Nursing Diagnosis and Intervention For Type 1 Diabetes- A Student’s Guide

Nursing Diagnosis For Type 1 Diabetes

Introduction

When considering nursing diagnosis for type 1 diabetes, you must understand and take these complications into account. Because there is no singular diabetes nursing diagnosis, we’ll go over the many NANDA for diabetes and concerns that necessitate nursing intervention. Elevated blood sugars, difficulty with fluid balance, difficulty with nutritional regimens, skin and healing problems, and problems with feeling are all risk factors for diabetes. While not all of these diagnoses may apply to your patient, other factors, including education level, history, and social supports, should always be considered when selecting a nursing diagnosis.

Type 1 Diabetes mellitus is a chronic condition characterised by insufficient insulin synthesis in the pancreas or inefficient insulin utilisation by the body. As a result, the concentration of glucose in the bloodstream rises (hyperglycemia). Disturbances in carbohydrate, protein, and lipid metabolism characterise it. Sustained hyperglycemia has been demonstrated to affect nearly all of the body’s tissues. It is associated with significant complications of multiple organ systems, including the eyes, nerves, kidneys, and blood vessels.

This blog post discusses various nursing diagnoses, signs and symptoms, care plans and nursing interventions for Type 1 diabetes. As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor if you’re looking for medical advice.

The deficit is thought to occur in persons who are genetically predisposed to the condition and have had a precipitating event, such as a viral infection or a change in their environment that triggers an autoimmune reaction that affects the pancreas’ insulin-producing cells (beta cells).

Insulin injections and dietary and physical activity management are used to keep physiological functions in check. Hypoglycemia and hyperglycemia, which, if left untreated, can lead to insulin shock or ketoacidosis, are complications of incorrect coordination of these. Neuropathy, nephropathy, retinopathy, atherosclerosis, and microangiopathy are only a few of the long-term repercussions of the condition.

Diabetes Warning Signs

  • Vision is hazy
  • Fatigue
  • Feet and hands are numb or tingling.
  • bladder infections on a regular basis
  • The time it takes for wounds to heal is excessively long.
  • Gaining or losing weight is a common occurrence in both men and women.
  • Irritability
  • Vomiting, nausea
  • Itching

Clinical Manifestations

Hyperglycemia. Although some children describe general malaise, headache, and weakness, hyperglycemia alone may not create noticeable symptoms; children may also appear angry and ill-tempered.

Glycosuria. This disorder causes increased urine frequency and volume (polyuria), which is especially bothersome at night (nocturia) and frequently leads to enuresis in previously continent children.

Polydipsia. Increased thirst, which can be insatiable, is a side effect of dehydration caused by osmotic diuresis.

Polyuria. Urinary production rises dramatically, most likely due to enuresis.

Polyphagia. Hunger is on the rise, as is food consumption.

Loss of weight. Failure to thrive and wasting may be the first symptoms noticed in an infant or toddler and may precede frank hyperglycemia. Insulin deficiency causes uninhibited gluconeogenesis, which causes protein and fat breakdown; weight loss may be dramatic, though the child’s appetite usually remains good; failure to thrive and wasting may be the first symptoms noted in an infant or toddler and may precede frank hyperglycemia.

Malaise without a specified cause. Although this condition may exist prior to the onset of hyperglycemia symptoms or as a separate symptom of hyperglycemia, it is frequently only noticed after the fact.

Diabetic ketoacidosis. DKA is characterised by tiredness, dry skin, flushed cheeks, and cherry-red lips, as well as fruity acetone breath and Kussmaul breathing.

Pathophysiology

The following is a possible mechanism for the occurrence of type 1 diabetes:

  • Insulin is required for the metabolism of carbohydrates, fats, and proteins; it lowers blood glucose levels by allowing glucose to enter muscle cells and stimulating the conversion of glucose to glycogen (glycogenesis) as a carbohydrate store; it also inhibits the release of stored glucose from liver glycogen (glycogenolysis) and slows the breakdown of fat into triglycerides, free fatty acids, and ketones; and it promotes fat storage.
  • An insulin insufficiency causes unregulated gluconeogenesis, which limits the use and storage of circulating glucose, resulting in hyperglycemia (a random blood glucose concentration of more than 200 mg/dL or 11 mmol/L).
  • Increased fat and protein breakdown leads to ketone generation and weight loss; the kidneys are unable to reabsorb the excess glucose load, resulting in glycosuria, osmotic diuresis, thirst, and dehydration.
  • When glucose levels fall below 65 mg/dL (3.2 mmol/L), counterregulatory hormones (such as glucagon, cortisol, and adrenaline) are produced, and hypoglycemia symptoms appear.
  • The glucose level at which symptoms appear varies widely from person to person (and from time to time within the same person) and is influenced by factors such as the duration of diabetes, the frequency of hypoglycemia episodes, the rate of glycemia decline, and overall control.

Assessment and Diagnostic Findings

Diabetes consequences can be delayed or minimised by detecting and controlling the disease early on.

