Nursig care plan diabetes mellitus diabetic ketoacidosis

I. Pathology
a. Diabetes mellitus (DM) is a chronic metabolic disorder in
which the body cannot metabolize carbohydrates, fats, and
proteins because of a lack of, or ineffective use of, the hormone
insulin.
b. Diabetic ketoacidosis (DKA) is a life-threatening emergency
caused by a relative or absolute deficiency of insulin.

II. Classification
a. Three primary types that are different disease entities but
share the symptoms and complications of hyperglycemia
b. Type 1, type 2, and impaired glucose tolerance or
pre-diabetes—formerly known as “borderline diabetes”

III. Etiology
a. Conditions or situations known to exacerbate glucose and
insulin imbalance
i. Previously undiagnosed or newly diagnosed type 1
diabetes
ii. Food intake in excess of available insulin
iii. Adolescence and puberty
iv. Exercise in uncontrolled diabetes
v. Stress associated with illness, infection, trauma, or
emotional distress
b. Type 1 diabetes (American Diabetes Association [ADA],
2004a)
i. An autoimmune disease possibly triggered by genetic
and environmental factors, such as with virus, toxin,
stress
1. Destroys beta-cells in the pancreas
2. When 80% to 90% of the beta cells are destroyed,
overt symptoms occur.
ii. Totally insulin-deficient; clients require exogenous
insulin to survive (Peeples & Seley, 2007).
iii. Characteristics
1. Usually occurs before 30 years of age, but can occur
at any age
2. Peak incidence occurs during puberty
3. Abrupt onset of signs and symptoms of hyperglycemia
4. Prone to ketoacidosis
c. Type 2 diabetes (ADA, 2004a)
i. Involves a decreased ability to use the insulin produced
in the pancreas (Peeples & Seley, 2007)
1. Decreased insulin secretion in response to glucose
levels
2. Insulin resistance blocking cells from absorbing
glucose
3. Excess production of glucose because of defective
insulin secretory response
ii. Accounts for 90% to 95% of all diabetes in the
United States
iii. Characteristics
1. Usually occurs after 30 years of age, but is now
occurring in children and adolescents.
2. Increased prevalence in some ethnic groups—African
Americans, Hispanic/Latino, Native Americans,
Asian Americans, and Pacific Islanders
3. Strong genetic predisposition
4. Frequently obese
5. Not prone to ketoacidosis until late in course or with
prolonged hyperglycemia
d. Associated with many complications, including heart disease
and stroke, high blood pressure, blindness, kidney and
nervous system disease, amputations, and complications of
pregnancy

IV. Statistics
a. Morbidity: More than 20.8 million Americans diagnosed
with either type 1 or type 2 diabetes; affects 20% of people
over the age of 65 years; approximately 1.5 million new
cases of diabetes diagnosed in 2005 (National Diabetes
Information Clearinghouse [NDIC], 2007).
b. Mortality: In 2002, diabetes was reported to be the sixth
leading cause of death (NDIC, 2007).
c. Cost: In 2007, the total cost (direct and indirect) of diabetes
in the United States was estimated to be $174 billion (ADA,
2007).

Care Settings
DM is managed in the community setting. Diabetic ketoacidosis
(DKA) may be encountered in any setting, with mild DKA
managed at the community level; however severe metabolic
imbalance requires inpatient acute care on a medical unit.

Related Concerns
Amputation,
Fluid and electrolyte imbalances,
Metabolic acidosis—primary base bicarbonate deficiency,
Psychosocial aspects of care,

Nursing Priorities
1. Restore fluid and electrolyte and acid-base balance.
2. Correct or reverse metabolic abnormalities.
3. Identify and assist with management of underlying cause
or disease process.
4. Prevent complications.
5. Provide information about disease process, prognosis,
self-care, and treatment needs.

Discharge Goals
1. Homeostasis achieved.
2. Causative and precipitating factors corrected or controlled.
3. Complications prevented or minimized.
4. Disease process, prognosis, self-care needs, and therapeutic
regimen understood.
5. Plan in place to meet needs after discharge.

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