATE:
May 13 2023
Wk. 15 Performance Task - Problems in Metabolic and Endocrine Hormones
Formulate a nursing care plan for a 14 year old adolescent client with Diabetes Mellitus Type 1.
The client is very active in school and loves playing basketball.
1.
What nursing diagnosis and goal of care will the nurse come up with this client?
- Imbalanced nutrition: less than body requirements related to insufficient caloric intake to meet growth and development needs and the inability of the body
to use nutrients.
2.
What nursing interventions will be identified to meet the nurse’s goal for this client?
-Assess for the signs and symptoms of hyperglycemia including increased thirst and urination
- Educate parents and child to regulate insulin, control dietary intake, and exercise especially basketball to accommodate needs of an individual
- Educate parents and child about signs and symptoms, reasons why it happen, and blood glucose levels causing measures to take.
- Monitor vital signs and blood glucose level every 2 hours.
- Ensure adequate and appropriate nutrition.
3.
What is the expected outcome for this goal?
Short Term
-The patient is able to verbalize the understanding of individual therapeutic interventions, medications
-The Blood Glucose level area maintained within its normal range
Long Term
After six hours of nursing interventions, patient was able to maintain blood glucose levels within normal limit
Nursing Care Plan
Diagnosis: Diabetes Mellitus Type 1.
Patient’s Initials:
________________
BSN2
OUR LADY OF FATIMA UNIVERSITY
College of Nursing
ASSESSMENT
NAME:
COURSE:
DIAGNOSIS
Eleina Marie L. Jar
NCMA 219
PLANNING
SECTION: YB 12
SCHEDULE:
INTERVENTION
GROUP #
RATIONALE
DATE:
May 13 2023
EVALUATION
Subjective:
Priority Diagnosis
Short Term
Independent
Independent
Short Term
“pakiramdam ko po lagi
Risk for unstable blood
The patient will be able to
-Assess for the signs and
-Hyperglycemia arises
The patient is able to
akong gutom at nang
glucose level related to
verbalize the
symptoms of
when there is inadequate
verbalize the
hihina” (i feel like im
hyperglycemia
understanding of
hyperglycemia including
level of insulin to glucose.
understanding of
individual therapeutic
increased thirst and
Hyperglycemia is
individual therapeutic
interventions,
urination
associated with a
interventions,
medications
always hungry and weak)
as verbalized by the
patient
Objective:
- Weakness
- Increased tiredness
- Confusion
- Blurred Vision
Vital Signs
BP - 110/70 bmp
PR - 65 bpm
RR - 15 bpm
Temp - 38.6 c
Hyperglycemia BG level
180 mg/dL
Other Diagnosis
Risk for imbalanced
medications and its
heightened risk for
nutrition: less than body
purposes.
diabetic complications
requirements related to
altered glucose
metabolism
Maintain Blood Glucose
level within its normal
range before meal (80 -
Risk for Injury related to
130 mg/dl) and after meal
fatigue as evidenced by
(<180 mg/dl)
blurred vision and
- Educate parents and
child to regulate insulin,
control dietary intake, and
exercise especially
basketball to
Long Term
After 4-6 hours, the client
’s blood glucose levels
will maintain between 60
mg/dL and 120 mg/dL
- Supports the child’s
area maintained within its
growth and development
normal range
needs while avoiding
complications.
accommodate needs of an
individual
weakness
The Blood Glucose level
- Provides information
Long Term
- Educate parents and
about the effect of
After six hours of nursing
child about signs and
increased blood glucose
interventions, patient was
symptoms, reasons why it
levels caused by an illness,
able to maintain blood
happen, and blood
inappropriate diet, stress
glucose levels within
glucose levels causing
or failure to administer
normal limit
measures to take.
insulin.
OUR LADY OF FATIMA UNIVERSITY
College of Nursing
BSN2
NAME:
COURSE:
Eleina Marie L. Jar
NCMA 219
SECTION: YB 12
SCHEDULE:
GROUP #
- Monitor vital signs and
- For baseline data and
blood glucose level every
comparison for changes.
2 hours.
- Ensure adequate and
appropriate nutrition.
- Maintain nutritional
status without increase
glucose level
Dependent
-administered two or
more injections per day or
a continuous
subcutaneous infusion
using portable insulin
pump as prescribed
Dependent
- anti diabetic treatment
regimen promotes
glycemic control,
promotes optimal tissue
perfusion and reduces risk
for complications
Collaborative
Collaborative
Refer and consult to a
Consulting to a pediatric
pediatric endocrinologist
endocrinologist and
and nutritionist
nutritionist may improve
patient’s endocrine
disorder such as diabetes
DATE:
May 13 2023
OUR LADY OF FATIMA UNIVERSITY
College of Nursing
BSN2
NAME:
COURSE:
Eleina Marie L. Jar
NCMA 219
SECTION: YB 12
SCHEDULE:
mellitus type 1
GROUP #
DATE:
May 13 2023