NURSING CARE PLAN

ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTION RATIONALE EVALUATION

Independent:
Subjective: • Fluid volume • Diabetes • After 8 hours • Monitor • Hypovolemia • After 8
deficient mellitus (DM) of nursing orthostatic blood may be hours of
“Pakiramdam ko related to is a chronic interventions, pressure manifested by nursing
lagi akong osmotic metabolic the patient changes. hypotension intervention
nanghihina saka diuresis from disorder will and s, the
na uuhaw” (I feel hyperglycemia caused by an demonstrate tachycardia. patient was
weak and I’m always . absolute or adequate • Monitor • Lungs remove able to
thirsty) as hydration. respiratory carbonic acid demonstrate
relative
verbalized by the deficiency of pattern like through adequate
patient. insulin, an Kussmaul’s respirations, hydration
anabolic respirations and producing a evidenced
Objective: acetone breath. compensatory by stable
hormone.
Type 1 respiratory vital signs,
• Dry skin and diabetes alkalosis for palpable
mucous mellitus can ketoacidosis. peri pheral
membrane. occur at any • Monitor • Fever, chills, pulses,
age and is temperature, skin and diaphoresis good skin
• Poor skin characterized color and are common turgor and
turgor. by the marked moisture. with infectious capillary
and process; fever refill.
• Sudden weight progressive with flushed,
loss. inability of the dry skin may
pancreas to reflect
• V/S taken as secrete insulin dehydration.
follows: because of • Assess peripheral • Indicators of
autoimmune pulses, capillary level of
T:37.1 destruction of refill, skin turgor, dehydration,
P:85 the beta cells. and mucous adequacy of
R:20 It commonly membrane. circulating
BP: 110/80 occurs in volume.
children, with a • Monitor input and • Provides
fairly abrupt output. Note urine ongoing
onset; specific gravity. estimate of
however, volume
newer replacement
antibody tests needs, kidney
have allowed function, and
for the
identification of effectiveness of
more people therapy.
with the new- • Weigh daily. • Provides the
onset adult best
form of type 1 assessment of
diabetes current fluid
mellitus called status and
latent adequacy of
autoimmune fluid
diabetes of the replacement.
adult (LADA). • Maintain fluid • Maintains
The intake at least hydration and
distinguishing 2500 ml / day circulating
characteristic within cardiac volume.
of a patient tolerance with
with type 1 oral intake is
diabetes is resumed.
that, if his or • Promote • Avoids
her insulin is comfortable overheating,
withdrawn, environment. which could
ketosis and Cover patient with promote further
eventually light sheets. fluid loss.
ketoacidosis
develop. Collaborative:
Therefore, • Administer fluids • Type and
these patients as indicated. amount of fluid
are dependent depend on the
on exogenous degree of deficit
insulin. and individual
patient
response.