  • Glucose test by fingerstick –  A fingerstick glucose test should be used to monitor glucose levels in children who have a family history of diabetes.
  • Dipstick urine test –  The child should have a urine dipstick test to check for ketones in the urine.
  • Blood sugar levels after a fast (FBS) –  A fasting blood sugar test is performed if the blood glucose level is increased or if ketonuria is present; an FBS result of 200 mg/dl or higher usually always indicates diabetes when other symptoms are present.
  • Profile of lipids – Increased circulating triglycerides caused by gluconeogenesis typically cause aberrant lipid profiles at diagnosis.
  • Glycated haemoglobin – Glycosylated haemoglobin derivatives result from a nonenzymatic interaction between glucose and haemoglobin; there is a substantial link between average blood glucose levels over an 8- to 10-week period and the amount of glycated haemoglobin.
  • Microalbuminuria  – Microalbuminuria is the first sign of nephropathy; the exact definition varies by country, but an increased AER is commonly defined as a ratio of first morning-void urinary albumin levels to creatinine levels greater than 10 mg/mmol, or as a timed, overnight AER greater than 20 mcg/min but less than 200 mcg/min.

Nursing Diagnoses

Based on the assessment data, the major nursing diagnoses for diabetes mellitus type 1 are:

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.

Risk for impaired skin integrity related to slow the healing process and decreased circulation.

Risk for infection related to elevated glucose levels.

Deficient knowledge related to complications of hypoglycemia and hyperglycemia.

Deficient knowledge related to appropriate exercise and activity.

Medical Management

Insulin therapy is a treatment for diabetes. Insulin therapy is an important aspect of the treatment of diabetes in children; the dosage of insulin is adjusted based on blood glucose levels to keep them close to normal; many children have been prescribed an insulin regimen that is given twice a day, once before breakfast and once before dinner.

Diet. The current diabetes dietary management stresses a healthy, balanced diet high in carbohydrates and fibre and low in fat.

Activity. Type 1 diabetes necessitates no activity limitations; exercise provides genuine benefits for a child with diabetes; and current rules are becoming increasingly complex, allowing youngsters to compete at the highest levels in sports.

Continuous glucose monitoring. Continuous glucose monitoring is recommended for children and adolescents with type 1 diabetes, whether they are receiving injections or a continuous subcutaneous insulin infusion, according to the American Diabetes Association’s Standards of Medical Care in Diabetes-2018.

Pharmacologic Management

Insulin is always needed to treat type 1 diabetes and is also used to treat type 2 diabetes that hasn’t responded to medication with diet and/or oral hypoglycemics.

Insulin deficiency. Insulin aspart is a rapid-acting insulin that has been approved by the FDA for use in children aged two years and older with type 1 diabetes for SC daily injections and SC continuous infusion by external insulin pump; however, it has not been studied in children with type 2 diabetes; onset of action is 10-30 minutes, peak activity is 1-2 hours, and duration of action is 3-6 hours; onset of action is 10-30 minutes, peak activity is 1-2 hours, and duration of action is 3-6 hours.

Glulisine is a kind of insulin. Rapid-acting insulin; the safety and effectiveness of SC injections of insulin glulisine in pediatric patients (aged 4-17 years) with type 1 diabetes have been established; however, it has not been studied in pediatric patients with type 2 diabetes; onset of action is 20-30 minutes, peak activity is 1 hour, and duration of action is 5 hours; onset of action is 20-30 minutes, peak activity is 1 hour, and duration of action is 5 hours.

Insulin lispro. Only lispro U-100 has been approved by the FDA to improve glycemic control in children aged >3 years with type 1 diabetes; however, it has not been studied in children with type 2 diabetes; onset of action is 10-30 minutes, peak activity is 1-2 hours, and duration of action is 2-4 hours; onset of action is 10-30 minutes, peak activity is 1-2 hours, and duration of action is 2-4 hours.

Insulin how it should be. Insulin that works quickly. The FDA has approved Novolin R to improve glycemic control in pediatric patients with type 1 diabetes aged 2 to 18 years; however, it has not been studied in pediatric patients with type 2 diabetes. Humulin R is indicated to improve glycemic control in pediatric patients with diabetes mellitus requiring more than 200 units of insulin per day.

Insulin NPH. Intermediate-acting insulin is used to enhance glycemic control in children with type 1 diabetes. Its onset is 3-4 hours, the peak effect is 8-14 hours, and the average duration of action is 16-24 hours.

Insulin glargine is a kind of insulin that is used to treat diabetes. Long-acting insulin; the safety and efficacy of glargine U-100 in pediatric patients (6-15 years old) with type 1 diabetes have been established; however, it has not been investigated in pediatric patients with type 2 diabetes.

Insulin detemir. Long-acting insulin. Insulin detemir is approved for once- or twice-daily SC delivery in pediatric patients with type 1 diabetes (aged 6-17 years).

Nursing Care Plans

When caring for a client with diabetes, nurses play an important role in educating the child and family about hyperglycemia and hypoglycemia management, including insulin administration, dietary regimen, and exercise requirements for the child, assisting the family in adjusting to having a chronic disease and preventing short- and long-term complications of diabetes.

Nursing Care Plans based on Diagnosis include:

  • Deficient Knowledge
  • Compromised Family Coping

Deficient Knowledge

Evidence of Deficient Knowledge include:

  • New diagnosis of IDDM
  • Request for information regarding the pathology, blood and urine testing, insulin therapy, activity/exercise needs, dietary regimen, personal hygiene and health promotion

Desired Outcomes

  • The client will verbalise understanding of IDDM.
  • Client and parents will demonstrate appropriate blood-glucose monitoring, insulin administration, dietary management, and exercise plan.
  • Client and parents will identify signs and symptoms of hypoglycemia and hyperglycemia and correct response.
Nursing InterventionsRationale
Assess parents and child understanding of disease and ability to perform procedures and care, for educational level and learning capacity, and for developmental level.Provides information essential to develop a learning program; children ages 8 to 10 may be able to take responsibility for some of the care.
Provide a quiet, comfortable environment; allow time for teaching small amounts at a time and for reinforcement, demonstrations and return demonstration; start educating one day following diagnosis and limit sessions to 30 to 60 minutes.It prevents distractions and facilitates learning.
Include as many family members in teaching sessions as possible.Promotes understanding and support of family and feeling of security for the child.
Teach about the cause of disease, disease process and pathology; use pamphlets , and other aids appropriate for the age of child and level of comprehension of parents.Provides basic information that may be used as a rationale for treatments and care and allows for different teaching strategies.
Instruct parents and children in insulin administration including drawing up insulin into the syringe, rotating vial instead of shaking, drawing clear insulin first if mixing two types in the same syringe, injecting SC, storing insulin, rotating sites, adjusting dosages, reusing a syringe and needle and disposing of them.Promotes proper technique of insulin administration to avoid complications.
Instruct in use of a syringe-loaded injector.Provides an alternative method of insulin administration if the child is afraid of skin puncture.
Teach parents and child on how to operate a portable insulin pump to regulate insulin delivery.Provides continuous subcutaneous insulin infusion.
Instruct parents and children to monitor blood glucose levels four times a day (before meals and before bed), with a lancet and blood-testing meter or a reagent strip compared to a colour chart; collection and testing of urine with ketostix or Clinitest.Monitors blood and urine for the presence of glucose and ketone.
Teach parents and children about dietary planning with importance on proper meal times and adequate caloric intake according to age as ordered. Teach that food intake depends on activity, and describe methods to judge amounts of foods; provide a list of acceptable food items from “fast food” restaurants.Provides information about an important aspect of the total care of the child with diabetes.
Teach parents and children about the role of exercise and changes needed in food and insulin intake with increased or decreased activity.Provides information about common activity patterns and effects on dietary intake and insulin needs.
Teach parents and children about skin problems associated with diabetes, need for regular dental examinations, foot care, protection of and proper care of nails, prevention of infections and exposure to infections, eye examinations, immunisations.Provides information about common complications as a result of chronic effects of the disease.
Instruct parents and children to keep a record of insulin administration, glucose monitoring, responses to diet and exercise, noncompliance in medical regimen and effects.Provides a method to improve self-care and demonstrates the need to notify the physician for treatment evaluation and possible modification.
Instruct the child to wear or carry identification and information about the disease, treatment, and physician name.Provides information in case of an emergency.

Compromised Family Coping

Evidence of Compromised Family Coping include:

  • Expression and/or confirmation of concern and inadequate knowledge about long-term care needs, problems and complications
  • Anxiety and guilt
  • Overprotection of child

Desired Outcomes

The family will talk about their feelings about the child’s long-term requirements.

The family will decide on the best support networks and coping techniques for them.

Nursing InterventionsRationale
Assess family coping mechanisms and its effectiveness, family dynamics and expectations related to long-term care, developmental level of family, the response of siblings, knowledge, and use of support systems and resources, presence of guilt and anxiety, overprotection and overeating behaviours.Recognises coping methods that work and the need to develop new coping skills and behaviours, family attitudes; child with special long-term needs may tighten or strain family relationships, and that over-protection may be deleterious to child’s growth and development.
Allow family members and child to express difficult areas, anxiety and explore solutions responsibly.Lessens anxiety and improves understanding; provides the family with an opportunity to recognise problems and generate problem-solving methods.
  
Assist family in establishing short- and long-term goals for the child and to involve the child in the activities of the family; include the participation of all family members in care routines.Promotes engagement in and control over situations and keeps the role of family members and parents.
Encourage family members to verbalise feelings, to tell how they handle the chronic needs of the family member, and to define coping patterns that support or inhibit adjustment to the problems.Encourages expression of feelings to identify the need for information and support and to dismiss guilt and anxiety.
Provide support to social worker, counselor, clergy, or other as needed.Provides assistance to the family dealing with the long-term care of a child with chronic illness.
Teach family about long-term care and treatments.Improves family’s understanding of treatment regimen and responsibilities of family.
Teach family that overprotective behavior may inhibit growth and development so they should treat the child as normally as possible.Facilitates understanding of the significance of making the child a part of the family and illustrates the unfavorable effects of being overprotective.
Explain the importance of attending follow-up appointments for physical examinations, laboratory tests.Promotes positive outcome when family collaborates with the physician and health team to monitor disease.

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